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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  1. 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

      Well-loved. Like or Dislike: Thumb up 11 Thumb down 1
    • 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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  2. 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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  3. Kathryn says:

    Hidden due to low comment rating. Click here to see.

    Disliked! Like or Dislike: Thumb up 6 Thumb down 15
    • 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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  4. dave says:

    Hidden due to low comment rating. Click here to see.

    Disliked! Like or Dislike: Thumb up 5 Thumb down 10
    • 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

      Well-loved. Like or Dislike: Thumb up 6 Thumb down 1
  5. 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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  6. 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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  7. 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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  8. 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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