Goodbye, handshake. Hello, elbow bump? Greetings to avoid during the coronavirus outbreak

As coronavirus spreads, people are getting more cautious and creative with their social interactions. USA TODAY

As coronavirus spreads in the United States, killing at least six and infecting more than 100 as of early Wednesday, people are beginning to get more creative with their social interactions as they try their best to avoid contact.

Institutions are already starting to implement best practices in the West Coast. The Roman Catholic Diocese of San Bernardino announced that parishes have the option “to implement liturgical restrictions that are allowed during the annual flu season,” according to a letter from the Office of the Vicar General sent to the Los Angeles Times.

Global leaders also are taking precautions. German chancellor Angela Merkel was waved away by Interior Minister Horst Seehofer after she extended her hand for a greeting during a meeting Monday.


Handshakes are popular among co-workers, classmates and acquaintances inside a professional setting, but health experts warn that shaking hands is a prime way to spread the coronavirus.

In Germany, where children are taught to shake hands with adults and the firmness of the grip can be seen as correlating to personality strength, health experts and doctors are trying to persuade people to stop.

At Virchow hospital in Berlin, doctors not only stopped shaking hands with their patients – even noncontagious ones – but are encouraging them to follow the example as cases in Germany exceeded 200. 

Friendly kissing

In other countries, health officials are advising the public to avoid friendly kissing, or a quick peck on either one or both cheeks as a way to say hello. 

The Italian government’s special commissioner for coronavirus, Angelo Borrelli, has suggested that Italians' demonstrative nature could be contributing to the virus’ spread. More than 2,000 people have tested positive and 79 have died, almost all of them in the country’s north.

In neighboring France, Health Minister Olivier Veran on Saturday advised people to cut back on “la bise,” the custom in France and elsewhere in Europe of giving greetings with kisses, or air kisses, on the cheeks, along with shaking hands. France, which has had more than 200 cases and four deaths, made a similar recommendation during the swine flu epidemic a decade ago.

In Spain, a country rooted with a strong tradition of cheek-kissing in social as well as many professional exchanges, has been continuing the practice unabated. Spain has registered more than 150 coronavirus infections.

But even more reserved northerners are grappling with whether to forgo the hallowed handshake.

Fist bumps and high-fives

A 2014 study published in the peer-reviewed American Journal of Infection Control found that nearly twice as many bacteria were transferred with a handshake compared with a high-five and that transmission was even lower for fist bumps.

But that all depends on how long that high-five or fist bump lasts. Because handshakes typically last longer than high-fives or fist bumps, the study prolonged the contact for three seconds.

Researchers found that the transfer of bacteria didn’t significantly increase for the long high-five but did for the fist bump.

Germ transmission doesn’t just vary with the type of greeting or how long it is, but it also depends on the force of contact. Scientists involved with the study also said the different parts of the hand also would have higher or lower transmission.

The elbow bump

Instead of handshakes or high-fives, U.S. Surgeon General Jerome Adams introduced the elbow bump at a news conference in Connecticut as a possible alternative to avoid the coronavirus.

He showed reporters how it was done by demonstrating the elbow bump with Sen. Richard Blumenthal and Gov. Ned Lamont.

“We’re encouraging communities to think about the steps they can take to limit spread within communities to mitigate the effects of the virus,” he said at a news conference Monday. “We should probably rethink the handshake for a while.”

Other world leaders are also adopting the elbow bump. World Health Organization Assistant Director General Bruce Aylward was photographed offering an elbow to a reporter who extended his hand for a handshake.

The CDC notes the virus spreads when people are within six feet apart. “Respiratory droplets” when an infected person coughs or sneezes, “can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs,” CDC said.

So the safest way to avoid transmission is to avoid all contact, experts say. That may mean a simple wave or a grander Namaste bow instead of a hand or elbow.

“Namaste,” the Indian style of greeting familiar to yoga practitioners, includes a prayer-like hand position and slight bow.

Dr. KK Aggarwal, a cardiologist and former president of Indian Medical Association, told the Times of India that 30% to 40% of the risk of coronavirus would be eliminated if people adopted what he called “Corona Namaste” instead of the handshake. 

Contributing: Jayne O'Donnell, USA TODAY; The Associated Press


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