Tuesday, October 1, 2013

Here come the maskers


Recently, the New York State Health Department mandated that all healthcare workers either be vaccinated against influenza or wear a mask. This week’s JAMA has a commentary by the ethicist Art Caplan and New York’s Commissioner of Health, Dr. Nirav Shah. In the JAMA piece they argue the ethical imperative underlying the mask ruling. You can read about the ruling here and the JAMA commentary here (free full text). Unvaccinated HCWs will be required to wear the mask during periods of widespread influenza activity. It’s important to note that over the past 6 years, the period of widespread activity in New York varied from 11 to 22 weeks. That’s a long time to wear a mask, which is required in any area where patients are typically present. The document notes that this includes the cafeteria, though the unvaccinated worker is allowed to be mask-free when eating.

For many reasons, I dislike mandatory influenza vaccination. But I despise the mask regulation. I have to question the rationale. It seems to me to be less about ethics and more about being coercive and punitive. It’s wasteful. There have been periods of time when masks were in short supply with the shortage being made worse by the maskers. Most importantly, wearing a mask for prolonged periods of time is impractical—it’s uncomfortable and distracting. If we are going to argue for masking on an ethical basis, since influenza vaccination is only 60% effective at best, wouldn’t it be consistent to argue that all healthcare workers, vaccinated and unvaccinated, should wear a mask? It's also laughable that the ethicist doesn't mention that it's unethical to come to work while sick with influenza, which studies tell us is quite common. Presenteeism remains the elephant in the middle of the room, and reducing it is likely far more important than mandating influenza vaccine or masks to prevent transmission of infectious diseases in the healthcare setting.

Photo: REUTERS/Yuri Maltsev

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