When the German chancellor, Angela Merkel, extended her hand to her interior minister, Horst Seehofer, at a meeting on Monday, he refused her handshake and waved her away.
Pre-coronavirus, his gesture would have been the epitome of bad manners. But, with 150 cases now confirmed in Germany, a smiling Merkel immediately held up her hands and said: “That was the right thing to do.”
Coronavirus is changing social interaction, especially in the western world. Handshakes, cheek-kisses, hugs – the everyday greetings ingrained in our culture – are not as welcome as they used to be.
In Italy, Angelo Borrelli, the country’s special commissioner for coronavirus, has suggested that Italians’ demonstrative nature could be contributing to the virus’s spread, urging citizens to be “a bit less expansive”.
Likewise in France, where the health minister, Olivier Véran, has advised people to cut back on hugs and kisses, though the French president, Emmanual Macron, was seen to double-cheek kiss the Italian prime minister, Giuseppe Conte, twice during a summit in Naples on Thursday.
In the UK, Public Health England has not gone quite as far. When Prof Paul Cosford, emeritus medical director for PHE, arrived at Radio 4’s Today studios on Monday, presenter Mishal Husain asked if it was OK to shake hands, assuming he would say it was not.
But Cosford was quite happy to, he said – though perhaps not in the future. “We do need to get to a point where we reduce social contact if we see more widespread infection,” he said. “At the moment, we’re in the position [that] we need to continue life as normal, but we need to be prepared for the actions that we may need to take.”
In the meantime, good hand hygiene is the key message.
“Science says shaking hands is disgusting,” Nicky Milner, director of medical education at Anglia Ruskin university told the Guardian. She pointed to research showing on average we carry 3,200 bacteria from 150 different species on our hands. On average, we will shake hands 15,000 times in our life time, she said.
A handshake transfers twice the amount of bacteria compared to the quicker fist-pump or high-five. “If you’re shaking hands, you tend to put your palms together and wrap your fingers around. Whereas, when you minimise the contact between the skin, you have a small surface area in which there are micro-organisms, so transfer fewer. It’s all probability,” she said.
The Japanese bow, the Thai “way, where palms are pressed together in prayer-like fashion, are all healthier”, she added. “In Ethiopia, they touch your elbow, then you bang opposite shoulders.”
Yet, she cannot see such greetings becoming commonplace here in the UK. “The challenge would be the cultural shift.”
“In the UK, the handshake is formal. It’s professional. It’s used in meeting and greeting. It closes business. It’s such a powerful procedure that we perform. It’s not just about saying hello. So that brings us back to good hand hygiene.”
The World Health Organization’s director of pandemic disease, Sylvie Brand, meanwhile, has endorsed the elbow bump, footshakes, waves and the “wai” as safer alternatives to shaking hands.
Dr Adam Kucharski, associate professor at the London School of Hygiene and Tropical Medicine, researches how social behaviour and immunity shapes disease transmission. On reducing handshakes and kisses, he said: “Obviously all these things can reduce transmission, but there’s no one quick fix”.
“We are doing a lot of modelling, and others are, to try to understand what combination [of measures] would have what effect on an outbreak.
“If this becomes an outbreak, it’s not going to be a matter of people making one small change to their behaviour. It’s going to be series of changes across a number of aspects to their behaviour.” Awareness of and modifying interaction with vulnerable groups, such as the elderly, was crucial, he said.
As more people begin changing their behaviour, church communities are among those taking precautions. Congregants with coughs and flu symptoms are advised to refrain from the “sign of peace”handshake, and to receive the communion host in their hands, rather than on their tongues.
Many Catholic priests are already choosing to deliver the host this way for all parishioners, the church said. The sign of peace would be suspended in the event of confirmed coronavirus case in any congregation. Meanwhile the Church of England advice to those with cold and flu symptoms is to refrain from taking wine from the common cup.
Social etiquette consultant Jo Bryant, believes the UK may have a slight advantage over its European nations, “because we are a non-tactile nation, and we do like our personal space”.
“This is new territory for etiquette,” she said, advising people to “hang back a little”, before they go in for the big handshake.
Her advice: Take time, hang back, look at how the other person is approaching the interaction as well, “and between the two of you, work it out”.