Boston Declares Health Emergency Due To Massive Flu Outbreak

skade88 writes "Boston has seen 10 times more flu cases this year than last. They are now up to 700 cases and counting, with 18 deaths in the city. The city of Boston has declared a public health emergency in the wake of the epidemic. 'The CDC said the proportion of people visiting health care providers with flu-like symptoms climbed from 2.8 percent to 5.6 percent in four weeks. By contrast, the rate peaked at only 2.2 percent during the relatively mild 2011-2012 flu season. The estimated rate of flu-related hospitalizations in the U.S. was 8.1 per 100,000 people, which is high for this time of year, according to Dr. Joe Bresee, chief of the epidemiology and prevention branch of the CDC’s influenza division. The agency’s next advisory will be issued Friday.' As previously discussed on Slashdot it would also be nice for your friends and coworkers for you to stay home if you are sick."

Comments

Good Advice

[masternerdguy]

Why do people wait for an epidemic to stay home when they are sick? If you are sick, don't go out! If you do, you are part of the problem.

Re:Good Advice

[SerpentMage]

Beep wrong answer in America...

Most workplaces don't have paid sick leave. Honestly, it is what it is, and this what Americans want. Hence this is what America gets.

Re:Good Advice

[masternerdguy]

I am an American. By the way, many companies will punish you for coming to work sick now, especially in retail and food service positions where you might infect the customers.

Re:Good Advice

[Bremic]

It's fairly simple. When employers insist that you need to go to a doctor when you are sick and get proof or they won't believe that you were, then people decide "if I have to go out anyway, I may as well go to work."
Also, when one person in an office is very sick, then they get a lot of negative attention. If it spreads and a number of people get sick, then they were one of the unlucky ones.

I used to stay home when sick, until I had a manager who told me that if I took any more time off I would probably lose my job. So when I next got the flu I took drugs and went to work. I can tell you though, I really enjoyed my lengthy closed door meeting with him and HR that day. I don't think they were happy I scheduled that meeting.

Re:Good Advice

[TubeSteak]

If you are sick, don't go out! If you do, you are part of the problem.

By the time you're sick (aka showing symptoms), you've already been infectious for at least a day.

The real solution is to get vaccinated and hope that the pharmaceutical companies guessed correctly about this year's strain.

Re:Good Advice

[SerpentMage]

"many" does not imply policy. I have American friends and lived there for a while. The problem is that folks want to earn a living and either they take it from their vacation (which people do not want to do) or they just come to work and hide it as best as they can.

I find your comment quite odd on how society deals with a problem. They punish, instead of just changing policy into a better policy. Either way there are society costs. At least with sick paid leave people will be assured that they can continue to earn a living.

Re:Good Advice

[Trepidity]

But by default you won't be paid if you stay home, so there's still an incentive to try to come in and hide it if you feel you're at all on the borderline, and to come back as soon as you no longer look visibly sick (even if you're still contagious).

Some employers do give their employees a certain number of sick days to reduce that incentive, but labor law in most states doesn't require it, and many employers don't. For example, neither Starbucks nor McDonald's offer sick days to their retail workers. Oddly, they do offer sick days to their non-retail workers (office employees, e.g. accountants, managers, etc.), despite those employees not being customer-facing. Perhaps they care about whether corporate HQ is sick more than whether customers get sick. :P

Re:Good Advice

[Jetra]

They punish you if you take a sick day, they punish you if you come in sick. Do they expect you to be 100% until you're dead?

Re:Good Advice

[X0563511]

Yea, going to the doctor, waiting half an hour or more, spending at least at $30 copay (assuming you actually have insurance worth a damn) to be told "yep, you're sick" - sounds like a good idea...

Re:Good Advice

[RearNakedChoke]

Even places that do have paid sick leave, its rationed. So I will make a decision, each time I'm sort of sick, whether or not its worth it to use one of my 5 sick days, or whether I think I'll get REALLY sick in the future and should save for that day.

Employers need to actively encourage/have contingency plans for sick people. Especially for office workers, to have a working telecommuting policy/system in place so that a person can not only easily work from home on a mildly sick day, but be encouraged to work from home and still be productive without infecting others.

Re:Good Advice

[h4rr4r]

How are they forcing companies to do that?

I think you mean these companies like to use that as an excuse to save a couple bucks on what used to be a normal part of compensation. Everything will have some level of abuse, the ideal is to keep it to a minimum you will never not have it. It sure is a convenient excuse to screw the rest of the workers though.

Re:Good Advice

[vlm]

I am an American

Are you sure?

By the way, many companies will punish you for coming to work sick now

That is easily the strangest thing I've ever heard. I've literally never heard of such a thing in all my decades.

I think we're more likely to see the Republicans convert en mass to Islam or we'll see Karl Marx carved into mt rushmore before any american company will try to increase sick days taken. Its just too easy of a metric to grade "resources" and their supervisors.

I really have to point out, that having had the actual real flu in the past, if you have it, you'll be so sick there is no way you'll make it to work unless you're Hercules himself. If you're physically able to go to work, trust me, its almost certain you just have a minor cold or a minor cough or at most a weak case of walking pneumonia. If your only symptom is you have a slightly stuffy nose, thats a cold, not the flu. When your fever is 103+ and you feel like you can barely get out of bed and you feel like you're about to cough out a lung, now thats the start of the flu.

Re:Good Advice

[Anonymous Coward]

Oh yes, the doctor's note. Well isn't THAT just a wonderful thing to go get. Let's take a look at my options:

1. Lie in bed, eat some nyquil and chicken noodle soup, and sleep the sickness away to let your body heal.
2. Sit in a waiting room for 6 hours, surrounded by dozens of people sick with everything under the sun while you're immune system is compromised, only to have a doctor look at you for 3 seconds, tell you you have a cold or whatever, followed by paying $30 for the doctor's note. After that, I can go home after essentially putting in the equivelant hours of a full day's work surrounded by sick people, get nowhere even remotely close to enough sleep and rest to heal, and be 10 times as sick due to the dozen other things I caught.

Yeah, option 2 sounds awesome, thanks workplace.

Re:Good Advice

[CanHasDIY]

I forgot, all corporations are evil. Meanwhile in the real world people are calling in sick to go party, sleep in, or because they need more vacation time.

Anecdotes:

They do not equal evidence.

To quote the meme, pics or it didn't happen.

Re:Good Advice

[Kittenman]

Who pays for the doctor visit? Also I now have to drag myself to a doctor's office and wait for who knows how long, rather than resting in bed?

Damn right - I self-diagnose myself over the internet. (Resting in bed right now with a bad case of leprosy compounded by Muelenbach syndrome. Don't worry though - I'll be fine on Monday).

Re:Good Advice

[gv250]

Most American employees work for someone who offers sick leave.

I used to believe that. However, I've recently worked for two fortune-100 companies, and one startup spun off from one of them. In each of these companies, leave is called "PTO" or "paid time off." The idea is that you have a single account for earned time off -- you use it whether you are sick or on vacation. In essence, you are required to use vacation days for *every* sick day.

Re:Good Advice

[CanHasDIY]

Yes. That is the very definition of a good serf.

FTFY.

Re:Good Advice

[Archangel Michael]

Cough ... "I"m not feeling well" happens to fall on first day of Duck Season (or big game day, or round of golf)

I get sick days, paid. But I know people that take all of their sick days for whatever reason and then when they DO get sick, don't have any and end up whining about not having enough sick days. Dude you went duck hunting (sick day) and got sick now that you're out of sick days ... I have no sympathy.

On the other hand, don't get the flu, it sucks. And all those flu vaccines aren't helping.

http://prn.fm/2013/01/08/gary-null-flu-vaccine/#axzz2HWMRMGv4

Re:Good Advice

[Quiet_Desperation]

Ever put the Nyquil *in* the chicken soup? Yeah, bad fevers make the most horrid ideas seem like bright and shiny inventive genius. :-)

Re:Good Advice

[Beardo the Bearded]

Where my ex works, they had to get rid of sick days.

See, everyone got 10 sick days a year but they were bankable. So you had people coming in baked out of their minds on cold meds getting everyone else sick and banking the time to use as extra vacation time.

What they ended up doing was giving everyone unlimited sick days that switch to STD once you go 30 days in a row. Abusers are dealt with on a case-by-case basis.

Re:Good Advice

[niado]

The plural of anecdote is not evidence. Provide some actual evidence that more than a tiny minority of workers actually do this. I won't hold my breath.

I can't find much statistical data on this (the difficulty in conducting a study on these types of activities should be evident), but this Monster.com survey indicates 8% of workers call out "sick" at least twice per summer, "to enjoy the summer weather", while 11% do it about once per year. This is a pretty unrepresentative data point, but read into it what you wish.

Re:Good Advice

[Captain Splendid]

5 sick days? Jeeebus.

Granted, I'm a small business, but I'll give any employee whatever time they damn well need to not look like shit in my office and probably make the problem worse by infecting others.

Hell, even for lower grade stuff, I'd still rather you got some rest for a day or two instead a week spent int he office delivering subpar work.

It's more cost effective for me in the long run to provide sane sick leave instead squeezing the ju-uice. Being a boss with a shred of humanity is just icing on the cake.

Re:Good Advice

[AaronW]

I ran into this too when I went to work for a large networking company in Silicon Valley (competitor to Cisco). Anyway, after I joined I learned that they combined their sick leave and vacation pay and as it was the vacation was not all that generous. Of course the first thing that happens is I get the cold from hell. Next I find out that they have mandatory vacation days which were at odds with some trips I had planned and paid for long before I started working there (and told them about up front). Needless to say, I was happy to leave there over that and numerous other bonehead policies. They mandated that everyone take the week off of the 4th of July (3 days of vacation wasted) as well as the week of Labor Day (4 more days of vacation wasted).

Many other large companies also do not offer sick leave, even food chains like Red Lobster and Olive Garden.

Re:Good Advice

[geekoid]

Yes they do. we see every time. Make Accurate predictions based on how close it matches the virus. We can make predictions basde on uptake.
Any one who says the data doesn't support the vaccine is an idiot or a liar. That data is pretty well documented.

Is it perfect? no, it's not 100%, yet.

Gary NUll is an idiot. as an example:
"since the hype and subsequent fizzle of the H1N1 scare in 2008, "
Fizzle? mahny people died, hospitals around the coutry were running out of beds. They ONLY thiing that saved it from disaster was the distribtution and uptake of the vaccine.

But since disaster was averted, clearly is wasn't needs. That Gary Null's idiotic logic.

The post is full of out of context, and cherry picked data.

He is a SCAM idiot that has been cherry picking and lying about data and medicine for 40 years. And it's always been the same crap, never changing, never showing good data.
He does what he says others do, and he should be thrown in prison for malpractice, but since he is a SCAM practitioner, for some reason he is immune from liability when his advice kills people.

There are people dead from treatable disease because of this guy, and other selfish, and evil people like him.
And when I say evil I mean will take money from dying people for nonsense advice. Then the people die.
He preys on the vulnerable and naive.

He is an AIDS denialist.

Re:Good Advice

[JustOK]

Sound like you have hypochondria. Take two placebos and call me maybe.

Re:Good Advice

[cheesybagel]

Most forms of diabetes are not contagious. Same reason why you can drink alcohol but not smoke in a restaurant.

Re:Good Advice

[elucido]

If you are sick, don't go out! If you do, you are part of the problem.

By the time you're sick (aka showing symptoms), you've already been infectious for at least a day.

The real solution is to get vaccinated and hope that the pharmaceutical companies guessed correctly about this year's strain.

But those vaccines aren't healthy. How many vaccines can you take before the vaccines present side effects?

Re:Good Advice

[TheLink]

Big deal, the Germans get 4-5 weeks of paid vacation (4 weeks minimum by law). Their economy seems to be doing OK despite that. In Denmark it's 25 days. http://en.wikipedia.org/wiki/List_of_statutory_minimum_employment_leave_by_country

The US employer style seems to be burn out your employees, then discard them. Might work fine for low end jobs that require little training and investment. It may well be that most of these low training low end jobs will be taken over by robots and other automation in the future.

Whatever it is, not having paid sick leave is a big health issue. If more people quarantined themselves when diseases made them feel miserable and reduced the spreading of those diseases, that would make those diseases less likely to make people so miserable, whether because they spread less, or because they evolve to be less nasty.

Re:Good Advice

[CptNerd]

One time with the flu I drank a NyQuil capful of chicken soup and a bowlful of NyQuil. Fun times. The taste, though, the taste still haunts me...

Re:Good Advice

[Farmer Pete]

Here is my real life experiences. I'm currently working for state government. We get 13 sick days a year (4hrs a pay period), and we can bank those indefinitely. It's not uncommon for people to have +1000 hours of banked sick time, accumulated over +15 years of service. I'm constantly hearing coworkers making sarcastic comments to other coworkers about how they're not feeling well, and they probably wont be in tomorrow. Comments are complete with fake coughs. These same people are getting +4 weeks of vacation a year, but what's the point in having 1000 hours of sick time if you can't use it? So that's my public sector experience. My private sector experience started with getting 4 sick days a year (.333 days a month). Then, after getting a few promotions, my sick time was removed, and I was switched to a system where I had basically unlimited sick days, within reason. There was more or less an unspoken rule that if you used more than 6 days a year, they would start asking questions. Of course, if you had to be out for 2 weeks after a surgery, they would allow that with no questions asked.
In both situations, I don't feel like the company was evil. I feel like the State is waaayyy to giving, and with my private company, sick time (or lack thereof) was never an issue for me in the 7 years I worked there. It wasn't even an issue when I only had 4 sick days a year.

Flu shots

[golodh]

This looks like a good opportunity to study how effective flu shots are.

I'd like to see a breakdown of flu patients by whether they had a flu shot in the past 6 months.

If it's effective, probably best to mandate flu shots for health care workers, shop attendants, and all civil servants.

Re:Flu shots

[masternerdguy]

I'd also mandate them for public utility workers, public transit workers, and food service workers.

Re:Flu shots

[kwerle]

My partner is a nurse. Her choices are:
* Get a flu shot
or
* Wear a surgical mask for the flu months while at work (I think that's December-February)

Re:Flu shots

[halfelven]

We know that already. They are about 60% effective.

http://www.npr.org/blogs/health/2013/01/08/168814935/can-you-get-a-flu-shot-and-still-get-the-flu

Re:Flu shots

[geekoid]

"who get flu shots are still carriers "
people who get the flu shot can not be carriers. Unless you get some on your hands from someone else and then spread it to a door knob.

People who get the vaccine can not cause a mutation. depending on the year and strain match.

I'm not sure you understand how the immune system works.

Re:Flu shots

[koan]

So you want to live in a country where people are forced to get vaccinations for the flu, even though the vaccine might not even be effective depending on what you catch.

Re:And it's only going to get worse.

[hawguy]

Here's a fun fact to contemplate. The version wandering the US right now is H3N2. The prevalent strain making the rounds in China is H1N1. How long before it crosses the pacific and starts round two of the process. Folks if you haven't gotten vaccinated against this yet. DO IT NOW! These strains are no fun and the current vaccine is supposedly a good match against the strains most prevalent.

Which strains were in this year's vaccine?

Oops, answered my own question:

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm315365.htm

Based on that information and the recommendations of the FDA’s Vaccines and Related Biological Products Advisory Committee, the strains selected for inclusion in the 2012-2013 flu vaccines are:
A/California/7/2009 (H1N1)-like virus
A/Victoria/361/2011 (H3N2)-like virus
B/Wisconsin/1/2010-like virus.

I'm home sick, now.

[mark_reh]

A couple of my coworkers came to work sick over the last two weeks. I asked them why they come to work when they are sick- they are dentists at a public heath clinic,and should now better, but they come to work any way. Their response: they feel like they have to be there. Starting their own mini epidemic among patients and coworkers...

Maybe the problem is that unused sick time can be rolled into vacation time.

Re:I'm home sick, now.

[BMOC]

Maybe the problem is that unused sick time can be rolled into vacation time.

This is actually the problem. My company doesn't work this way anymore. Sick time is allowed to be taken as needed and does not accumulate. However if you go above X hours a year of sick time you get a stern lecture from your level X boss, if you go above Y hours, Y+X boss, etc... It doesn't get abused often I don't think, at least I haven't seen it.

Re:And it's only going to get worse.

[John3]

http://www.pennlive.com/midstate/index.ssf/2013/01/flu_deaths_influenza_cases.html

The most common strain this year is H3N2 and it's one of the strains covered in this year's flu shot.

24,000 Americans die each year

[TubeSteak]

While the CDC does not keep a tab of deaths overall from the flu, it estimates that 24,000 Americans die each year.

Why doesn't the CDC keep tabs on overall deaths from the flu?
You can make policy without hard numbers, but you will never know if the policy is effective.

Re:24,000 Americans die each year

[durrr]

Elderly and children do not respond with classic symptoms always, along with possible co-infections and whatnot else it's pretty hard to tell if it's actually flu, some passing other infection, or other natural causes.

Re:24,000 Americans die each year

[kwerle]

While the CDC does not keep a tab of deaths overall from the flu, it estimates that 24,000 Americans die each year.

Why doesn't the CDC keep tabs on overall deaths from the flu?
You can make policy without hard numbers, but you will never know if the policy is effective.

Huh.

http://www.cdc.gov/nchs/fastats/deaths.htm
...

Influenza and Pneumonia: 53,692
...

Re:24,000 Americans die each year

[radtea]

Influenza and Pneumonia: 53,692

Right, so how many died of the flu?

0? 53,692?

This is the dirty little open secret of the anti-flu business: no one knows how many people die of the flu. The number is certainly not zero, but it is equally certainly not the full tally of "flu plus other things that present similar symptoms that are not the flu".

So the question remains: "Why doesn't the CDC keep tabs on overall deaths from the flu?" and the answer is: "It is not economic to do a proper diagnosis of every fatality from 'flu and penumonia'."

The real question is: why so much hype around flu shots, whose effectiveness varies from year to year but is never over 75% (and sometimes is considerably less) when every now and then a problematic batch produces a risk of about 1 in a million of serious neurological consequnces? The risk of death from "flu and pneumonia" is about 1 in a million amongst healthy adults, so the risk of death from flu is lower than that.

There is an argument to be made for flu shots amongst health care workers, the elderly, and possibly the very young (risk goes up dramatically below the age of 5), but the case is much harder to make--except possibly for herd immunity--amongst healthy adults.

When I worked in a hospital I got my flu shot. Now that I don't, I don't.

Help!

[DeTech]

I work/Live in boston and half the office is out and all I hear around me is coughing/sneezing/sniffling... If I didn't have to be here this week I'd be telecommuting but alias I'm boned. Anybody got any great ideas for combating this outbreak in a open lab type environment.

Re:Help!

[vlm]

It was a high dose of zinc plus some homeopathic garbage, any person with a science background should be laughing. It did have enough zinc, however, to cause quite a few people to overdose. From my experience welding galvanized sheetmetal (don't do this at home kids) this is to be strongly avoided, but somewhat below the dosage required for semi-permanent flu like symptoms, you'll get semi-permanent loss of smell.

CDC doesn't show this

[vlm]

I'm confused WRT

http://www.cdc.gov/flu/weekly/

I was just looking there this morning and thought to myself, how nice it is that the peak is already over, and the flu season has begun its decline.

I do see that its "normal" that a "bad year" has about 10 times the deaths as a "good year". So about twice as bad as last year (a "good" year) it doesn't look like its the end of the world yet.

I did look at some historical records and the higher the peaks seem to go with earlier peaks, this peak being somewhere in between would imply its a moderately bad year.

Not quite 1918 yet, or ?

Stay home two weeks?

[Catbeller]

You'd have to stay home until your symptoms disappear, as you're contagious the entire time. Not even the most liberal workplace would allow that.

And it might kill millions, some day, our addiction to "productivity". One bad virus plus our right-to-work culture will equal one mighty epidemic.

Re:Thank you anti-vaxers!

[SleazyRidr]

But it was the anti-vaxxers who reduced the number of people by enough that the transmission rates have gone up. I am vaccinated, but I know that it is not 100% effective. If it's 90% effective and I'm the only person who has it I still have a 10% risk. If everyone around me has also had it my risk drops to 1%. These statistics matter when you start talking about outbreaks and pandemics.

Once again!

[Nexion]

We have another opportunity for the flu shot fascists to espouse their message of authority over individual rights, and perhaps some of the zealots who feel these shots are an affront to their deeply held beliefs? Bring forth the flu shot pseudoscience conjecture from both sides of the debate! Please, this time, explain how your sources established a large enough pool and maintained control of subjects to avoid contamination for a proper experiment! I bet our fascists have great suggestions on how we could better control unwilling medical experiment subjects taken from the peasantry! Please, I need a good laugh.

Nexion

Boston hospitals already mandate them

[SuperBanana]

Flu shots are mandated for clinical staff by most if not all of the Boston hospitals, and there are a huge number of them - I've counted 11 so far, and I think I'm probably missing one or two:

Childrens, MGH, Brigham & Womens, Faulkner, Beth Israel, Tufts Medical Center, Spaulding Rehab, Shriners, Mass Eye&Ear, New England Baptist, Veterans Administration Boston...and those are just the ones that are actually in Boston proper.

Honestly, I think hospitals are part of the problem. They focus illness and weak populations (same with nursing homes and assisted living facilities.) Also, there tends to be huge pressure on clinical staff to report for work even when sick. The medical profession is astoundingly arrogant when it comes to not doing harm to patients...another good example would be the sloppy handwriting doctors use when filling out prescriptions, injuring or killing thousands.

Re:Thank you anti-vaxers!

[Anonymous Coward]

I hope you're proud of yourselves. How does it feel to be accessories to completely unnecessary deaths?

You assume your opinion equates to fact.

It doesn't.

The weak and infirm are the ones who die from the flu.

It is simply natural selection at work.

And you are a simple-minded fool.

I don't get flu shots

[pr0t0]

That's actually a half-truth; I get them every three or four years to see if the same thing happens (oh boy). Every time I get a flu shot (here it comes), I get sick.

Sing with me: "IT'S NOT AN ACTIVE STRAIN! YOU CAN'T GET SICK FROM IT...MORON!"

Yeah, I know. I don't know what to tell you. It happens every single time, within 24 hours of the shot. Then, inevitably, because it's the wrong strain...I get sick again. I know a lot of people claim this. All I can say is biology and physiology are complex. There must be some kind of historical or environmental factor at play. I've lately decided it's maybe because I had mono once, really bad? Maybe I'm just unlucky and always seem to already have the flu just before the shot. Or maybe (probably) it's not the flu at all, but just flu-like systems brought on by my body's response to the shot. I dunno. It could be psychosomatic, but I was dead-certain it would not happen when I got the shot last year. I had to take the next two and a half days off afterward.

But I don't advocate that people should not get flu shots. I may be a crackpot, but I'm not crazy. You absolutely should. Even if there is a legitimate biological reason for every person to claim what I just have, it's still a pretty small minority. Get the shot.

Hey, at least I didn't claim it was a government conspiracy!

Re:I don't get flu shots

[tgd]

That's actually a half-truth; I get them every three or four years to see if the same thing happens (oh boy). Every time I get a flu shot (here it comes), I get sick.

Sing with me: "IT'S NOT AN ACTIVE STRAIN! YOU CAN'T GET SICK FROM IT...MORON!"

Actually, the correct statement is "its not an active strain, you can't get influenza from it". You will not get a self-replicating, contagious herd of viruses from getting the flu shot. That said, the whole intent of a vaccine is to trigger an immune response. If you don't get an immune response, its not a vaccine. So its "normal" to have "some" issue from them. Soreness, localized fever, etc. If you have a particularly aggressive immune system, you can get stronger symptoms (that's the ironic thing about immune systems -- the stronger it is, the stronger your symptoms of a disease are but the less likely it'll kill you...)

If you consistently have the problem, its also possible you are allergic to something in it. Have you tried one of the other types?

In either case, getting vaccinated -- even if you have some reactions to it -- is just taking one for the team. A very large part of why its so important to get immunized when vaccines are available isn't because its going to keep you from getting the disease. You're likely a healthy adult and you might, once in a while, get knocked on your ass and feel like crap and get over it. But very young children can't get the vaccines and can be killed by a lot of these diseases. You getting vaccinated means you can't give it to them.

That's why I get it. Everyone who dies from influenza every year got it from someone else. Bet they'd wish that someone else had gotten a dose, too ...

Free Government Money

[EmagGeek]

And that's what it's all about.

Ignorant Advice for the USA

[rubycodez]

we can lose our jobs or be penalized for staying home. on the other hand, if we go to work we can infect the money grubbing scum and shitty co-workers who put us through hell monday through friday. fuck 'em.

Re:Got mine

[David_W]

shame on you CareFirst Blue Cross/Blue Shield for not covering it

FYI, assuming your plan is somewhat similar to mine (same insurer), they will cover it in a "clinical" setting (i.e., doctor's office). Of course the catch there is a lot of offices can't give it on a normal visit unless you are deemed "high risk" and you have to show up to one of the cattle lines, er "flu shot clinics". So there are ways to get them to pay, but sometimes it's just easier to pay the $30 like you did...