How a pandemic may kill the handshake


My grandfather was a dedicated physician.  To me, he was the caring, attentive doctor depicted in the classic Norman Rockwell paintings.  He was a brilliant and religious man of few but powerful words who didn’t greet his patients with a handshake, but yet he was loved by so many.   He also happens to be the person who taught me as a young child why cheerios float, how lifesavers got their name, and the “correct” way to wash my hands.  I knew as just a young child that it was important to get between my fingers and make sure I scrubbed well.  Putting this as respectfully as possible, I don’t think my grandfather had much of an affinity for germs.  It has been nearly 20 years since his death, but I do believe that despite the antiquity of many of his beliefs and practices, he was ages ahead of his peers.  If he were alive today, he would not have commented publicly on the fact that he was right or point fingers.  Instead, he would carry on, humbly caring for his patients, making house calls and sacrificing sleep, his own health, and his family to do so.

The handshake was thought to originate in Greece around 500 B.C. as a form of demonstrating that one did not hide a weapon in their sleeve.  It has transformed into a ritual that is a social expectation and a way of showing respect in the Western world.  However, the Western world has become a pluralistic society where the handshake isn’t necessarily the traditional form of greeting others.  We could bow, fist-bump, or simply smile.  Maybe it is time for us to reconsider the necessity and importance of the handshake in a current time of recurrent endemic and pandemic infection.

We should consider ourselves lucky to live in an age of technological and medical advancements.  They allow us the opportunity to live healthier lives than all of our grandparents and great-grandparents.  There are likely no individuals on earth who can clearly recount based on personal experience any details of the 1918 Spanish flu pandemic. In fact, the life expectancy for a man living in the United States in 1918 was just over 36 and a half years.  This was over 75 years after Ignaz Semmelweis of Vienna, Austria, first suggested that physicians might be the source of hospital-acquired infections and ten years before Sir Alexander Fleming would discover penicillin.  SARS, MERS, and H1N1 all had the potential to become a pandemic.  However, due to the nature of the virus that causes each and the response of the affected community to the outbreaks, each was sufficiently managed so that a pandemic did not occur.

Based on lessons learned from the previous pandemic near misses and the rapidity with which we acquire and apply new information and technology in the medical world, one would think that we would have better control over the spread of infections in modern times.  It seems that we often lack the ability to accurately communicate new information to those who need it.  At this moment, despite all of our advances in medicine and communication, it is difficult to know whether what we are hearing is accurate, incorrect, or even outdated.

The recent novel coronavirus outbreak with COVID-19 has most of us fearful of touching one another without having a hand sanitizer or a sink and soap readily available.  At this point, finding these products on the shelves has become increasingly difficult.  The CDC has recently placed heavy emphasis on the recommendation that we cough or sneeze into a clean tissue or use our elbows as a backup.  We should immediately wash our hands afterwards and dispose of any contaminated tissues.  Why do these recommendations feel so novel?  Isn’t this what our parents taught us?

Of course, we should practice good hand hygiene, but many of us are augmenting this with social distancing.  This term, often described as avoiding large crowds and keeping a 6-foot radius between oneself and all others, is a bit of a misnomer.  Keeping a physical distance should not require one to “become distant” and disengage socially.  It seems that many are running to the stores to stock up on food and self-care items in the expectation that they will not be leaving their home or see others for weeks.  We should consider the alternative: That this social distancing might instead have a positive impact on our interactions.  This might encourage us to pick up the phone and talk to our friends and family instead of texting and to really connect to those we live with or are close to.

In public, we might find ourselves changing our social interactions as quickly as this virus mutates.  The handshake, fist bump, kiss, and other physical greetings are only the beginning of our interactions with one another.  We do not need to shake hands or touch in order to create a connection with someone else.   Around the world, various cultures have proven this.  In Thailand, the Wai is a bow that exposes both hands.  Like the handshake, it is thought to originate as a form of proving no weapons are held.  Similarly, Muslims and Orthodox Jews don’t shake hands for entirely different reasons.  The belief is that a handshake could be misinterpreted as an affectionate or intimate gesture.  Both cultures have other socially acceptable ways of showing respect and affection.  In fact, studies have shown that individuals prefer that the person they are speaking with makes them feel they are a priority, be respectful, personable, and polite.  This may be done through eye contact, addressing them by their name, and body language.  No handshake is required for this, and in fact, it is often found to be less important than other nonverbal communications.  I ask myself, “Should we do away with the handshake?”

As much as this pandemic may separate us, as we continue to socially distance ourselves from one another, we may also find it ironically powerful in that it could offer us a chance to reconnect in less physical ways.  At the same time, the handshake may find itself an endangered species of communication, as within it may be hiding an invisible but deadly weapon.  As we make our way through this historic event, I exchange nods and smiles with others, often recalling my grandfather as he greeted me quietly from the doorway.

Lauren Fine and Vijay Rajput are medical educators.

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