Should Hospital Workers Who Don’t Get a Flu Shot Be Required to Wear a Mask?

(Photo: Yasser Alghofily)

A few weeks ago, before the flu was national news, a reader who works at a hospital in Portland, Or., wrote to say: “The organization I work for just started this policy, I think it is very interesting and may push those who don’t want to get a flu shot for whatever reason to get a flu shot to avoid the stigma of wearing a mask. The employee comment section has ranged from HIPPA violations to discrimination for those who can’t have a flu shot based on egg allergies.”

Here’s the policy:

You may have heard by now: Flu season is ramping up in Oregon, with cases now starting to affect hospitalized patients in greater numbers. For individuals whose immune systems are compromised by other conditions, the flu can be life threatening.

To keep patients safe, a new Influenza Vaccination and Masking policy requires that workforce members do one of two things during flu season:

  • Get vaccinated. Free vaccinations are available through Occupational Health. If you’ve already gotten a vaccination somewhere other than Occupational Health — but haven’t been offered an official blue check mark sticker on your ID badge to reflect that fact — make sure you’ve filled out your attestation form.
  • Wear a mask. If the vaccine’s not for you or you just haven’t gotten it yet, policy requires that starting at 12 p.m. on Dec. 19 — and until the active implementation is lifted — yellow procedure masks must be worn within 6 feet of patients in patient care areas.

Remember: The official blue check mark sticker on your photo ID badge is the visual key used to determine who needs to wear a mask. Wearing the sticker is a choice, for those who have been vaccinated, but without it masks are required.

This doesn’t strike me as unreasonable. After all, hospitals are in the business of making sick people well, not making sick people sicker, and one thing a flu vaccine is meant to accomplish is to stop relatively healthy people from passing along a flu to more vulnerable people.

Your thoughts? 


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Comments are moderated and generally will be posted if they are on-topic and not abusive.



  1. Mike B says:

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    • Martin says:

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      • Rusty says:

        Have you ever thought about the nurses who have an allergen and can not receive the vaccine? Your ignorance and lack for others amazes me.

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      • Deb says:

        Not to forget to mention…have you even taken the time to look up what they put in the flu vaccine. I’m sorry, but I don’t particularily care to inoculate my body with thermosol, detergents, mercury, chicken and pig innerds and God knows what else. TVM.

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      • Seminymous Coward says:

        There is no evidence of thimerosal harming anyone, and it was removed from vaccines sent to developed countries long ago. However, your constant complaints are making it difficult to use in countries without readily available refrigeration where it’s vital to getting life-saving vaccines safely distributed. Your ignorant whining has effects tantamount to mass murder.

        There are generally surfactants in your toothpaste. There is no elemental mercury in vaccines. I’d like to see a citation for chicken and pig innards in a vaccine.

        Do you realize the people who make vaccines are vaccinated, as are their children? There’s no evil conspiracy here. If nothing else, all these random scary things you imagine are put into shots cost money, and there are far cheaper ways for some cartoon villain to mass murder; anti-vaccine advocacy springs to mind. How exactly do you think the big nasty corporations are profiting from contaminating vaccines? Keep in mind that if it were simple fraud they’d just put perfectly safe saline in the shots.

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    • Seminymous Coward says:

      Mike B definitely has the right policy for this issue. They are being reckless with their own healthcare, endangering patients, and opposing a cornerstone of modern medicine. If they can’t be trusted to apply evidence-based medicine to themselves, they can’t be trusted to do it for others.

      It’s a public health issue both directly and because it gives the anti-vaccination crowd more ammunition in their fight to break our herd immunity and negligently slay an untold multitude.

      The egg allergy thing was born of (entirely reasonable) caution, and it’s being worn away by the research. ( Source: ) If some hospital employees have such severe egg reactions as to necessitate avoiding the flu shot, then they should be amongst the mask-wearing exception with the other people at and only those people.

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      • Aaron says:

        Your statement is provocative, and obscene. The evidence you claim does not even exist. The CDC just put out a report that the flu shot is barely 23% effective, 12% in adults. That is a joke. What we should be doing is allowing people to make informed decisions for themselves. And nobody is at risk because employees are not getting the flu shot.

        Besides that, this whole thing is a scam. Hospitals let people work sick all the time. Nobody gets sent home for having a fever, or having flu like symptoms. In fact, most places punish those who are sick, and ask to be sent home. Not only that, the hospital allows family, and hospital visitors within contact of patients without any history of flu shots, let alone other vaccines, or even a basic screening.

        This is a scam. 30 years ago Doctors said second hand smoke wasn’t dangerous. Now we know it is. Pretty soon, people will catch on to the damage of introducing adjuvants into your body on a yearly basis.

        For those of you who do take the shot, and believe the big pharma marketing and pseudo science behind it, why are you not taking it 3-4 times a year like you are supposed to for it to supposedly work? I think you should man up, and take the shot every 3 months.

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    • Kathy says:

      Mike B, there are a couple of problems with your proposal to fire hospital workers who don’t get a flu shot.

      One issue is people who cannot get one for medical reasons (egg allergy being a big one). ADA says that you need to find a reasonable accommodation for those people, and wearing a mask is a reasonable accommodation.

      Another issue is that vaccines, while the greatest thing humans have ever invented, are not risk free. I’m sure hospital lawyers have nightmares about someone getting a flu shot to avoid being fired, ending up with a reaction, and suing the (bleep) out of the hospital. It wouldn’t look good to a jury when they were told that the hospital passed up the reasonable requirement of masks in favor of firing.

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      • Enter your name... says:

        A severe egg allergy (anaphylaxed and ended up in the emergency depatment, not just hives) might be a common reason for exemptions, but a severe, life-threatening reaction to the flu vaccine itself is an absolute contraindication. It’s also quite rare.

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      • Mike B says:

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      • TexCIS says:

        The hospital could also be sued if a patient gets the flu and dies, and the family can prove the patient was cared for by a nurse who did NOT get the shot but came down with the flu while caring for the patient.

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      • Jay says:

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      • Tina Marie says:

        Well said!

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    • Enter your name... says:

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      • Seminymous Coward says:

        Infecting the other employees is also bad. It violates sensible herd-immunity-based precautions.

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      • Nick says:

        I don’t think it’s reasonable to expect hospitals to pay a skilled nurse’s salary to shuffle paperwork if they’re unwilling to vaccinate themselves to interact with patients.

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      • Enter your name... says:

        Nick, they’re already paying skilled nurses to shuffle paperwork. There is a lot of paperwork that is supposed to be done by nurses. They review patient care documentation and check for protocol compliance and so forth. (In fact, we have a relative who is an RN and has done exclusively this for her hospital for years, and as a result can work from home or while traveling.)

        There are frequently dozens of nurses doing paperwork in a large hospital. The only question here is which nurse is doing it.

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  2. YX says:

    Interesting… as at least some hospital require every employee get flu shot. Not sure if this apply to contractor though.

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    • Enter your name... says:

      I’ve never heard of an American hospital that requires flu shots for all nurses, much less all employees. Every time it comes up in contract negotiations, the nurses’ unions all say that flu shots are good, but their own hospital shouldn’t be the first one to require it for all nurses, and instead everyone should wait until there is a law requiring it for the whole state or whole country. Besides, it’s probably those poor janitors or food service employees, rather than skilled nurses who are so contagious anyway.

      The service employees then say that whereas the nurses don’t have to have the flu shot, despite sometimes spending hours in close contact with patients, then the cooks and janitors shouldn’t be required to have it either.

      Then all the unions go to the government and say that since no hospital requires it for anyone, then it is not at all normal or accepted in the industry and should not be required by law.

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  3. Joel Upchurch says:

    There is little indication that facemasks will slow down the spread of influenza, so this falls under the heading of medical theater.

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    • Seminymous Coward says:

      The study you cite was cut off by their steering committee before it collected anywhere near enough data. Look at that confidence interval: “the difference between arms was 0.40% (95%CI: -10% to 11%, P?=?1.00)” . Read their own conclusion: “This study should be interpreted with caution since the lack of statistical power prevents us to draw formal conclusion regarding effectiveness of facemasks in the context of a seasonal epidemic.” The only real justification I could see for publishing it would be so the data could be collected by review articles.

      Based on and , it seems the debate is whether surgical masks are as good as dual-purpose surgical masks and respirators, not whether any mask at all is effective. The N95/P2 respirators seem to be ~75% effective at stopping confirmed flu infections based on those much larger, non-interrupted studies.

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      • Joel Upchurch says:

        You are asking the wrong question. The answers indicate not that the masks work, but how often do they fail. They don’t rely on surgical masks for really dangerous viruses. They have full biological containment to protect doctors and staff in those cases. When you are dealing with a virus then is only 120 nanometers, then there is no question that the masks will fail some of the time. The masks are mostly for preventing the spread of bacteria, not viruses.

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      • Seminymous Coward says:

        I’m not suggesting they rely on masks over vaccinations, as I’ve made clear in other comments.
        Beyond that, I’m not sure what you’re trying to say. Masks are better than nothing, and they do have an effect. They are also frequently used to slow or prevent the spread of influenza specifically. We aren’t discussing exotic hemorrhagic fevers.

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      • James says:

        “When you are dealing with a virus then is only 120 nanometers…”

        Except that transmission is not (according to current knowledge, anyway) spread by naked viruses, but by viruses contained in much larger droplets of fluid expelled when infected people sneeze or cough.

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      • Nick says:

        This recent summary of masks/respirators and their role in prevention of influenza in the NYT is timely for this discussion. )

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    • Dan says:

      But the theater is effective if it increases the number of employees who choose to get the vaccine

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  4. scott says:

    In terms of modifying behaviour the policy may be effective.

    In terms of preventing flu the policy seems questionable. I am not sure that masks and flu shots are all that effective.

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    • Seminymous Coward says:

      “I am not sure that … flu shots are all that effective.” Would you care to cite some evidence for your assertion against the overwhelming body of research?

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      • scott says:

        60% effective is the number that I generally hear, but I am sure if you look hard enough you can find any number you want.

        Flu is not caused by one specific virus, but a number of different viruses. For a given flu season the vaccine used is based on the viruses that are expected to dominate that season. This leads to a number of issues;

        – for an idvidual I may catch a virus not covered by the vaccine
        – the estimates of which viruses are going to dominate may be wrong, reducing the overall effectiveness of the vaccine
        – a specific virus may mutate, to a form the vaccine is ineffective against

        I think even the CDC will agree that flu shots are not as effective as a lot of people may think.

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      • Seminymous Coward says:

        60% effective is pretty damn effective in my book. 60% of the 1918 pandemic would have been 30 million human lives. I’m going to repeat that now: the flu vaccine would have saved a minimum of 30 million living, breathing humans with names, faces, hopes, and dreams.

        Herd immunity is key; James beat me to the general idea, but here are some flu-specific thresholds: . A relevant chart showing herd immunity thresholds for viral reproduction number, vaccine effectiveness, and vaccination rates is contained within, and it can be viewed (annoyingly as a single-slide PowerPoint presentation) at .

        There are other multiplier effects. Keeping 60% of healthcare workers up and working during outbreaks is also extremely valuable in and of itself. There’s also the benefit of the increased solidarity of message from the healthcare community.

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      • Kathryn says:

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      • Seminymous Coward says:

        Kathryn: Here are roughly two dozen citations: Wikipedia isn’t hard research or anything, obviously, but in this case its references are; most are double-blind controlled studies. As just one example, here’s one giant review: . I’m not sure how you could have missed the enormous amount of research data if you looked for even the briefest moment. Did you seriously imagine that vaccine effectiveness was just made up? Of course scientists have actually checked that vaccines work.

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    • James says:

      Look up herd immunity. Briefly, even though a vaccine may not be 100% effective for the individual getting it, getting a large fraction of the population vaccinated reduces the transmission rate of the virus to less than what is needed to sustain an epidemic.

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      • scott says:

        For a large population there might be benefits I hadn’t thought about. I guess I am stuck on the fact that I personally don’t bother with flu shots because as an individual I am basically flipping a coin and I don’t get sick often anyway.

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  5. Jaime says:

    Regarding the issue of egg allergies, this is the CDC’s (straight from their website) opinion on the matter:

    TIV should not be administered to the following:1

    People who have experienced a severe (life threatening) allergy to a prior dose of an seasonal influenza vaccine (TIV or LAIV)
    People who have a severe allergy to a component of the TIV vaccine. Package inserts should be consulted for components 3

    Recommendations for vaccinating egg allergic patients were updated in 2011 and are available in the MMWR.8 Generally, egg allergic patients can safely receive TIV. Individuals with a history of severe (life threatening) allergy to eating eggs should consult with a specialist with expertise allergy prior to receiving TIV.


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  6. Speed says:

    People with egg allergies can be protected with the flu vaccine. First, the risk is vanishingly small and not well documented as simply egg related …

    Allergy to eggs must be distinguished from allergy to influenza vaccine. Severe allergic and anaphylactic reactions can occur in response to a number of influenza vaccine components, but such reactions are rare. A review of reports to the Vaccine Adverse Events Reporting System (VAERS) of adverse events in adults noted four reports of death caused by anaphylaxis following influenza vaccine during 1990–2005; the vaccine components potentially responsible for these reactions were not reported (20). A prior severe allergic reaction to influenza vaccine, regardless of the component suspected to be responsible for the reaction, is a contraindication to receipt of influenza vaccine.

    Second, those who believe or suspect that they are allergic to eggs can receive the flu vaccine if special precautions are taken — detail at the above link.

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  7. Leah says:

    Tip of the ice burg……..

    I have worked in healthcare for 15 years, 11 of which in an institution that recommends but does not require the influenza vaccine. I guess I would like to see more institutions take a bold stance of employees protecting those who are under our care. Currently, there are signs posted all over the hospital I work at that differentiate the signs of a common cold with that of influenza. That being said, I have a number of colleges from housekeeping to physicians that come to work despite symptom burden suggesting influenza type illness. Although the “blue sticker” system above may seem invasive, it seems much more effective than a flyer campaign.

    I also have to wonder what the future of mandating vaccines will be given the choice that currently exists in vaccinating our pediatric population with our “standard” vaccines. That, however, is another conversation entirely.

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    • Enter your name... says:

      I think that the institutional response to a potentially contagious employee is more important than either. What happens if you call in sick? Do you get irritable comments about how inconvenient your illness is or how short-staffed they are? Do you get told that you can only have the day off if you find your own substitute?

      A lot of physicians seem to go to work when they’re plainly sick because there’s no one else available. I’ve never heard a good explanation for the lack of scheduling a backup in the hospital, or for why they can’t swap with whoever is taking all the phone calls.

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      • Another side . . . says:

        It seems that most responses are from the employee or patient POV. There is also the hospital as business side of the story.

        I managed an office that dealt directly with the public. Our peak busy season (the time during which we brought in the most money) coincided with flu season. Every year in the fall, I would suggest that my employees (commissioned or not) get flu shots (as well as follow other common sense hygienic procedures, such as hand washing, etc). The reason was to avoid being laid up during our biggest period. This had nothing to do with protecting the public. It was all about having as many “hands-on-deck” during our peak productive period, so they and the company could maximize profits.

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      • John says:

        It makes perfect sense then to require EVERY visitor to wear a mask when they enter the hospital. The people in the general public are much more susceptible to diseases then healthcare workers. We have to be vaccinated against everything and visitors get off scott free. All people on airplanes should also be required to wear masks too, if you follow the hospitals logic.

        It’s simply a way to publicly shame and harass people who don’t want to partake in the process. Not to say that vaccines don’t work…I believe that they do when they are appropriately given. But to command everyone to take them is folly.

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  8. Nick says:

    On average the influenza vaccine (the shot, not the mist) provides about 60% protection in young health adults (think healthcare workers) against getting medically attended influenza ( This was recently re-affirmed for this influenza season by the CDC ( Its clear the influenza vaccine doesn’t work as well as public health wants it to, but its clearly the best tool we have to prevent influenza. Every HCW should be getting it to protect themselves and their patients, however we cant oversell the value of vaccination to meet policy goals (

    That being said even if you vaccinate 100 HCW against influenza, in a given year 40 of them will be at risk for getting influenza or giving it to their patients just like those not vaccinated. You cant identify these 40 either. Then you also have lots of other people who may or may not be vaccinated in your hospital, such as patients, family members, visitors, contractors, etc. They can spread influenza just as well, which is why there are visitor restrictions during bad flu years.

    Regarding using masks routinely if you’re not vaccinated, I question the evidence and purpose of that policy ( I would also question why everyone is not masked if that’s your policy, since you cant identify those vaccinated but still at risk.

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    • TK says:

      Exactly correct and 60% is meaningless in terms of effectiveness, because to get a true number every person with flu like illness would have to be tested to verify whether they had a strain that was included in the coverage of the vaccine and document whether that person had the vaccine. No such study has ever been done.

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  9. Andrew B says:

    I am a physician and totally in favor of the flu shot, and it is fairly effective, as others have noted, but not perfect in preventing disease (almost nothing ever is). That being said I am a little uncomfortable forcing people to get shots- is not even the minor thing of sticking someone with a needle considered assault if we are forcing it against their will? Patients of sound mind nowadays are given their free choice to refuse any medical care they wish, even needle sticking, so how can we force others to do so? Would like to hear an ACLU type attorney make an educated comment about this.

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    • Seminymous Coward says:

      It’s not any more against their will than other conditions of employment. No one forces them to be healthcare workers, and it’s entirely justifiable that they be expected to behave rationally regarding public health issues.

      Hot debate. What do you think? Thumb up 12 Thumb down 9
      • Elena says:

        Vaccines are tough because the risk is all on your kids, but the beftnies go to the whole community. My girls are both on schedule (although had my #2 come at a less crazy time, I might have spaced them out). Here is why I believe in vaccines:A few years ago, we missed our flu shots. I never got them before having my first, and never really liked them. And I never get the flu. Except that year. I got the flu when I was about 1 week pregnant. I gave it to my whole family (husband, daughter, in-laws, dad). My dad gave it to my mom. From there, I don’t know where it spread. We all came out okay, but I had a miscarriage a few weeks later. Maybe getting the shot wouldn’t have helped, but it might have stopped the spread.

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    • Butch says:

      In order to work at a hospital, you need proof of other vaccines (hep b) and a Tb test. These are all needles being forced into employees. Why such an ACLU style concern over the flu shot, then

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    • nancy says:

      Since you are a doctor, I would like to know how this is different from antibiotics, what is keeping the flu from being more ferocious because of the vaccine?

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    • Tina Marie says:

      Exactly what I’ve been saying for 5 years now.

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  10. Des says:

    This is such a hot-button issue because of the vaccine controversy…but it doesn’t have to be. Flu vaccinations aren’t a guarantee you won’t contract it in some form or another. So, why not just make all employees wear face masks? If it effective enough to make non-vaccinated people wear them why not just have everyone wear them? Wouldn’t that be in the patients’ best interest?

    Unless, of course, the masks not for disease prevention – and are instead intended as a punishment or a coercion measure to get employees to be vaccinated. That would be a clever way to get around the vaccine controversy that would surely arise if you mandated flu vaccinations in the workplace. That is the only “good” reason I can see for not simply requiring masks on everyone.

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  11. Kathryn says:

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    • Seminymous Coward says:

      Is it alright to force a surgeon with a 3-inch-long, bleeding cut to the palm to get it properly bandaged before operating on a patient? Does it become alright if they carry a known, serious contagion? If either of those is alright, then you’re arguing degrees, not taking a stand for liberty.

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      • Pshrnk says:

        Only a bunch of facists would make surgeons and other OR personnel wear masks! :-)

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    • Butch says:

      In order to work at a hospital, you need proof of other vaccines (hep b) and a Tb test. These are all needles being forced into employees. Why such an ACLU style concern over the flu shot, then?

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  12. dave says:

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    • Butch says:

      This would be an effective post, but this tear’s flu shot has this far proven to be 60% effective, not 15. I would also challenge your comment that three of your coworkers have the flu. Sick, yes. But very few people who think they have the flu actually get tested. Additionally, have all ten coworkers been vaccinated? How close are the workers? Your stat might be one of success. Assuming the flu did run through your office, well then one might surmise it was as much as 70% effective

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  13. Tc says:

    At best from all the comments is that 6 out of 10 will not get the flu , so 4 people who got the shot will infect patients , as Heath care professionals who read what is in the shots I feel if they refuse the vaccination it doesn’t work.. if the hospital was truly concerned they would all wear masks all the time. there has not been a disease in the number of cases or deaths ever.

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  14. Butch says:

    The basic understanding of hurd immunity is lacking amongst these nurses and the public. A rather straight forward example follows. Imagine I am a vaccinated patient in the hospital during a flu epidemic. If I contact someone with the flu, my chance of getting the flu is roughly 40%. But if my nurse (for simplicity, we’ll assume I have one nurse, but it would be the same if everyone i contact in the hospital is vaccinated) is the only person I contact (for simplicity), and she is out contacting flu virus, and she has been vaccinated, now my odds of contracting the flu go to 16%. See, now both of us would have to be in the unlucky 40%. If all the people she contacts were vaccinated (unlikely, but follow me anyway) now my risk falls below 7%.
    This is a very simplistic example, but it underlines the hurd immunity idea. The more people you contact that are vaccinated, the lower your chance of contracting the flu, because both you AND your vaccinated contact have to be in the minority of people who get the flu.
    If you are a nurse or doctor, your job is to ensure the health of your patients as best you can. Your health, with respect to public health, comes second. I am a physician, and I am accepting of the fact that, if there were ever a “Contagion” style outbreak, I will have to be on the front line, risking my health. Most other healthcare workers feel the same. It is unfortunate that these few complaining nurses and docs have chosen this field, yet place there own pride, misgivings or ignorance ahead of the very purpose of their chosen profession

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    • Nick says:

      Herd immunity is a well defined concept in public health. It requires high vaccination levels and high efficacy levels to work. We see this in childhood immunizations all the time. However we have little to no evidence that there is herd immunity associated with influenza vaccination. Yes we see it in closed community with high vaccination rates, but that does not apply to hospitals or the US in general. If we had a more effective vaccine and higher vaccination rates, then your arguments would be valid. With todays vaccines and usage rates, its simply not accurate.

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      • Seminymous Coward says:

        Nick: Above I have a comment with a link to influenza-specific herd immunity thresholds. It also has a chart for the thresholds in general with vaccine effectiveness included as an input. For example, it would take approximately 82% coverage with a 60% effective vaccine to achieve herd immunity to the 1918 influenza strain.

        In any case, herd immunity is a consequence of the very structure of disease transmission. It’s more like a property of graph theory than a property of any particular disease, so there’s no particular reason it wouldn’t apply to influenza. The probability of Bob being infected because Alan was infected is the probability of at least one path from Alan to Bob being infected at each link; the probability for any given path is the product of the infection probability at each link.

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      • Nick says:

        Seminymous Coward: Your right, studies have suggested that you can achieve herd immunity with influenza vaccines. Like all models this one has lots of assumptions. They make assumptions about populations and vaccine effectiveness, which are not consistent with effectiveness studies over the last few years. I understand why they did what they did and how studies like this are useful. In this case it provides a number that is not realistic given what is know about how the vaccine performs in the field in different populations. They assume those at high risk have on average 20% less protection from the vaccine. We have enough data to say that assumption is an overestimation of protection in some populations (over 65) and under estimated in others (kids in their model).

        They noted that “The model suggests that the vaccination coverage objectives proposed in the United States—80% for healthy persons and 90% for elderly and high-risk persons — are sufficient to establish herd immunity against most influenza viruses” ( This is with overly optimistic vaccine effectiveness numbers in their model, along with several other assumptions including regarding how efficient the virus spreads.

        I think we are in agreement on herd immunity, I just dont find any evidence to suggest it occurs on a population level with our current influenza vaccine. When we have a better vaccine, I am confident we will see the benefits of herd immunity.

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  15. exsanguine says:

    You can still transmit the flu virus even though you have had the flu shot — you can have the virus on/in you long enough to transmit it to someone else before your immune system can kill it.

    Hell, just walking into an emergency room, hospital, clinic and taking a deep breath is dangerous enough.

    A nurse that works full time in such an environment, that has not had the s hot, more than likely has an cast iron immune system and is immune already.

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    • nancy says:

      My sentiments exactly and what prevents a virus our immune systems can’t handle because of these vaccines, just as antibiotics did with bacteria.

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  16. jared says:

    Here is an article that ran in the NY Times last fall about the flu shot and its efficacy.

    Article discusses how the flu shot is less effective than understood by most, that studies show that healthcare workers who get the flu shot have no impact – good or bad – on number of deaths related to the flu and how the Center for Infectious Disease admits the flu shot is overhyped. Studies also show the flu shot can reduce the time of recovery by a half day but have no impact on number of people hospitalized for flu. Also, as stated by many each year it’s a guess as to which strain of the flu will present itself and the flu shot is a best guess effort. Many years the flu shot is designed for the wrong strain and then its effectiveness for that year is quite minimal.

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  17. Roger says:

    Draconian measure: it’s only the flu, not the bubonic plague…

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    • Seminymous Coward says:

      Just in case that’s not sarcasm, I’ll note that influenza has a much higher overall death toll than bubonic plague. The 1918 pandemic was nearly a match for the Black Death by itself, and there’s a flu pandemic roughly thrice per century.

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  18. nancy says:

    I am trying to make the connection between, not getting the flu shot and the spread of the virus. If the vaccine increases your immune system, then logic tells me, it can still be spread whether you get the vaccine or not, so why doesnt everyone have to wear a mask? or no one wear one?

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  19. nancy says:

    Mike, if you understand how the flu vaccine works, should show that it doesn’t prevent the passage of the flu, only the extent that you may suffer.

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  20. Rod Griffiths says:

    The key question is does it work? Is this based on properly conducted trials, or is it just someone’s hunch. Personally I get the flu shot every year, my decision is based on some study of the mortality data. That works for me, but does it work as a health and safety policy?

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  21. Steve Cebalt says:

    Masks don’t work (according to the CDC), and they scare people. As I wrote my blog,

    “Spare me your courtesy; don’t make me pay for your illness”

    I read a quote in a travel article from a guy congratulating himself. He was REALLY sick but REALLY wanted to go on his vacation trip — on an airplane.

    “I wore a face mask as a courtesy to my fellow passengers,” he said, smugly and ignorantly. It is not a courtesy to wear a mask that tells me that if I am the unlucky one to draw the seat next to you, I’ve just won the communicable disease lottery; it means I am about to get sick. His sick-mask gesture was for his own self-satisfaction, so he could take his vacation flight and feel OK about making me sick — to ease his own guilt. So as to his “courtesy,” I say:

    “Don’t piss down my back and tell me it’s raining.”

    Economists call his behavior a negative externality, which in this case simply means I pay the price for something HE did. The sick guy’s got nothing to lose; he’s already sick, and it costs him nothing to make ME and others sick on his way to his vacation resort. Thanks a lot!

    You are not being courteous nor considerate. You are making me feel very uneasy, sitting like packed sardines with my head 3 inches from yours, our elbows sharing an armrest on a lengthy flight where we also share the dead air trapped inside a flying tin can. I do not know what horrible disease you are covering up with an ill-fitting $2 tissue-paper sick mask, but my mind has to assume the worst; you’ve got something really bad and now I’m going to get it too, and I am going to die.

    I know this is a cultural thing, and in Asia and increasingly in Mexico and elsewhere people wear face masks all the time, on subways and in crowds. That doesn’t mean they work; they don’t, according to the Centers for Disease Control (CDC).

    “The CDC has not recommended the use of masks by the general public,” even during outbreaks of serious global viruses like Swine Flu, let alone your average common cold or seasonal flu.

    “Our study suggests that community use of face masks is unlikely to be an effective control policy for seasonal respiratory diseases.”

    What does the CDC say about illness and flying? “Don’t.” Don’t fly when you are ill unless the purpose of the flight is to seek specialized medical care for your ailment.

    There is no way to fly without putting everybody around you at very high risk of catching whatever illness you’ve got; they’ll pay the price for your selfish, asocial behavior. If you wear a mask, be honest and say you’re doing it to cover your shame, not to protect fellow passengers

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  22. Nancy says:

    All this talk about wearing or not wearing a mask. I guess a mask would work if you had a cough. Other than that, the germs are passed. Back to whether a person should be required to get a flu shot? So far it hasn’t been proven that the shot keeps the germ from being spread.

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  23. Jon says:

    Gosh. As economists you should be ashamed of yourselves. You are treating a supply side problem with a demand side solution! Ideas like firing employees or forcing them to wear masks are terrible solutions. You are making up for the shortfalls of the vaccine by punishing the doctors/nurses/staff! I believe this type of thinking is backwards and instead you need to focus on supply. Increasing flu shot clinics and making it easier to get the flu vaccine will help, but the problem will not be solved until a recombinant vaccine is made that provides lifetime (decades?) immunity to the flu. Right now, the seasonal influenza vaccine is not an enticing enough product to achieve the desired level of immunization.

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  24. Michele says:

    Does anyone know if the physicians in these hospitals are required to receive the flu vaccine? What about patients being admitted for elective procedures?

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  25. Tam Dl says:

    What I heard out east here was that the currently circulating , and troublesome flu virus is not one of those included in this year’s shot. That still leaves other potential threats the current vaccine could protect against. But it is a 100% fail on the main threat.

    Basically if one wants to mask the hold-outs, why not the rest? The risk is very high this year.

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  26. Butcher says:

    You can get the virus and be a carrier, whether you had the flu shot or not.

    You can spread the disease whether you were vaccinated or not, you can spread the virus weeks before you even know you have symptoms.

    There are four main flu viruses circulating the country the flu shot is only good for three of these, one of the swine flu’s are not covered.

    So with this logic everyone in the country should wear a yellow mask.

    35% of the people who had flu shots came down with the flu.

    These diseases mutate and change forms, this can happen also when the disease is passed from one person to another, no vaccine will mutate to protect you…

    Flu and disease have always been with mankind, and will always be, this flu shot sounds like mideval thinking, giving a dead virus will somehow stop what nature has put in place.

    Look into the CDC’s own statistics, of how ineffective this government campaign has been.

    But they seem to have been very effective into scaring uneducated people to run down and get flu shots, thinking somehow they will be safe, or escape the virus, or would not be carriers of the virus, if they were injected with a dead disease.

    What If Hitler had this technology, and passed laws everyone who wishes to work must get vaccinated and spread the kind of propaganda we see with this flu shot, you had better hope you have blue eyes when getting your shot from the Gestapo.

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  27. Anurse says:

    I had a flu shot 23 years ago was bedridden sick for over 72 hours couldn’t keep a sip of water down. Probably should have been hospitalized but recovered at home.

    I have been in nursing for over 20 years NEVER had a another flu shot. Have had the flu twice in the past 23 years~ lasted no more than 24-36 hours and I was FULLY recovered within 72 hours.

    I would rather quit nursing than subject myself to a federally funded drug experiment~ they create these “new” vaccines and have no idea what the long term effects.

    I am nurse but I am a human being. My life, my body, my choice!

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  28. Anurse says:

    The FDA and the CDC obtain funding and “suggestions” from private companies like pharmaceutical corporations. These companies profit when they get FDA approval and their products are cleared for take off.

    And people who invest in these companies~ make money as well.
    The federal government has invested in the influenza vaccine industry.

    How many times we have seen a medication or a medical procedure suddenly off the market because “after further review…” you know the rest.

    If they can get health care workers to use the flu vaccine then they can “suggest” it to everyone else!

    So in 10 years or so those sheep who followed the rules and repeatedly subjected themselves to the annual “flu shot” begin to show signs of brain damage whose going to be handling your care?

    Those of us who still know how to think for ourselves may or may not be interested in picking up the slack.

    But don’t hold your breath, if you don’t support us now we will probably not care what happens to you in the future. And there is your Karma!

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  29. Sharona says:

    In my family there is a history of Guillain–Barré syndrome which was contracted from the flu vaccine. There is not enough information about how genetics may play into this contraction. I choose to not put myself and my children at risk for this and now I am being forced to wear a mask all the time while I work in a hospital and I do not work with patients in any way. The building where I sit doesn’t have any patients.

    Is that fair? What should I do?

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  30. Donald says:

    Interesting debate – where I am from (Sydney Australia) such dramatic measures have not as yet been suggested but perhaps it is only a matter of time. Our fairly outspoken cival libertarians would have a lot of fun with the idea.

    As a front line health employee (anaesthetist – what the US would call an anaesthesiologist) officially I am expected to call in sick at the public hospitals I work at if I contract the flu; unofficially I am stongly discouraged from calling in sick unless I absolutely cannot get to work (eg. shark attack etc)

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  31. Ronald B Low says:

    Hospitals also require workers to wash their hands and, in many places, wear masks whether they have been vaccinated or not. We wouldn’t allow a surgeon to sneeze onto the new kidney she just was sewing to your body. Sneezing flu viruses onto grandma in the ICU is about as dangerous. The true incidence of egg allergy is pretty rare.

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  32. Eva says:

    Stephen, Since you guys are great at looking at the cost/benefit of things, you should calculate the cost/benefit of the flu vaccine. The results will shock you. Roughly 7% of all influenza like illness (ILI) is influenza. With the 30-70 efficacy, even if you vaccinate 90% of health care workers, you only cover them against 2-4% of the ILIs circulating in a given year. That is a paltry return on investment, not mentioning the potential side effects that may cost the hospital even more than absenteeism from the flu. Furthermore, there is zero evidence that taking the flu vaccine will actually prevent someone else getting the flu since you cannot talk about herd immunity from a vaccine that is less than 90% effective. Health care workers and patients are better off washing their hands and staying home when sick.

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    • Seminymous Coward says:

      Your primary complaint seems to be that the influenza vaccine doesn’t prevent other diseases with similar symptoms. That seems unreasonable to me.

      You have provided no cost to weigh against your unsourced numbers for the benefit, which are themselves expressed as percentages of an unknown (but very likely quite large) number, the total IFI count for a year. Therefore, your conclusion about return on investment is unsupported.

      Here’s a chart showing herd immunity thresholds given the various factors involved, and it can be viewed (annoyingly as a single-slide PowerPoint presentation) at . For example, a 60% effective vaccine like a middling year’s flu shot tips into herd immunity against a middling flu with a 2.5 base reproduction number at 90% coverage.

      There is a vast amount of high-quality research available demonstrating that influenza vaccines prevent people from getting influenza; it’s kind of the point. I’ve linked some in other comments, and it’s trivial to find with even the simplest search.

      Nothing about a flu shots implies that those who get them can’t wash their hands and stay home when they’re sick.

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      • Jon says:

        Here is the pubmed article… seriously I couldn’t understand that graph on its own… you should link original articles when you can… thanks!

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      • Seminymous Coward says:

        Jon: I posted that link in 2 prior comments. To be honest, I was a bit afraid of tripping some antispam protections if I kept posting the same links. People keep making the same false claims; I feel compelled to answer them, but I don’t want to be too repetitive or get banned from commenting at a site I rather enjoy. Also, a copyable DOI link to the article is in the PowerPoint file, so at least it has one advantage.

        The graph itself is a pretty straightforward contour map, though I suppose they might be unfamiliar to some. Effectively, higher reproductive numbers for a virus mean a higher climb up a metaphorical mountain, which is sloped differently with respect to vaccine coverage and vaccine effectiveness but always increasing or flat with each at any given point.

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  33. Eva says:

    As for the mask, this may sound like a good solution but it is like the white coat or a necktie. Unless changed often, it can become a carrier of germs. In addition, some people with asthma cannot wear them. A nurse with asthma who was forced to choose between the shot and the mask, ended up in the ICU after her flu shot. The mask is really just a penalizing measure in this case (not the same as a surgeon wearing a mask) but not a meaningful solution. The flu vaccine mandates are just a way for bureaucrats to check a box and feel good that they are doing something about hospital infections.

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  34. Pshrnk says:

    Hospitals may not be in the business of getting people sicker, but if you compare nosocomial MRSA rates in American hospitals to those in places like the Netherlands you might wonder.

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  35. GLK says:

    Might make sense if hospital workers were the only ones coming in contact with patients but they’re not. There are lots of comings and goings in hospitals from the patient’s friends and family members to contractors, vendors, delivery workers, maintenance people, sales reps, on and on it goes… Hospitals are a veritable bee hive of people coming and going, add the fact that flu shots are maybe 60% effective and really, who’s fooling whom? Basically I see the flu shot policy as more of a PR activity than anything that’s actually effective in a meaningful way.

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  36. Nancy says:

    No one has yet been able to say whether all these vaccines being given won’t create a super virus. It happened with antibiotics, they are being used effectively, for the most part, not abused. Seems as if we’re asking for trouble, but we do seem to be a society of “fast action” then face the consequences instead of thinking things through logically

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    • Ronald Low says:

      Jenner started vaccinating against smallpox in 1796–so far, no super smallpox virus. Pasteur started vaccinating against rabies and the population of vaccinated potential hosts of rabies (mostly dogs and cats, also a few people like me) is HUGE–but so far, so super rabies. Other virus vaccines used much more often than penicillinase resistant penicillins: measles, mumps, rubella, hepatitis B. So far, no superviruses in over 200 years of vaccine use.

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      • Ronald Low says:

        P.S. I forgot polio, another widely used vaccine for over 50 years. It’s new, but so far, no super HPV, and no super veneral warts or super cervical cancer, thank God.
        For that matter, vaccination against bacteria have not produced bacteria resistant to vaciination: super pneumococcus or super meningococcus–though there are some strains that are resistant to some antibiotics.

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      • Nancy says:

        Every vaccine that you mentioned, such as polio, were made from a live virus and made specific to the disease unlike the flu vaccine, which is a guess as to what the virus may be. That is the same as giving an antibiotic for an infection that has not been identified, alas, MRSA

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  37. Nancy says:

    Any bacteria that is cultured and treated specifically are treated successfully. It’s when we start trying to outguess nature that we ask for problems. We need to let our immune systems fight for itself, when it can’t then treat the cause. Every drug comes with side effects, even so called natural ones. We can never know enough to trick nature, maybe work with it, but not trick it

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  38. Nancy says:

    New update, there is now a whooping cough that is resistant to the whooping cough vaccine

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  39. Umrah says:

    “I am not sure that … flu shots are all that effective.” Would you care to cite some evidence for your assertion against the overwhelming body of research?

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  40. San Diego PT says:

    Such diverse comments, sadly many of these have a hostile tone. For those of you who do not work in the health care field (and those that do), your concerns are understood. No one wants to get the flu. Certainly not from the person taking care of you.

    A health care worker’s responsibility is to stay home when they get sick, returning when they are well, thus keeping patients safe. I just received a memo stating that my hospital will begin mandatory flu shot requirements in 2013 with the option of using a mask.

    I have been working in the health care field for nearly 15 years and have been sick 2 times from the flu, both times I stayed home. I have never received the flu shot, I am a healthy person and want my body and immune system to stay strong and fight any illnesses that come my way.

    Almost every person I know who has had the flu shot, and believe me most people I know get it, most of them have been sick several times per year even while getting the shots. Yes, I am very skeptical about vaccines. I know many of them have helped people over the years such as polio, measles, etc. But the flu vaccine seems more like a “guess” of what viruses may cause problems over the following year.

    I understand the push for these vaccines, but I believe the number one way of prevention is not a vaccine, but good old fashioned solid care which includes “universal precautions” such as washing hands, using a clean technique or sterile if needed in certain day to day situations. And also to STAY HOME when sick! That should be mandatory, but then you see people at work with red sniffly noses. And they did get the flu shot. So where does that leave us.

    It was interesting about one person’s comment of 60% success with the vaccine. Thats close to 50/50 if you ask me. I don’t like putting “unknowns” in my body or my children both of whom have not received the flu shot either. They are are perfectly healthy. Our country puts way too much emphasis on flu vaccines and drugs. Let mother nature do the work. Unfortunately, some people die from the flu, even those who do take flu shot.

    I don’t want to wear a mask, but I will and I will still give the best care I can and instill confidence in my patients as I always do. I am sorry for those who have been fired, that is wrong. No one should be forced, end of story.

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  41. Concerned says:

    San Diego pt: couldn’t have said it better myself. I don’t think we rely enough on our bodies own immune systems.

    My question still, that no one has answered, maybe because of lack if knowledge, are we creating a super strain of flu by trying to prevent the natural way of things?

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  42. Ronald Low says:

    Our hospital system has pretty much the same policy. Influenza is a major nuisance, but only occasionally fatal to healthy people. If the system is working correctly, the hospital is not filled with healthy people, and the extra stress to an already unhealthy person may tip them over the edge. You give up all kinds of rights to anonymity when you join the hospital staff: you are usually required to wear a badge that shows your name, your education level (which is highly correlated to income), what department you work in… and, armed with that information,patients can find even more information about you–where you trained, when you graduated, whether your medical or nursing license has ever been partially or totally suspended and, if so, for what reason….

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  43. Junko says:

    Actually, I would suggest taking this one step further.

    Everyone who works at a hospital should wear a surgical mask. The flu vaccine is far from 100% and there are many other viruses and bacteria that can be transmitted by a cough or a sneeze.

    Plus, it’s less discriminatory against those that have not had a flu shot, for whatever reason. For instance, there are medical reasons, such as allergies, in which people absolutely can not get a flu shot.

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  44. JOEL says:


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  45. Rick Thomas says:

    My Story!

    My Name is Rick Thomas age 48 Years old I am what you call a Dangerous Severe Needle Phobic witch is a Real Medical Condition! for the past 48 Years I have never had a vaccination or Blood work or any Needle procedures Ever Done on me. Back in 1976 I was on Vacation in Wisconsin with a severe Ear Infection and I was taken to a local doctor in town but I had no idea this Doctor was going to Give me a Shot of Penicillin with a 2 inch Needle and Totally got Violent and very angry and was thrown to the Ground by 4 Doctors and I threw them in the Air against the wall and Ran the Hell out of there the Doctor and Nurses from what I was told got Hurt with my Temper! so for the past 48 years I live in Fear and Anger because I Refuse to Ever have a Needle for any Reason even if I am Dying! I Have No Medical insurance and NEVER WILL!!! I Never go to clinics or Hospital and stay away like the plague! I know this might sound extreme but this is my life and I will not Except being a Lab Rat for anyone and I live my life in fear Every day. I have never been so Angry to see Children go through Hell of Vaccinations These Things are very Painful and your Hurting Children and adults everyone has Rights including children but if the Medical field Keeps Treating patients in this manner More and more people will avoid medical care and stay far away. This past week I had a encounter at a local Walgreens of a woman who walked up to me and grabbed me by the arm and I went into full rage telling her to f off keep that crap away from me. I mean what I say I will Never Ever let Anyone stick me with a Needle because they will be very very sorry they tried

    Advise For Adults & children.

    1. Never Hold or force anyone to take a Needle They Have Needle phobia
    2. if you see a person who has this condition Refuse to treat them and have them seek Help
    3. Children will soon have Rights to refuse Needles and parents will no longer be able to force this on them. I am working on this goal
    4. More and more Family’s are Refusing Vaccinations and that’s a good thing Never Refuse to treat patients because there not vaccinated

    I Understand Hospitals need to care for patients but this subject Has Bothered me for the past 48 years and there is no need for the neglect of patients living with this fear and for the medical field to ignore and force this on people!

    Please Google Needle Phobia A Real Medical Epidemic That 10-20 percent of the world has!

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  46. freedom says:

    I personally think the mask does not prevent those from getting the flu. Question, if you have a mask on, and you sneeze, should you sneeze in the mask? It makes no sense to wear the mask, especially since I sit behind a desk, sort of like a bank teller, and I have no contact with patients. Most of my time is spent on the phone dealing with insurances and patients, and half the time they can barely hear me on the phone…then when patients come in they are startled to see me with a mask and feel they need one too for fear that I may be sick as well. It is strange even to see some who are sick, walking around coughing in their hands, sniffling…and touching everything…how come those people dont wear masks, or better yet, stay home, go to the doctor and don’t spread your germs??? working in a healthcare facility it just amazes me how many nurses, managers and doctors don’t take better precaution to keep from getting others sick, instead of worring about who has on a mask, who isn’t wearing it properly, etc. Further more, I have seen people almost die from the flu shot…Why would I want that in my body? No thanks…I am curious to see how long the “law” drags this “mask” thing out…There should be a law against people who harrass you about wearing the mask…

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  47. Lou says:

    Should we ALL become slaves of the state and its pal BIG Vaccine INC?

    If you take a little time to explore the flu evidence you may come to these conclusions on “the flu”.

    The bottom line on the “Seasonal Flu” is you do NOT want protection from ONLY the seasonal flu virus. You want protection from ALL VIRAL infection. The “Seasonal Flu” is a minor, UNKNOWABLE apriori, subset of VIRAL INFECTION.

    Vitamins D and C, in ADEQUATE AMOUNTS will protect you from ALL VIRAL INFECTIONS.

    It is just this simple and difficult.

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