By Frank Long, MS, Editorial Director

A year ago the handshake was the gold standard in polite greetings for most social encounters. Now it elicits a reaction similar to letting a pit bull off the leash.

Healthcare workers have to address the downfall of this longstanding social gesture that was once the tactile bridge between clinicians and patients. None of the allied healthcare professions seems quite ready to issue a position paper that definitively guides clinicians in the proper greeting of patients and colleagues. However, a recent article published by Time offers some possible solutions and examines the future of social touch.

If social touch disappears more than just temporarily, there’s no consensus on what will replace it. But one thing is little disputed: Social interactions are about to start feeling really weird.

— The Coronavirus Killed the Handshake and the Hug. What Will Replace Them? (from

Saved by the Fist Bump

Suitable alternatives to the handshake exist on a continuum where contact and infection control are inversely proportional. For example, some may find the fist bump and high five to be suitable alternatives yet each of those interactions carries a risk of microbial transmission. Influencing factors include duration of the interaction and exposed surface area of the skin.

To put the trade-offs associated with these alternatives into perspective, this short video compares microbial transmission for the handshake, high five, and fist bump. Ali Haider, MD, Associate Professor of Medicine at Tufts University Medical School, explains the data behind the comparison and why the handshake should take a permanent vacation from healthcare settings.

Sanitize and shake

In the video Haider notes that he, himself, is not ready to discard the handshake entirely, and that vigilant hand hygiene can preserve the gesture in some situations. He suggests that in place of shaking hands upon meeting, as is tradition, two individuals could sanitize their hands in front of each other and then shake hands; replacing the shake with what he calls the “sanitize-and-shake.”

Haider quips, “If that’s what it takes to keep the handshake alive, I’m all for it.”

Eventually, science and social etiquette will find their way to a new standard for polite social greetings. Until then, healthcare clinicians will continue to lend a hand in fighting disease throughout COVID-19 and lead patients through the pandemic, so long as those helping hands have the proper infection control.

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