Under a regulation proposed by the NY Health Department, any health care workers who don't get a flu shot will be required to wear masks.

The measure is a response to the unusually high number of seasonal influenza cases in New York. It would cover personnel in any place where patients are present, including but not limited to hospitals, nursing homes, diagnostic and treatment centers, home care agencies, and hospices.

At the peak of the current flu season, the week ending January 19, 2013, there were more than 5,000 confirmed cases of influenza in New York state, with more than 1,120 hospitalizations - an even higher weekly total than during the fall 2009 H1N1 flu pandemic.

To date, there have been more than 33,000 influenza cases throughout the state, with an estimated 1,440 New Yorkers dying each year during an average flu season.

State Health Commissioner Nirav R. Shah, MD, said in a statement released earlier this month: "This regulation will enable health care workers to meet their obligation to do no harm to patients."

The proposed regulation was presented to the New York State Public Health and Health Planning Council (PHHPC) on February 7, and is open to public comment until April 1.

Shah believes that all health care workers should be vaccinated against influenza. "Flu vaccinations are the best way to protect against influenza and we strongly urge everyone who has not received a vaccination yet to do so as soon as possible."

The state briefly mandated flu vaccinations for health care workers during the H1N1 swine flu pandemic in 2009, but suspended the regulation after it sparked backlash from health care workers and unions.

According to the Health Department, less than half of New York's health care workers were vaccinated during the 2011-2012 flu season - only 48.4 percent.

Since over half of health care workers have declined to get vaccinated, those behind the measure believe this is a less coercive method of preventing flu transmission to patients.

Masks are not as effective as vaccination, but have been shown to decrease transmission from people with respiratory symptoms. People infected with influenza may shed the virus before they have noticeable symptoms, so wearing a mask can be an extra precaution.

Some medical leaders are backing the proposed mask requirement.

"This decision was made with the singular goal of protecting the health and well-being of both patients and health care workers during a particularly intense flu season," said Greater New York Hospital Association President Kenneth E. Raske. "New York's hospitals strongly support this sensible measure."

In other parts of the country, there is already controversy among health care workers who find the masks to be an extra burden.

David Welch, a nurse who represents the California Nurses Association, told the Chico Enterprise Record that they oppose mandatory vaccination, and that "mandatory wearing of masks is not the greatest thing in the world. They have limited ability to stop the spread of those kinds of particles, to or from people."

"There's the sense that their individual health care choices are not something [health care workers] want to be labeled with," he added.

A PHHPC vote will be held on April 11 to determine whether or not to adopt the regulation, with a forum held beforehand that will be open to the public. The Health Department has made a pamphlet about masks available.

It remains to be seen how New York health care workers will react to this measure. If it passes, the mask requirement will take effect later this year, during the 2013-2014 flu season.