Flu Shot or Mask?

[Nurse Beth]

Recently at the nurse's station at work, I was talking with Lisa. Lisa was wearing a surgical mask. To keep her job, she has to wear a mask until flu season is over because she declined to get a flu vaccination this year.

I asked how it felt to wear a mask for 12 hours. She said, "Well...it's kinda claustrophobic, but I'm getting used to it. What's really weird is people keep asking me to repeat myself.. It's like they can't hear me if they can't see my lips moving. And when I smile at patients, I have to try really hard to smile with my eyes."

Position Statements

The American Nurses Association (ANA), the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP), a CDC panel of medical and public health experts that advises on vaccine use, all align in recommending flu vaccines for healthcare workers with allowable exceptions for religious and/or medical reasons.

National Nurses United (NNU) opposes mandatory flu shots as fostering an atmosphere of distrust. Likewise, they oppose masking on the basis of stigmatizing the individual.

Masking: the Science

The influenza virus is transmitted by direct contact, large droplet spray (like a sneeze or cough, distance of about 3 feet), and by aerosolization (smaller particle aerosols).

The rationale for masking is that unvaccinated asymptomatic persons can shed the influenza virus for 24 hours before symptoms appear and up to 5 days after the onset of illness. However, minimal data regarding aerosol shedding and infectiousness of aerosol particulates exist.

The effectiveness of N95 respirator masks in preventing transmission of airborne viruses has been shown but the results of studies on the efficacy of surgical masks are mixed.

Many surgical masks are not certified as protective against respiratory infections and are loose fitting. There are no clear guidelines on how frequently surgical masks should be changed.

According to the CDC, there are no definitive studies to show that surgical masks worn by health-care workers reduce influenza transmission.

Legislation

State law, state Departments of Health, and county health officers have the authority to mandate flu shots and/or masks. For example, California state law (Health & Safety Code §1288.7 / Cal OSHA §5199) requires either flu vaccination or the signing of a declination statement for all acute care hospital workers and most health-care personnel, including clinic and office-based staff.

Additionally, many county health officers in California mandate that health care workers either receive an annual flu vaccine or wear a mask during the flu season.

Employee Rights

Many acute care facilities have adopted coercive "flu shot or mask" policies. In some cases, healthcare workers have been fired for refusing to be vaccinated.

Legally, most employers can require flu shots as a condition of employment as most employees work under an "at-will" work agreement.

However, the research used by employers to justify mandating flu vaccines for healthcare workers may be flawed and insufficient. Four such studies cited by employers were conducted in long-term care facilities and have not been proven to be generalizable to acute care settings.

Ethics

The ANA maintains vaccination is a public health concern and nurses should role model illness prevention through immunization. Nurses have a responsibility to not place their patients at risk.

Vaccination is for the greater good, but individual rights must also be considered. Sometimes the ethical principle of preventing harm is in direct conflict with the ethical principle of autonomy.

Protective or Punitive?

When I see a co-worker wearing a surgical mask I cringe a little. My core values of justice and fairness are triggered. Is this really about protecting patients based on robust evidence or is this about shaming the nurse?

I believe in doing what is best for the greatest good but I also believe in autonomy. It comes down to personal rights versus social responsibility. I am pro-vaccination but stop short of supporting "flu shot or mask" policies.

For me, it would take irrefutable evidence of patient benefit to justify overriding personal rights and I don't believe we have that.

The rush to disregard individual freedom over scanty evidence concerns me more than the thought of Lisa not wearing a surgical mask.

Do you believe nurses should be required to get mandatory flu shots or mask? Why or why not? I'd love to hear your view.

More thought-provoking articles by Nurse Beth:

Ageism in Nursing is Real

Why Do Nurses Quit?

References

Booth, C. M., Clayton, M., Crook, B., & Gawn, J. M. (2013). Effectiveness of surgical masks against influenza bioaerosols. Journal of Hospital Infection, 84(1), 22-26.

CDC. Interim Guidance for the Use of Masks to Control Influenza Transmission.2009. Accessed January 2017 Interim Guidance for the Use of Masks to Control Influenza Transmission

| Health Professionals | Seasonal Influenza (Flu)

Serres, G., Skowronski, D., Gardam, M., Lemieux, C., Yassi, A., Patrick, D., Krajden, M., Loeb, M., Colignon, P., Carrat, F. 2017. Influenza Vaccination of Healthcare Workers: Critical Analysis of the Evidence for Patient Benefit Underpinning Policies of Enforcement. PLOS.org. accessed January 2017 Influenza Vaccination of Healthcare Workers: Critical Analysis of the Evidence for Patient Benefit Underpinning Policies of Enforcement

[BostonFNP, APRN]

I have to share a recent article on this topic. I have had an opinion that much of the vaccination-mask push is more hype than outright fact. I would appreciate any input from others. I included the link and a few sentences directly from the article.

Mandatory flu shot policies may be based on flawed research, study suggests

Mandatory flu shot policies may be based on flawed research, study suggests

Written by Heather Punke February 01, 2017 |

While the CDC urges everyone to get a flu shot, some hospitals take it a step further and mandate employees to get a flu shot or face possible termination. These mandatory flu shot policies are rooted in the belief the shot protects both workers and patients from the virus. However, a study published in PLOS says the policies may be built on faulty research. "The impression that unvaccinated [healthcare workers] place their patients at great influenza peril is exaggerated," according to the study.

Actual study link: Influenza Vaccination of Healthcare Workers: Critical Analysis of the Evidence for Patient Benefit Underpinning Policies of Enforcement

This was talked about above. Having read it a few times, my thoughts:

• The analysis is interesting in an academic sense.
  
• It presents a competing perspective and a critical analysis on a small part of the extant data.
  
• I am not an epidemiologist, so I confess that some of the calculations and assumptions made are above my comfortable understanding, though they seem theoretically sound.
  
• It is clear there is a clear difficult-to-describe all-cause mortality result; this has been seen in many other studies and always warrants further evaluation as it is suggestive of selection bias. It suggests the use as a primary endpoint is concerning.
  
• The reduction in LCIV (where studied) is significant and more consistent with the predicted data.
  
• This was only 4 trials reviewed and no new data was created.
  
• There is a lot of data manipulation in this case by the very nature of the analysis.
  
• This is not a blinded study and several of the authors have a clear historical bias as well as the funding sources having pending legal actions on the topic.
  
• I am still not sure I understand the "generalized" extrapolation nationwide; the numbers don't seem to add up and it is not clear how they arrived where they did and they make a large assumption that the previous study data would be linear.
  
• The authors' conclusion is exaggerated.
  

[Feelgood RN]

Ah man I love studies, especially ones where there are so many variables that it's pretty much a guessing game and you can say whatever you want with the numbers because....like I said, guessing game. That article states it would take 6k-32k HCW getting vaccinated to potentially prevent one death. For a research study that number has quite a large interval. Base on 2015 estimates of number of nurses, mind you just RN nursing and not advanced practice, if every one of them was immunized according to the study could be preventing anywhere from 86-460 lives.

We know the flu shot has the potential to prevent the flu. Yes some years it works and others it misses the mark. Unless we take lab verified flu victims and put them in rooms with vaccinated people and purposefully try to inoculate those people for the sake of science there isn't going to be a study that shows what people want to see related to the vaccine. Do all the people that die of sepsis have the flu or did they come in with ILI and people assumed it was the flu? How many people "cry wolf" as in have flu like symptoms, get ILI and CLAIM to have gotten the flu after receiving the vaccination? I work in a rural hospital, many of the patients here get "the flu" but it's never lab verified so there's no way to determine if it was the flu or not.

My argument is that it only takes one nurse. One nurse to determine whether a patient gets the flu or not. One nurse to decide they want to help protect themselves and those around them. We cannot control those around us as much as it makes us sick to our stomachs at times. We can chose for ourselves. If your choice is to not receive the flu vaccine I say good for you, stand your ground and do what you think is right. Know either way you choose you will be judged; whether you are the one with the mask on and people think "ah why didn't they get the flu shot" or you're the one without the mask and others are thinking "I can't believe they caved and got the mandated shot". While many religions state we should not judge it is NOT a right to not be judged, make your decisions and live with the consequences.

[SouthernBelle85]

I haven't heard any cases to where the flu vaccine has caused harm to anybody, I'm sure it has but can't be a huge percentage. I don't understand why people are so against it on this forum. When we are around patients who possibly have weak immune systems and the flu could potentially be deadly to them, shouldn't we protect them...with either the vaccine or a mask?

[Cheyenne RN,BSHS]

SouthernBelle85

I haven't heard any cases to where the flu vaccine has caused harm to anybody, I'm sure it has but can't be a huge percentage. I don't understand why people are so against it on this forum.

SouthernBelle85, I am not so sure that people are as much against the vaccine as they are against the fact it is mandated. Administrators state the vaccine is not forced on anyone because they are given a choice between the flu shot or a mask...but the idea has evolved into now being part of the hiring process at my facility. Then the choice is between having a job or not having one, which few are rich enough to do that.

I think that it would not bother me so much where I work as long as it is the same treatment and fairness across all disciplines. Right now half the doctors ignore the need for vaccines or compliance. When you ask administration about this double standard they are quick to remind you that the physicians are the ones that bring in the money and that they can only ask them to comply.

By the way, thanks to all who had input on the article. I loved having the different points of view and to anyone thinking it is a school type question, at my age school is the last thing I want to be doing. LOL.

[MandaKD]

At my job we have to get the flu vaccine. You can't choose to wear a mask instead. You have to have an allergy to it to be able to opt out.

[r1013]

As much as I hate needles coming at me... I use to get the flu shot for work because it was sorta pushed as a good thing being a nurse. I followed as a good employee and pushed it as we were asked to do. Approx 2 years ago I was watching an interview with a chemist from a pharmaceutical company that produces the shot. All the typical questions were asked and responses were as expected except one. He was asked if it worked. With a smile and slight laugh he said "well... we can't prove it and we have never seen it work, but the science behind it is sound so we highly recommend it." I shrugged that off. Over the next few years flu news caught my attention. Many many news articles like... A US Navy aircraft carrier with 100% flu shot compliance has out break of the flu. A certain school that requires the flu shot has out break of the flu. Then watching year after year as my co-workers at two hospitals got the flu even though they had the shot months prior. Then I noticed as the flu season appeared so did someone giving the flu shot on every corner. Push, push, push for what appears not to do anything at all. I'm definitely not an expert. I have degrees in Exercise physiology, nutrition and nursing. I am not a chemist so I don't really know for sure what is real and truthful as far as the science or bull crap conspiracy theories. I have only went on what I see around me happening. I have trusted my prior teachers and the doctors I now work with and I highly respect there opinions. I decided to ask the physicians a few questions. At the two hospitals I work at I asked rounding physicians if they had received the flu shot, was planning on taking it or recommended it. Out of 30 plus (I lost count) only two had taken it and recommended it. The rest were adamant (just between you and me) with a hell no attitude!! I had one physician as a patient and he actually acted scared when i asked him if he wanted to get the flu shot. Almost like he thought he had to take it. He said, "I promise I'll get it at my office by my own employees after discharge". Even after that I still took the flu shot like a good boy up until this year. This year I wore a mask. A rounding physician and her medical student stopped me in the hall and asked why I wore the mask. I told her I just didn't like needles and wasn't sure it worked anyway. She said she didn't blame me at all. Her student then asked: ****"By the way why are we (doctors) exempt from the flu shot when we see more patients than nurses?" She said she didn't know but maybe because they generate the revenue for the hospital and there toes were not to be stepped on. I am a bit irritated and confused as to what the truth is. I feel like I'm becoming a conspiracy theorist with the flu shot because to me things don't add up. What I have come to the conclusion of, is that it doesn't work. Most doctors personally don't like it and don't take it. It gets pushed on the rest of the population. It's never been seen or proven and probably never will... to protest healthcare workers or patients and anyone else. What I am left with is why are they pushing it so hard? The developing conspiracy theory side tells me there's chemicals in the shot that will cause problems later for the purpose of cutting population back. Neurological problems from the mercury? Cancers??? That actually is Bill Gates opinion on the shot. I know he isn't medical but I thought it was funny and it feeds the... conspiracy :) ! My more practical side tells me it's probably simply "MONEY". The pharmaceutical companies are probably backed by the government because they are paid off and they all get a cut. I am still trying to decide 100% but right now I am 90% leaning its all a bunch of bull. The hospital actually thinks they are punishing me by making me wear a mask. I have learned to ignore it. Patients ask me why I am wearing a mask at there admission. I simply tell the truth, that I don't take the flu shot and hospital policies require me to wear a mask. To my surprise, 75% or more get angry at the hospital and REFUSE the shot when asked. Another way to protect my patients from what me and apparently most doctors think is harmful. This is probably just all a money making scheme. I just hope the harmful chemicals contained in the injection are actually in low enough amounts to not cause problems later. If it does ever cause harm... You are not allowed to sue the manufacturer, doctor or hospital. They are all immune from anything related to the flu vaccination. You must go to the "National Vaccine Injury Compensation Program" and sue the Federal Government for compensation through the compensation Trust Fund. You can read more here: Flu Shot Remains Most Dangerous Vaccine Based on Injuries and Deaths Compensated by Government

[mrl3fnp]

As much as I hate needles coming at me... I use to get the flu shot for work because it was sorta pushed as a good thing being a nurse. I followed as a good employee and pushed it as we were asked to do. Approx 2 years ago I was watching an interview with a chemist from a pharmaceutical company that produces the shot. All the typical questions were asked and responses were as expected except one. He was asked if it worked. With a smile and slight laugh he said "well... we can't prove it and we have never seen it work, but the science behind it is sound so we highly recommend it." I shrugged that off. Over the next few years flu news caught my attention. Many many news articles like... A US Navy aircraft carrier with 100% flu shot compliance has out break of the flu. A certain school that requires the flu shot has out break of the flu. Then watching year after year as my co-workers at two hospitals got the flu even though they had the shot months prior. Then I noticed as the flu season appeared so did someone giving the flu shot on every corner. Push, push, push for what appears not to do anything at all. I'm definitely not an expert. I have degrees in Exercise physiology, nutrition and nursing. I am not a chemist so I don't really know for sure what is real and truthful as far as the science or bull crap conspiracy theories. I have only went on what I see around me happening. I have trusted my prior teachers and the doctors I now work with and I highly respect there opinions. I decided to ask the physicians a few questions. At the two hospitals I work at I asked rounding physicians if they had received the flu shot, was planning on taking it or recommended it. Out of 30 plus (I lost count) only two had taken it and recommended it. The rest were adamant (just between you and me) with a hell no attitude!! I had one physician as a patient and he actually acted scared when i asked him if he wanted to get the flu shot. Almost like he thought he had to take it. He said, "I promise I'll get it at my office by my own employees after discharge". Even after that I still took the flu shot like a good boy up until this year. This year I wore a mask. A rounding physician and her medical student stopped me in the hall and asked why I wore the mask. I told her I just didn't like needles and wasn't sure it worked anyway. She said she didn't blame me at all. Her student then asked: ****"By the way why are we (doctors) exempt from the flu shot when we see more patients than nurses?" She said she didn't know but maybe because they generate the revenue for the hospital and there toes were not to be stepped on. I am a bit irritated and confused as to what the truth is. I feel like I'm becoming a conspiracy theorist with the flu shot because to me things don't add up. What I have come to the conclusion of, is that it doesn't work. Most doctors personally don't like it and don't take it. It gets pushed on the rest of the population. It's never been seen or proven and probably never will... to protest healthcare workers or patients and anyone else. What I am left with is why are they pushing it so hard? The developing conspiracy theory side tells me there's chemicals in the shot that will cause problems later for the purpose of cutting population back. Neurological problems from the mercury? Cancers??? That actually is Bill Gates opinion on the shot. I know he isn't medical but I thought it was funny and it feeds the... conspiracy :) ! My more practical side tells me it's probably simply "MONEY". The pharmaceutical companies are probably backed by the government because they are paid off and they all get a cut. I am still trying to decide 100% but right now I am 90% leaning its all a bunch of bull. The hospital actually thinks they are punishing me by making me wear a mask. I have learned to ignore it. Patients ask me why I am wearing a mask at there admission. I simply tell the truth, that I don't take the flu shot and hospital policies require me to wear a mask. To my surprise, 75% or more get angry at the hospital and REFUSE the shot when asked. Another way to protect my patients from what me and apparently most doctors think is harmful. This is probably just all a money making scheme. I just hope the harmful chemicals contained in the injection are actually in low enough amounts to not cause problems later. If it does ever cause harm... You are not allowed to sue the manufacturer, doctor or hospital. They are all immune from anything related to the flu vaccination. You must go to the "National Vaccine Injury Compensation Program" and sue the Federal Government for compensation through the compensation Trust Fund. You can read more here: Flu Shot Remains Most Dangerous Vaccine Based on Injuries and Deaths Compensated by Government

EXCELLENT!!

[mrl3fnp]

I didn't read the previous comments. After the legal case in Canada where nurses won a case against this it has me wondering about it here in the US. Basically Nurses in Canada faught the hospital claiming forgoing the flu shot and wearing a mask indicates to patients and staff that you did not receive the shot. This is a violation of privacy and or hippa and therefore against the law. Now the nurses can make their own decision and not have to wear a mask if the nurse decides not to get the shot. It's like asking a Nurse to wear a sticker indicating if they have hiv or hep c it's private information! I think if nurses banded together and got a lawyer there could be a case made here on this issue.

EXCELLENT!!

[Feelgood RN]

There are many conspiracy theories out there, if this is one you want to follow and choose to fight against that's great, like I've stated before everyone should and has the right to choose their fights. A couple points I'd like to make though.

The only thing I've found about an aircraft carrier was this:

Flu Sickens 3

[Feelgood RN]

EXCELLENT!!

LOL. Come on mrl3fnp I know you can Google, but here:

http://www.employmentlawalliance.com/Templates/media/files/Canadian%20Overview%20--%20Distinctions%20Between%20US%20and%20Canadian%20Labor%20and%20Employment%20Law%20-%209-3-13.pdf

In case you don't feel like reading, CANADA, where the nurse won the suit, does NOT have at will employment meaning there has to be plausible reason for termination. With a few exceptions many states in the US are considered AT WILL meaning you can be fired or quit without reason. There are exceptions for "isms" and for retribution for reporting or implied contracts. Unless you're in a union though you can pretty much assume you are an at will employee.

[BostonFNP, APRN]

Approx 2 years ago I was watching an interview with a chemist from a pharmaceutical company that produces the shot. All the typical questions were asked and responses were as expected except one. He was asked if it worked. With a smile and slight laugh he said "well... we can't prove it and we have never seen it work, but the science behind it is sound so we highly recommend it."

Can you link to this interview, I'd like to see it.

A US Navy aircraft carrier with 100% flu shot compliance has out break of the flu.

I don't see any news stories or published papers about this. Can you cite your source for us please?

I feel like I'm becoming a conspiracy theorist with the flu shot because to me things don't add up. What I have come to the conclusion of, is that it doesn't work. I am still trying to decide 100% but right now I am 90% leaning its all a bunch of bull.

You can read more here: Flu Shot Remains Most Dangerous Vaccine Based on Injuries and Deaths Compensated by Government

You are concluding the vaccination is not effective and 90% leaning on some anecdotal evidence and reports from sources like "Health Impact News". You seem to have the right gut reaction: you are becoming a conspiracy theorist, or at very least, a pseudo-scientist.

Perhaps "things don't add up" because you are asking the wrong question: this is confirmation bias.

[Feelgood RN]

I couldn't find anything on a 100% crew Boston, but I was able to find a CDC article that had a crew on a small naval ship and 99% compliance which I think they may have been talking about. It's in my last post.