Swine Flu Upsets Rituals of Greeting

The era of swine flu poses the thorny challenge of how to express cordiality, even love, while preventing infection.

Comments: 57

  1. If this means the end of absent-minded hugs (with turned-away head) then this is good news, not bad. Not since the days of mutual lice-scratching has a group of hominids (the Americans) adopted a more disgusting habit.

  2. My father came home from WW II with TB. He was in sanitoriums and having relapses for years while we were either quarintined or socially isolated. The good news was that my sister and I did not get polio which was rampant in our Brooklyn neighborhood.

    Good health etiquette should be stressed in families, schools and with the family doctor.

    Wash hands frequently and don't touch every thing in sight.

    In terms of physical contact use the US Marines or a Japanese women as your role model, not the average American teenager.

    Carry tissues and stay home if you are sick.

    Typhoid Mary was no one's best friend.

  3. Several years ago after reading about the dangers or risk of transmitting diseases by the simple act of one person touching an object which a contagious person has just contacted, I started thinking about door knobs and handles in public places and wondered if those surfaces might be some of the most logical locations where transmittable bacteria and virus might reasonably be assumed to reside. From what I understood, the cleansing power of the air is enough to render a contaminated surface not harmful after a given period of time, once the moisture is gone and the oxygen does its job, but the range of time period to safety was (to me) somewhat of a mystery. It has been stated from a few seconds to over several minutes in various articles which talked about "germs" and their transmission. Thinking about that, I figured that the door knobs (or other mechanical devices for opening doors) in highly trafficked commercial or government facilities would be a very likely candidate for the most likely areas where residual fluids would remain in a dangerous state after being deposited from the hands of previous portal travelers suffering from the flu or a common cold or maybe even something more serious, because often only a few seconds elapses between one person handling the door and the next one coming along grabbing right where the previous individual touched. Just think about that person who just sneezed into his hand or merely touched his nose or mouth while suffering from some communicable illness and picture them having just gone through that door only seconds before you are presented with that very same handle to grab. Scary.

    So, about three years ago, I started doing something which for a long time garnered a glance or two, because what I was doing has characteristically been shamed as an indication of a person having some sort of psychological malady or phobia (and any of those are generally automatically considered to be misplaced). But I accepted that my phobia (fear can be a good thing) made sense and so I began using a part of my shirt or sweater (or jacket) to open doors, never touching any door handle with my bare hands. Yes, it looks a bit "wacky." But, it is very satisfying and for me (as a sampling of one... I know it's not very scientific, of course) it proved to be very beneficial. In previous years, I had experienced the usual run of colds and coughs and sniffles along with a bout of at least a "flu-like" illness every winter. But, to the amazement of my friends and family members, since I began my crazy "compulsive" paranoid never-touch-a-door-handle behaviour, I haven't had but perhaps two very mild colds over three years. Sure, it might be a coincidence, but once the swine flu publicity started to spread and friends began to reflect on my "coincidental" lack of illness, I have gotten quite a few converts from the ranks of those who originally scoffed.

    One thing that makes it easier for me is that I dress very casually, so having the soft cloth of a t-shirt or a Henley pullover makes it a lot easier than a more formal shirt or a business oxford cloth which is properly tucked in. In that case, I usually have on a suit jacket or a sport coat and I just use the bottom of that to grab the door. Yes, it looks wierd, but I am convinced (from my own healthy results) that this simple procedure is effective.

    I say, don't be influenced by the strange cultural customs which would pressure you into not taking a very simple precaution which is readily available from just a simple change in your routine. Start today only opening any public door with the edge of your shirt or sweater... I think you'll thank me for it before the winter is gone.

  4. In France where we always shake the hand of acquaintances and routinely give a peck on each cheek when greeting friends, especially of the opposite sex, the protocol is quite simple. When we have a cold or otherwise feel out of sorts, we simply excuse ourselves from the gesture by saying we feel unwell. No one is offended. To the contrary, we appreciate the other person's consideration.

  5. Less of a problem for women working outside of the home. Throughout my observing life, I have personally experienced, and also noticed, that men rarely shake women's hands, or look at them or touch them at all. (I call it 'disappearing someone'.)

  6. Another reason for us to be further alienated from each other. Just what the world needs.

  7. Are you trying to cause a crisis? This swine flu is a blip on the screen of problems. Stop publicizing it NOW!

  8. I was in NYC during the oubreak of swine flu in spring and what i observed with respect to Europe, where i live, was the different attitude about emergency. In this case, American people have trust in government because Mrs the Minister says the true about a possible pandemic influenza: it could be serious but we know that there are some drugs able to trasform it in a bad seasonal flu. Could a pandemic AH1N1 flu destroy civilization as we know it? I think that the answer is not, if scientists will be able to communicate this extreme risk. From my point of view the crucial aspect of this story is extreme risk communication and perception. It is crystal clear example of extreme risk and its governance requires to do the right questions, and as a consequence to divulgate the right answers.
    The AH1N1 virus is a pandemic one, it is not possible to stop its diffusion, so at the best of our knowledge we can only contrast it.
    Is this virus sensible to antiviral? Yes it is, we have at least two medicines able to contrast it and avoid its complicance and collateral -side effects that induce death. Could we have vaccines for this pandemic flu? Yes, it is possible to have vaccines, even if we could have more than one dose because of ricombinations of the virus. The crucial question is how many doses of antiviral we need to face an outbreak; everyone finds the answer in the WHO situ. How many vaccines are we able to produce and how many people need them, everyone can find the right answer in the WHO situ. In my view if a government accepts the WHO recomandation it is doing the right thing at the best of our knowledge, so there is no necessity to modify our habits and attitude. Of course if this pandemic flu will sweep away bad behavior such as: to split, to cough and sneeze in the face of other people, do not wash hand, and so on, it will be an improvement of our civilization. With respect to kiss, it is worth to rememember that we are talking about a flu, that can be treated, not a plague!

  9. I cringe when i see people touching their noses where strep germs may germinate and then touch food. Ugh! Americans, particularly for me, have nasty touching face and head/hair habits. Perhaps other cultures do as well, but I haven't noticed it. Since I have gastro problems I am especially aware of these movements. Americans don't seem to think of the consequences of not washing their hands.

  10. I like the Asian way of greeting: a polite bow.

  11. I always wear a wide brimmed Fedora or Panama style hat. For a moderate greeting, I have been tipping my hat. For a full greeting, I grab my hat by its top, remove it, bow and wave it in a deferential gesture. That grand greeting style, which goes back many centuries, always produces a very positive and sometimes bemused response.

    Removing your hat and bowing offers a display of respect that we have mostly lost in modern society. Wide brimmed hats also offer additional health advantages such as sun protection.

  12. Hope this isn't going to be the realization of Camus' The Plague.

  13. I challenge the press to get the word out on this one, simple measure. Declare the "end of the handshake" and replace it with TOUCHING ELBOWS. Whenever I have a cold I declare I have a cold and I offer my elbow and people automatically reciprocate and appreciate my doing it. This is better than a fist pump. The gesture is sincere enough and has the most minimal transmission I can think of. Everyone learned as a kid that you can't reach your elbow with anything. Help me spread the word. Let's get it out there.

  14. NYT, generating new hysteria is exactly what we don't need. I would expect you to be more responsible.

    I am a physician in primary care (which means I see EVERYONE who THINKS he MIGHT have a cold), and I hate to break it to you, but the flu comes around every year.

    This year, it's "Swine Flu," but it's really just the flu, which kills over 30,000 every year, usually without getting people upset enough to so much as get their recommended flu shots.

    I had what appears to have been Swine Flu a couple of months ago.
    My wife appears to be just getting over it now (we can't be sure because our local Department of Health asked us to STOP sending swabs to be tested months ago, as they were overwhelmed, and there's no difference in treatment between Swine Flu and any other flu anyway).
    I see people EVERY DAY with Swine Flu, and the flu season hasn't even started yet.

    Face it, we're all going to get it, sooner or later.

    You want to make a good recommendation? Tell people to stay home from work or school when they're sick. That'd make a HUGE difference.

  15. Maybe not so much the end of civility, but a restoration of a bit of reserve, sincerity, and authenticity.

  16. Why would this be the "end of civility?" Civility is characterized by treating other people with respect and consideration. There's no reason that has to include a handshake/hug/kiss. As different needs and concerns arise, our understanding of what constitutes "civil" behavior ought to change too. Maybe it's the end of handshakes, but surely not of civility.

  17. While people with underlying conditions may need to take precautions against swine flu, I have not read that the virulence of swine flu is higher than that of your typical influenza. While it is rather unpleasant and highly contagious, articles should stress that this is not yet a fatal disease. Rather than being the end of civility, perhaps this disease could teach parents basic consideration. Pull your kid out of school when he or she becomes symptomatic to decrease the amount of virus present in schools.

  18. Um, regular flu, or influenza, kills around 60,000 people a year in America and between a quarter and half a million a year world wide. So, despite what pharmaceutical companies desperate to offload vaccines and a government desperate to appear useful would say, it's not a big deal.

  19. Interesting post!

    How about the hands together at the heart in the Namaste greeting--the spirit in me honors the spirit in you. No touching.

    I'm noticing that it's becoming much more commonplace for people to use a paper towel to turn off faucets & to open doors in public restrooms. Not strange anymore. That's a good thing. And sanitizing dispensers everywhere.

    As for CIVILITY--it's much more than hand shakes and hugs--it's how we treat & care for each other! It's an attitude! And what we will really need if the flu strikes.

    "We still need to believe in something that will give us our vital daily dose of meaning and motivation. As we grapple with the complexities of our age, I suggest that we agree on one principle: that a crucial measure of our success in life is the way we treat one another every day of our lives....Good relationships make our lives good; bad relationships make our lives bad. We are usually happy (or unhappy) with others."

    For the Cliff Notes of Forni's Civility--25 Rules for Considerate Conduct:


    -P.M. Forni, cofounder of the Johns Hopkins Civility Project-

  20. To Poster #5, Moi: I believe the proper etiquette for men in regards to shaking hands with a woman is for the woman to extend her hand first if she is interested in shaking hands at all.

  21. The "end of civility"... because of the flu? This is the type of over-the-top reporting that has been stoking the hysteria around the swine flu. Heckuva job, NYT.

  22. One more result of the Great Swine Flu Panic of 2009.

  23. Abolishing the extremely necessary physical contact between people when they greet each other will have far greater detrimental effects on society as a whole than transmission of a relatively mild disease organism like swine flu.

    The best non-physical greeting I've seen for a person with a communicable illness is they cross their arms across their chest and bow (kind of like the crossed arms look of Wolverine in the X-men movie posters); while verbally greeting the person and offering the explanation of their illness for not properly greeting them. That prevents any ambiguous signaling for hand contact as well as providing an equivalently appropriate social acknowledgement of the person.

  24. What a ridiculous article.

    There's no evidence this is happening. Most people aren't the least bit afraid of swine flu. Turns out the media (including this newspaper) hyped this thing beyond belief and it's just not as scary as you said it would be. People are smarter than you think.

    And the doctor who said he holds his breath and cringes when a child wants a hug? Horrible. I'm glad he's not my child's doctor.

    It will not kill us to be a little kinder to one another. A hug won't kill you -- no matter what the New York Times might want you to think.

  25. Some background science: flu virus cannot reproduce on its own, it must travel via aerosol particles into the respiratory system, invade cells, and force them to produce more virus. Flu virus dies in a few hours on surfaces outside the respiratory system. Bacteria, on the other hand, reproduce on their own on hands and other surfaces. Handwashing thus has different purpose depending on virus or bacteria. A good practice is to carry paper tissues and cover the mouth and nose when coughing and sneezing, then safely discard the tissues, as this interrupts the aerosol transmission. The social practices outlined in the article, in contrast, have little effect other than to help people feel better.

  26. Ugh, I hope my mother-in-law reads this.... Swine flu or not, I cringe every time she grabs our faces with both of her hands when she greets (and kisses my husband on the mouth)!

  27. 99%+ of everyone alive in 1918 eventually caught some form of that flu. What killed most was the bacterial pneumonia that struck patients who were weakened from the flu virus. Antibiotics and ventilators can make the difference for many, with some qualifications. You don't want to be without access to antibiotics, or to be the 10th-richest patient in a rural hospital with nine ventilators.

  28. I don't understand some of the readers who suggest NYT is generating hysteria with this article. I enjoyed reading it. Thank you.

    However, one thing you forgot to mention is that when we cover our mouths when we sneeze or cough, we are supposed to cover them with the inside of our elbows, not our hands. That way, our hands would stay germ-free (relatively speaking).

  29. No hugs or brushing of the cheeks to make you safe from swine flu or any other flu or cold.

    By the time you get that close to someone you have already had exposure to the virus's. Coughing or sneezing and simply breathing are pumping those little nasties out into the air where they float to be breathed in by a passerby. Or they may settle onto a surface to be swept up by a hand or passing clothing and whisked on their way to another location.

    These little critters can survive for days and up to weeks under favourable conditions. Moderate temperatures and humidity all help longevity.

    The end result is by the time you get to greet someone by shaking their hand or kissing their cheek you are more than likely days to late to avoid infection.

    The only way to avoid is to live in a protective bubble which means even greater vunerability to all bugs.

  30. The worst place is in church, where I have observed people leaving the restroom without so much as a glance at the sink, soap, dryer, paper towels, etc. Then I am expected to "pass the peace" with the same people, and God forbid if I should refuse. Yuck! I would mention this to the pastor, but I know it would fall on deaf ears. Thank God for hand sanitizer!

  31. Can people stop giving into mass hysteria for five minutes and think about how much of a risk swine flu actually poses? Yes, fewer people have developed an immunity to this strain of the flu, which means that somewhat more people can expect to contract the flu this year. However, in terms of flu strains, this one appears to be no more virulent than the ones we see in an average flu season. Tens of thousands of people die in the United States every year from the flu, and this year's strain just happens to be the swine flu, and it is set to kill about as many people as other flu strains generally do. I hardly find this a reason to completely rearrange how we live our lives.

    Yes, people should be a little more hygienic, and most colds and flus spread because people are careless. Coughing into the shoulder, washing the hands in warm, soapy water, keeping the hands out of the eyes, nose, and mouth, and avoiding bacterial and viral havens like doorknobs, faucets, keyboards, and other places that the hands touch without then washing the hands all make good sense every year. But the degree of alarmism strikes me as bordering on silliness. Scientists and the media overestimated the danger of this flu strain when it first surfaced, and now the media is continuing with overblown fear-mongering as if to prove that they weren't wrong about swine flu in the first place.

  32. I wish we would just adopt the beautiful ritual of the simple bow.

  33. Yes, the important thing is to wash hands throughly, and often. I would also avoid large crowds if possible once this flu gets into full force. I lost my Great-Grand Father during the 1918 epidemic when he returned from WWI. Our Troops are usually the first to test any new vaccine. I wonder if this will be a repeat of 1918? I sure pray it is not, but we must be villigent, and protect ourselves, and families. Also, If you believe you have the flu, or your children may have it? Please do not go to work, or send you ill child to school to infect others. We just need to use some common sense in protecting ourselves, our families, and the public.

  34. NYT you are part of the problem!!! Stop writing these ridiculous articles.

  35. Question for Sam (Post #3):

    You're on the right track to awareness and I'm sure you have protected yourself from nasty creatures resting on doorknobs. However, there are unintended consequences to your practice. How long does your shirt tail stay contaminated after wiping several doorknobs? Doesn't that shirt tail become "another doorknob" that is now attached to you until pajama time? Did you know that doctors (male) in some hospitals are barred from wearing ties, which were proven to be carriers between one bed-bound patient to another after the docs casually bent over the bed to look and listen? Sure, hands are the main transmitters but, as the song says, they are connected to the wrist bone, the arm bone, etc., which are also potential fomites.

    I suspect we had best (1) keep our distance (within reason), (2) avoid touching faces (our own and others) and (3) rely especially on frequent hand washing -- and be sure to turn that public faucet off (and pull open that bathroom door) with your spent paper towel before you finally toss it in the trash basket. Otherwise, you'll be as contaminated coming out of the washroom as you were going in.

    Good luck to you and me as we thread our way through the coming flu season.

  36. The world will be a poorer place if we lose the desire and ability for simple physical touch upon greeting.

  37. good lord, just bring a little bottle of hand sanitizer with you and be done with it. It's not a mutagenic weaponized supervirus sent by aliens from the future, it's the FLU.

  38. I'm surprised that the most obvious substitute for shaking hands wasn't mentioned - the one used in India of simply joining ones hands together, palm to palm, fingers extended, prayer-like. It's a real and common greeting unlike the made-up elbow bump.

  39. I think they should cancel school for the year. Once the virus starts going around people who can afford to will keep their kids home anyhow.

  40. how about adopting the south asian way - palms together (like in prayer) looking into the eyes of the person you are greeting and saying "Namaste". It's the most gracious, respectful and possibly most spiritual greeting. It means "I bow to thee". On can understand it as a form of genuine personal respect and affection or one can understand and accept it as a recognition of the other's individuality as well as universality. "Thee" understood as the expression of the immortal universal soul which binds us all as one.

  41. I am astonished how every doctor I have been to comes through the door and reaches out to shake my hand. We need to educate THEM first on a new appropriate greeting. Unless they are laundered every night, the public would be better served if doctors and staff would not were the white coat and tie.

  42. Several years ago while in New Deli, we went to the local Anglican Church and were pleased to note that at the Peace, the people held their hands clasped and bowed to each other. There was no touching.

    I think that it is time to end the rampant touching, hugging, and kissing of mere acquaintances. I only want hugs and kisses from my wife, my sisters in law, my step daughter, and other cute women under thirty or ladies that I have known for a very long time. For all others, including male members of my own family and relatives a hand shake is enough.

  43. It is H1N1 flu. A publication like yours shouldn't need to dumb it down to "swine flu."

    This is a human condition. It's tough enough farming as it is without mass media casting aspersions and building hysteria over a different strain of something that arises every year.

    And no, I'm not a hog farmer. But I am involved in agriculture and this is another episode in the NYT's anti agriculture history.

  44. It may be swine flu but it's a pig if we all have to stop kissing.
    More seriously, I agree with the comments about door handles, etc., in public buildings and on transport.
    I hate travelling on the London Tube and having to hold a pole that hundreds of others have already gripped before me and can't wait to wash my hands.
    Taking this slightly further, although most people wash their hands when they've been to the lavatory, that's normally after they've flushed the cistern, or if in apublic building, opened the door.
    I think I'll start taking rubber gloves with me when I'm in the city.

  45. Thank you Eric, for putting this in perspective. It is easy to get caught up in anxiety with fears of infection. In the extreme it is Misophobia (or Mysophobia)- Fear of being contaminated with dirt or germs (thank you phobialist.com!).

    I think common sense should prevail here.

    In addition individuals should stay in touch with the actual frequency, symptoms and severity of the flu to understand when the need for additional measures - that at the extreme end may require changes in cultural behaviors.

    I would suggest we use care as we normally should in not spreading illness (sneeze/cough in crook of arm, not shaking hands if ill or symptomatic, wash hands regularly during the day/with meals).

    Most important is not going out into the world to share your symptoms. Unfortunately the workplace does not condone much absence, which promotes ill people being present at work. But that is a whole different issue.

  46. Blowing out candles on a birthday cake must surely be the easiest way to spread minuscule droplets of H1N1. A little virus for everyone in in the icing. Give Bobby's swine flu to all the other kiddies at the party. With one big huff he can spread the moist air of his lungs over the food. Health authorities should educate parents to put an end to this practice. How about electric candles like Christmas-tree lights? One, two, three, make a wish, Bobby, and push the button. When you come to think of it, wasn't this always an unhygienic -- almost disgusting -- habit even before swine flu, bird flu and SARS?

  47. The origin of hand shaking is to establish that you're not holding a weapon. So let's just hold up our empty hands towards each other and say "no viruses".

  48. If NYT cannot report accurately the name of the disease, why should a reader attriubute any reliability to an article? Once more . . . It is H1N1 not swine flu. This is not a game and it is not political correctness. This incorrect title has caused severe damage to pork producers because the public does not understand. Please . . .

  49. In India we generally do not touch people while greeting each other. 'Namaste' (Nam-as-tay) is the equivalent of a handshake and much more! Namaste = hands in the prayer like position. It means: I bow and honour the divine presence in you.

    In retrospect, I think our forefathers had a foreboding of things to come!

  50. lenore Rapalski: Either you have not traveled much or you are not very observant. Having traveled in Europe, Latin America and the South Pacific I can attest that although many Americans do not possess the recommended hygene or etiquette, there are plenty of such occurrences among those of other nationalities.

  51. PLEASE! I agree with #14 - you get the flu sooner or later and the best way to deal with it is to simply stay home. My company has an extremely generous sick leave policy and makes it very clear they want you to stay home when you're sick. Yet I am sick and tired of having to attend meetings where people are sneezing and coughing all over you. We need to tell these obnoxious eager beaver/martyrs that they will responsible for paying everyone's medical bills if they come in sick and infect the rest of the office. Period.

  52. It's possible to train yourself not to touch your face. I try to use a Kleenex from my pocket to scratch itches.

    To those who think H1N1 is not as serious as regular flu - you are correct. However, regular influenza IS serious, and H1N1 is more severe than a normal cold. My impression is that H1N1 can put you in bed for about five days, and those are not necessarily comfortable days. Why use the sick time and generally miss out life's activities? I'd much rather attempt to avoid H1N1 until I can get vaccinated. And if YOU take this seriously and avoid it, you will help me avoid it!

  53. This is a misguided concern. Handshaking and hugging are the least of the problems with civility - there are hand sanitizers and antibacterial handwipes, after all. And, using them has been widely accepted, so no offense should be taken if they are employed regularly. It will become part of our culture, like receiving a hot, moist cloth to wash your hands in a restaurant. The threat to civility has long existed because most people simply do not know how to behave. The knowledge and practice of good etiquette have been sorely lacking among most of society. If people respect each other, smile often, make eye contact, open doors, carry packages, pick up others' dropped items, avoid interrupting, speak softly, think of others' comfort in public and private places, write respectful emails, handle phone calls courteously and efficiently, dine gracefully and in general be helpful and kind and avoid offending and insulting others, avoiding a handshake or hug should not in itself spell the end of civility. We should worry about a handshake when the widespread chronic behavior of people from the subway to a formal business dinner is abysmal? We are worrying about the wrong things.

  54. Thank you, nos. 11 and 14, for your offerings of savior faire and common sense, both of which the world (and NYC particularly) is in dire need of. Should I get the flu, I shall stay home and perhaps ask the doormen to spread hay across E. 55th Street (as in olden days) so as to quell the traffic noise! Let's restore that old custom, too, as long as people are getting hysterical about nothing.

  55. I actually have been trying to cover door knobs with part of my clothing for some time now. Being a female and not always having extra clothing for the cover, I try to remember one other very important suggestion of "good ole mom from years ago," and that is to never touch your face with your hands, until you can wash them. So with a combination of the two I can say in my humble opinion it works. While many of my friends are often plagued with colds and the flu countless times over the years, I have pretty much been cold and flu free. Needless to say with the concern of the h1n1 I am even more vigilant. And I don't personally care if I look weird not touching a door knob either. As what is even more important to me is, I just plain hate to be sick! And I can say I rarely am!

  56. How about "don't worry about it." It's a flu. The whole use of fear to organize our society got played out in the Bush era, but I see some things just aren't going out of style in government and mainstream media circles.

    Memo: Please stop using this cheap tricks. It's just not that big a deal. It's like when they sprayed toxins all over the parks to stop West Nile virus, causing more trouble than the virus itself.

    If the NY Times was so concerned about people's health, perhaps they'd support socialized medicine and an immediate withdrawal from the USA's various wars of aggression... but... nope. No luck there! Worry about the flu!

  57. Pandemics spread more rapidly in more densely populated countries.
    One does not actually have to come into contact with an infected person; grasping the same door handles, traveling in the subway holding on to the bars, touching the railings on the stairs for support, knobs on the elevators etc can be hubs for germ exchange. To be safe wash hands with soap often; for the paranoid also wear a mask, not to prevent inhaling the germs, but to prevent yourself from touching your face near the nose or mouth.