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

[GM2RN]

Again, this isn't "forcing", it is a condition of employment at a place you choose to work. No one is tying anyone down and injecting them.

The legal definition of coercion is "the use of express or implied threats of violence or reprisal (as discharge from employment) or other intimidating behavior that puts a person in immediate fear of the consequences in order to compel that person to act against his or her will...". Coercion | Definition of Coercion by Merriam-Webster

What you describe is coercion and it's illegal. ANY policy that an employer comes up with that is agains state or federal law is illegal. Employers get away with it because of the fear that the coercion produces, plus the fact that many are unaware that it is illegal and others don't have the resources to fight it.

[GM2RN]

What did you learn and where did you learn it from, please share your ideas and your sources so we can all discuss.

The head of every major religion has ok'd the use of vaccines. Additionally the influenza vaccine does not use human cell lines.

Citing a blog from a website which features blogs with the title "How to get a vaccine religious exemption like a boss" doesn't help the concern for conformation bias that is the common theme through the blog that you linked.

Here is a good peer-reviewed publication on the topic:

Grabenstein, J. D. (2013). What the world's religions teach, applied to vaccines and immune globulins. Vaccine, 31(16), 2011-2023.

First, I am under no obligation to justify my decision. Someone asked "why" and I chose to share one reason. I don't need anyone to agree with my reasoning.

Second, I'm guessing you didn't read the article. Links to research were imbedded within it.

Third, if you read any of the article, you obviously did read it in it's entirety. You are correct that the current flu vaccines don't use human cell lines, but they ARE being used to develop new flu vaccines.

Finally, as stated before, I have been through "discussions" of this nature before and EVERY TIME someone asks nicely for my rational it has only been an excuse to attempt to ridicule and call names. NO ONE on the other side has ever taken an honest look at the research that they have put forth as justification for their choice to accept vaccines. I do not wish to engage in another such farce. I have shared one reason that I have chosen to stop vaccines but I will not provide more for the entertainment of the non-believing community.

edited to add: I forgot that I wanted to address the "religious" aspect of your statement. I have no idea who the so-called heads of major religions are to which you refer. They don't speak for me and I don't look to them as the absolute authority on any topic. The Bible is my ultimate authority and I think for myself.

[GM2RN]

The author says these claims only apply to "Jesus peeps," and not "Nominal (in name only) Christians" or non-Christians. I don't think I'm a Jesus peep, so it doesn't really apply to my decision-making.

I don't remember who, but someone asked my "why" I chose not to vaccinate. I provided this information to answer that question, not to say that it should be YOUR reason. I would think that any person who is honestly seeking to understand why someone else makes the choices that they do would read the information provided and not use the excuse that "it doesn't apply to me." Otherwise they shouldn't bother to ask the question "why." I guess you have to answer that question for yourself.

[BostonFNP, APRN]

First, I am under no obligation to justify my decision. Someone asked "why" and I chose to share one reason. I don't need anyone to agree with my reasoning.

Second, I'm guessing you didn't read the article. Links to research were imbedded within it.

Third, if you read any of the article, you obviously did read it in it's entirety. You are correct that the current flu vaccines don't use human cell lines, but they ARE being used to develop new flu vaccines.

Finally, as stated before, I have been through "discussions" of this nature before and EVERY TIME someone asks nicely for my rational it has only been an excuse to attempt to ridicule and call names. NO ONE on the other side has ever taken an honest look at the research that they have put forth as justification for their choice to accept vaccines. I do not wish to engage in another such farce. I have shared one reason that I have chosen to stop vaccines but I will not provide more for the entertainment of the non-believing community.

edited to add: I forgot that I wanted to address the "religious" aspect of your statement. I have no idea who the so-called heads of major religions are to which you refer. They don't speak for me and I don't look to them as the absolute authority on any topic. The Bible is my ultimate authority and I think for myself.

True you have no obligation to justify your decision, it is a choice you wanted to make. Most of us here are scientists: our practice is based on data not a choice/opinion. Don't expect people to understand your point of view when you choose top not share the rationale. There is also no use for a debate, you have already made your choice, simply state your opinion and leave it at that.

I did read most of the article. It had some links in it but that doesn't make it a peer-reviewed source, I think we both know that it is a blog and it would falter very quickly under even the slightest scientific review. As for the human cells lines, that doesn't effect the extant influenza vaccines available now.

I am not ridiculing you or calling you names, I am inviting you to share your research and engage the data rather than engaging your personal preference. If you provide no data then it is natural that posters will try to engage you personally as that is all you are providing.

Which part of the Bible tells you not to vaccinate?

[NotAllWhoWandeRN, ASN, RN]

Which part of the Bible tells you not to vaccinate?

The article GM2RN shared starts early with fictional vaccine-supporting God saying "I'm missing something…oh yes, Adam needs the DNA of a dog, some cells of a monkey's kidney, a couple of mutated viruses, bits of ground up aborted baby, a few carcinogens, some detergent, and a little hazardous waste to help trick his immune system into giving him some temporary, junk immunity. Well…Adam is a grown man, so maybe I should shoot up his baby first."

It then goes on to mention several verses that the author believes should be applied to vaccination. Mostly it's personal assertions. "Apparently, I owe my neighbor a Christian duty to get vaccinated…but you see, I don't owe my neighbor any duty that conflicts with God's Word. After God, I owe a duty to my child, not your child…and my child is not getting vaccinated."

The link doesn't outright say it, but doing something that "conflicts with God's word" is a sin. So they're calling vaccinating yourself and your children sinning. Have to admit I've never seen that before.

[BostonFNP, APRN]

What you describe is coercion and it's illegal.

Yet SCOTUS has upheld that it is not illegal or unconstitutional to have mandatory vaccination.

[PopcornRN36]

Re future development of flu vaccinations. It appears the use of cell-based development of a flu vaccination is only in Europe (not within the USA at this stage as they have not gone past the clinical trial stages). Another online site I reviewed referred to one (European) pharmaceutical company using mammal cell-base for their vaccinations (with the clarification human-cells not being used):

NE Journal of Medicine: Influenza vaccines for the Future Linda C. Lambert, Ph.D., and Anthony S. Fauci, M.D.

N Engl J Med 2010; 363:2036-2044November 18, 2010DOI: 10.1056/NEJMra1002842

[stutl2ep]

In 2002 I acquired the miserable Flu. Since then I have not missed getting a shot every Fall when my employer starts giving shots. This season like others since 2002, I received my shot in October as I should and ended up getting the Flu again. So all this Hype about getting a shot OR else....from Hospitals, CDC, Local & State Health officials is just bologna. When you get the shot you are getting immunized for what is expected to come. You can still get a different strain. As many patients and staff members including myself have found out this year. The shot literally is a stab in the Dark or Roll of the Dice so to speak. There are no guarantees whatsoever. Only guarantee is the older you are..the more ill you'll be when you get the Flu. Mandatory masks are merely a put on/pretend mechanism against this awful virus. This requirement makes them look as if what they say is the gospel and they know whats really going on. After falling ill again this year to whatever strain of the flu it was. I no longer have much faith in the shot that our employers and health officials swear by. Too many regulations. Really we all should just do a better job of handwashing and hygeine practices especially if we have what is deemed "common cold" symptoms or if we are out in public and we or another family member are ill, be more respectful of others and not spread our germs all over creation.

[jaycam, RN]

Part of advocating for our patients is doing everything we can to protect them. They don't get the choice of being in our facilities, we do. If you're allergic, that's one thing, but if you're just trying to avoid the shot because it's uncomfortable, you are not upholding your end of the contact. I get sick for a couple days every time I get vaccinated. Still not the flu, which sent me to the ER the last time I got it, years ago.

[stutl2ep]

One would think if "The flu is such a bad virus when you get it and there are so many different strains you can get," and it is such a hot button issue with health officials who require us to wear masks if we aren't imminized each and every year" as they mandate. Wouldn't it be better for us all if we were immunized against more than just one measly strain that the CDC ecpects to hit this upcoming season? Oh wait a second that too would make more sense and might make this even more of a hot button issue with even more regulations. Immunizing for just one whatever strain is expected for all this regulation is a bit much considering how many strains there are out there. We are all succeptable to the flu regardless of whether we are wearing a mask or not. Or whether we received our shot or not.

[BostonFNP, APRN]

Immunizing for just one whatever strain is expected for all this regulation is a bit much considering how many strains there are out there.

The common influenza vaccines protect against two influenza A virus subtypes and one/two influenza B virus subtypes.

We are all succeptable to the flu regardless of whether we are wearing a mask or not. Or whether we received our shot or not.

It is true that we are susceptible to influenza virus, however those that are immunized each year may be significantly less susceptible. Nothing is absolute.

[Here.I.Stand, BSN, RN]

The article GM2RN shared starts early with fictional vaccine-supporting God saying "I'm missing something…oh yes, Adam needs the DNA of a dog, some cells of a monkey's kidney, a couple of mutated viruses, bits of ground up aborted baby, a few carcinogens, some detergent, and a little hazardous waste to help trick his immune system into giving him some temporary, junk immunity. Well…Adam is a grown man, so maybe I should shoot up his baby first."

It then goes on to mention several verses that the author believes should be applied to vaccination. Mostly it's personal assertions. "Apparently, I owe my neighbor a Christian duty to get vaccinated…but you see, I don't owe my neighbor any duty that conflicts with God's Word. After God, I owe a duty to my child, not your child…and my child is not getting vaccinated."

The link doesn't outright say it, but doing something that "conflicts with God's word" is a sin. So they're calling vaccinating yourself and your children sinning. Have to admit I've never seen that before.

Wow...THAT is some Biblical scholarship! Here I've been wasting my time reading Calvin.

You know what hazardous chemical I don't wish to get into my children's bodies? Tetorifice toxin.

An honest question I have, is would anyone be so anti-vax if we lived in a time or place where tetorifice or polio or Spanish Flu was a clear and present danger? And why aren't they a clear and present danger, in the industrialized world in 2017? Hmmm...

That's probably skating toward the edge of on-topic, but I had to say it.