Can We All Please Just Stop Shaking Hands?

Photo: Yoshiyoshi Hirokawa/Getty Images

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DDavid Whitworth is not a fan of handshakes. The biologist at Aberystwyth University in Wales thinks humans should move away from the formality altogether. “I avoid shaking hands, and absolutely refuse to [do it] if I know I have a cold, or if there is a cold going around the workplace,” he says. “I also explain why I’m refusing, and hopefully educate other people to not spread germs through shaking hands.”

Whitworth has witnessed firsthand just how unhealthy handshakes can be compared to some alternative greetings.

In an experiment back in 2014, he had one person in the study dip their hand into a container filled with bacteria, then shake hands with another person. (Both wore sterile gloves, thankfully.) After the recipient’s glove was dry, Whitworth measured the bacteria on it. The experiment was repeated with high fives and fist bumps.

A handshake transfers almost twice as many bacteria as a high five, and “significantly fewer” bacteria are passed along in a fist bump compared to a high five, the researchers concluded in the American Journal of Infection Control. In all three greetings, longer duration of contact and stronger grips increased transmission. Whitworth says the results would likely apply to germs besides bacteria, including viruses, which cause the common cold, the flu and the new coronavirus that’s spreading around the globe.

“I don’t see any reason why we couldn’t move away from the handshake, and I think we are probably already doing so,” he tells Elemental. “Adoption of the fist bump as a greeting could substantially reduce the transmission of infectious diseases between individuals. We shouldn’t be paranoid about touching other people, but when we know transmissible disease is around, we should be extra cautious.”

His advice for anyone concerned about coronavirus: Try a nod, a smile, or a wave. “I would avoid any greeting which involves contact,” he says. “If people feel the need to touch, then a swift fist bump or similar would be much better than a handshake.”

“The handshake is such a terrible idea, from an infectious disease standpoint.”

Handshake-free zones

Oliver Wendell Holmes, the poet, professor, and doctor, proposed in 1843 that a common and deadly childbirth fever in women was caused by germs delivered from the hands of doctors and nurses. It was one of several discoveries that led to the recommendation that doctors should wash their hands. By the early 1900s, the health risks of the handshake were reported in medical literature.

Yet more than a century later, the friendly gesture continues to spread disease, working hand-in-hand with the bacteria-laden objects people handle constantly (phones, keyboards, doorknobs) and the human propensity to touch faces frequently, thereby handing germs off to the entry points: eyes, nose, and mouth. An observational study published in the American Journal of Infection Control determined that medical students touched their faces 23 times an hour, on average, contacting a mucous membrane 44% of the time.

Then there’s the dismal state of human hygiene: After using public restrooms, only 5% of people wash their hands with soap long enough to get rid of germs, while 15% of men and 7% of women don’t wash up at all, according to a 2013 study from Michigan State University. Even among health care workers, handwashing is often done poorly. Only 40% of doctors and nurses practice proper hand hygiene in hospitals, a 2010 review of existing research found.

“The handshake is such a terrible idea, from an infectious disease standpoint,” says Dr. Mark Sklansky, a self-described germaphobe and also professor and chief of pediatric cardiology at UCLA Mattel Children’s Hospital.

Sklansky, in a 2014 editorial in the Journal of the American Medical Association (JAMA), recommended removing the handshake from health care settings. The following year, he and colleagues set up a handshake-free zone in UCLA’s two neonatal intensive care units, “significantly reducing the frequency of handshakes among physicians and medical students” by educating health care workers and families on the risks.

“Patients and caregivers appreciated the change and supported any such effort to minimize transmission of disease to our sickest patients,” says Sklansky over email.

Should handshake-free zones extend beyond hospitals?

“Absolutely,” Sklansky says. “More now than ever it makes sense globally to take common-sense steps towards decreasing the likelihood of getting sick and/or transmitting viruses.”

Handshakes: The human version of dog-butt sniffing

Nobody knows when or why handshakes got started, but images and writings depict the practice going back thousands of years. One theory is that extending an open hand was viewed as a sign of peace, evidenced by the lack of a weapon. Or maybe shaking hands was originally a sign of sealing a deal, as it can be today.

Another idea is that hand-shaking evolved even earlier as a human version of dog-butt sniffing, whereby we get a sense of another person by the odors they pack. A 2015 study found that modern humans often sniff their own hands, but after shaking hands with someone else, they tend to sniff their own right hand twice as long as they usually do.

“Handshakes vary in strength, duration, and posture, so they convey social information of various sorts,” says study leader Noam Sobel, PhD, a professor of neurobiology at the Weizmann Institute of Science. “But our findings suggest that at its evolutionary origins, hand-shaking might have also served to convey odor signals, and such signaling may still be a meaningful, albeit subliminal, component of this custom.”

In negotiations, a good handshake can foster cooperation that leads to better outcomes for both sides, according to a 2018 study that used a variety of mock negotiations in an experimental setting to test the notion.

One exception to the finding: When a study participant thought the other person was sick, “handshakes no longer influenced cooperation,” the researchers concluded in the Journal of Personality and Social Psychology.

“Many of us still shake hands under duress — such as when we feel the need to please someone, as in a doctor-patient greeting or at a business meeting.”

Infection by affection

Anyone looking for an alternative to the handshake might consider the namaste gesture, common to India and parts of southeast Asia, where people meet and depart with a pressing together of their own hands, with thumbs close to chest, and then add a slight bow of the head.

In Japan and some other Asian cultures, the bow alone is used instead of handshaking.

Both of those approaches are far better than the cheek-to-cheek greetings common among many Europeans.

“In countries like Italy where a typical sign of affection results in kissing on the cheek, it is being advised to avoid this” amid coronavirus fears, says Dr. Peter Gulick, a professor of medicine at Michigan State University’s College of Osteopathic Medicine.

“I believe that any contact on the face may be risky, and with oral contact on the cheek this is definitely risky,” Gulick says. “In cases of kissing or touching cheeks, anything closer to the mouth where viral entry can occur can be riskier.” Even hugging can spread germs, Gulick says. (The CDC suggests people stay at least six feet away from anyone who might carry coronavirus.)

“Ultimately, it’s better to play it safe and avoid any of these greetings, especially with more community spread and asymptomatic carriers,” Gulick says, referring to people who are infected with coronavirus but don’t know it because they have no symptoms.

Cultural barriers to nixing the handshake

There are notable challenges to getting rid of handshakes altogether.

“I think it would be very difficult to change the culture of shaking hands,” says Nicky Milner, director of medical education at Anglia Ruskin University in the U.K. “Not shaking hands is often viewed as being rude and maintains a prominent place in our professional lives, where deals are made. There is no need to stop shaking hands completely.”

But Milner recognizes that “shaking hands is disgusting,” as she writes in an opinion article citing some of the gross science: The typical human hand carries 3,200 bacteria from 150 species, commonly including fecal bacteria. Yet rather than ban handshakes, Milner sees a need to educate people on the risks and solutions. “Washing hands effectively (taking 20 seconds to perform the task) will continue to be the best way to prevent the spread of infectious disease,” she says.

Sklansky, the germaphobe, doesn’t buy the cultural-barrier argument. He notes that cigarette smoking used to be an accepted cultural norm, an image largely destroyed by public service ads. Besides, he says, many people would appreciate an excuse not to shake.

“Many of us still shake hands under duress — such as when we feel the need to please someone, as in a doctor-patient greeting or at a business meeting,” he says. “The way to help us with the transition is through handshake-free zones, taking away from individuals the responsibility and cost of refusing to shake hands. This cultural shift may take many years to accomplish, but I advise my friends and patients not to wait for that time.”

Perhaps we can all shake on that?

The coronavirus outbreak is rapidly evolving. To stay informed, check the U.S. Centers for Disease Control and Prevention as well as your local health department for updates. If you’re feeling emotionally overwhelmed, reach out to the Crisis Text Line.

Explainer of things, independent health and science journalist, author, former editor-in-chief of LiveScience and Space dot com.

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