Aarhus University Seal / Aarhus Universitets segl

Coughs and sneezes spread diseases

We are afraid to shake each other’s hands, and now spend more time washing and disinfecting our hands than ever before. Is the simple handshake an outmoded form of greeting that is heading for the dust heap of history? Are we starting an era of more permanent social distancing? And will we continue to avoid human contact and accept limitations in our freedom in the name of public health?

2021.01.11 | Carsten Henriksen

When the British Prime Minister Boris Johnson launched his new Corona campaign at a press conference in September, he hammered home the government’s slogan in no uncertain terms: “Hands, Face, Space”. The same three principles also apply in Denmark: wash your hands, wear a face mask, and keep your distance. But “Hands” also means: “Stop shaking other people’s hands”. Boris himself was slow to acknowledge the wisdom of this advice. But nobody would dream of shaking hands with anyone else now.

Handshakes are dangerous

The handshake has a long history, explains Associate Professor Jens Erik Kristensen, a researcher in the history of ideas at the School of Education, Aarhus University and the co-author of a book published in 1986 entitled Lys, luft og renlighed. Den moderne socialhygiejnes fødsel (Light, Air and Cleanliness. The Birth of Modern Social Hygiene). The ritual and social function of the handshake can be traced back at least as far as the Assyrian Empire in the third millennium BC. In Denmark the handshake is first mentioned in the Law of Jutland in 1241. Since then, it has spread to most corners of the world. It’s a form of greeting, and a way to confirm friendships. Before written legal contracts became widespread, the handshake was the preferred way of confirming agreements. And the ritual handshake has survived as a symbol of this ancient convention.

The reason why handshakes have disappeared in 2020 is that we have rediscovered the importance of anti-tactility in combatting epidemic diseases: in order to prevent the spread of infection, we need to avoid physical contact with each other.

“This idea arose following the establishment of bacteriology in the second half of the 19th century. Until then, people were not aware that physical contact could transmit disease. But until the Corona crisis erupted, the handshake continued to be a central symbol of sociality. It involves actual human contact, so it’s a more intimate form of greeting than simply nodding at each other or touching elbows,” says Kristensen. He points out that the handshake doesn’t only indicate equality between the parties involved, but also helps us to read the other person’s character or demonstrate the sincerity of our feelings.

“Our sociality has become increasingly connected to physical contact, which is dangerous during the Corona epidemic. So the introduction of social distancing and the disappearance of the handshake have presented us with a problem: how can we replace the handshake with something that confirms our relationship with another person and brings us closer without actually touching each other? Just like a hug, a handshake is a way to bridge the gap between us,” he says.

In anthropological terms, the handshake is a gesture we use to greet another person as well as being a way to actually feel their physical presence. In other words, a handshake is a form of physical contact involving more than the simple exchange of microorganisms with another human being. It’s also an exchange of sensory impressions, explains Assistant Professor Jon Dag Rasmussen from Aalborg University.

“The handshake is a way to sense the presence of another person. The other person’s hand can be warm, cold, wet, dry, firm or limp. It’s an important source of information about the other person; but the question is, in the wake of Corona, whether handshakes have disappeared for ever,” he says.

In anthropological terms, the Coronavirus has transformed the handshake from being something clean into being something dangerous. Anthropologists often distinguish between forms of expression that various cultures regard as either clean or dangerous – or dirty, if you prefer. An approach which is reflected directly in the title of a book written by the British anthropologist Mary Douglas (1921-2007): Purity and Danger.

“The Coronavirus has changed the balance between cleanliness and danger in our society. The handshake is no longer a positive acknowledgement of each other. It has quickly turned into a symbol of the risk involved in physical contact, instead. Culturally speaking, our right hand has evolved into a form of space probe that we extend into the world to gather the information we need. Physical contact generates a great deal of microsensory information which shapes our relationship with the person whose hand we are shaking. We may have to learn how to get this information in other ways,” explains Rasmussen.

It’s airborne

“It’s airborne,” says Dustin Hoffmann in the disaster movie Outbreak from 1995, when he realises that the mysterious and lethal virus is transmitted not only by physical contact, but also through the air. The hounds of hell had been unleashed. At the start of the Corona crisis, we knew that coughs and sneezes spread diseases. So we quickly realised that the Coronavirus was airborne.

“At first we thought the Coronavirus was transmitted primarily via contact. But we now know that it’s not just physical contact, coughs and sneezes that are dangerous. We also need to give each other a very wide berth. The air we exhale can infect other people, and it’s no longer enough to simply avoid physical contact. We need to stop inhaling the air that other people are exhaling,” says Jens Erik Kristensen.

Unlike infections transmitted by physical contact, infections transmitted by inhalation have been a familiar phenomenon for a very long time. In the words of a Danish song written by Vilhelm Gregersen in 1911: “There’s something in the air, but I don’t know what it is”. And even though Gregersen was referring to the sense of spring rather than to a lethal virus, his words reveal that we have long been aware that things could be transmitted through the air even though we couldn’t explain why or how this happened.

“In ancient Greek medicine, a contagious power which had a life of its own was known as a miasma. The theory that a miasma could cause the spread of disease lasted for more than 2,000 years. For instance, ‘malaria’ means ‘bad air’ – although we now know that malaria is actually transmitted by mosquitos. Medically speaking, the theory was in one sense misleading. Even so, it is true that many infections are airborne. It wasn’t possible to understand and explain this fact until bacteriology and virology were founded in the second half of the 19th century. It was discovered that some viruses spread through the air. For instance, tuberculosis bacteria can be transmitted in air droplets,” explains Kristensen.

So although the use of anti-tactility to combat disease is a recent development, the Corona crisis shows that the ancient Greek concept of miasma still has some relevance today. We now know what the air can contain. But virus particles still seem slightly mysterious because we can’t see them or feel them. We have grown used to the idea that the air can be polluted, full of hazardous particles from chimneys and exhaust pipes. But we have only just found out that the air exhaled by other people can be dangerous, too.

“The Corona crisis has taught us a lesson in hygiene: we need to be careful about our own personal emissions to the atmosphere when we sing, shout or even just breathe. The air has become dangerous in a very real sense when we meet other people,” he explains.

The medical police and the Danish Health Authority

According to Jens Erik Kristensen, the way in which we are tackling the Corona crisis can be viewed in the light of the political interest in the population that arose in the 18th century. The French philosopher and historian of ideas Michel Foucault has described the way in which the enlightened despots of that period learned to appreciate the political significance of biological processes in the people, and subsequently the biological quality of the people as well. He characterised this as the birth of biopolitics.

“States and politicians started focusing on the frequency of births and deaths, sickness and health, hygiene and nutrition. Modern healthcare policies were born, and for the first time the exercise of power by states and princes was connected to the health of the people. This is also the key to understanding why people started to be interested in gender, sexuality, procreation, masturbation and perversions. If people’s way of life started to affect their usefulness and procreative ability, this would be a problem for their rulers,” explains Kristensen.

In this connection, a body known as the medical police was established in Germany and France. This was a symptom of the fact that the state was starting to monitor, regulate and intervene in people’s biological lives.

“Caring for people’s lives and health became a political issue which was naturally based on doctors, but which also used the kind of police force with which people were familiar at the time: a domestic administrative body designed not only to fight crime, but also to ensure that people led healthy and decent lives,” he says.

According to Jens Erik Kristensen, this is exactly what is happening today during the Corona crisis.

“The Danish Health Authority is the modern version of the medical police. When the Danish prime minister and government are accused of being high-handed, and the Danish Health Authority is accused of deciding too much, their critics say they have introduced a new form of enlightened despotism. But their behaviour is entirely in line with the notion of caring for the people which developed in a far more authoritarian form in the 18th century. The new departure (and this has shocked a lot of people) is that political concern for the health of the Danish people trumps all other considerations. But even though this tendency is being regarded as increasingly problematic by the Danish politicians and people, the will of governments to save lives has in fact been outweighing economic considerations and personal freedoms all over the world for most of 2020. In Denmark the government has even taken steps that conflicted with the Danish Constitution,” says Kristensen.

Where are all the housewives when you need them?

According to Jens Erik Kristensen, the measures introduced by society to cope with epidemics reflect the way in which we organise society on a more fundamental level. When bacteria were discovered in the second half of the 19th century, great attempts were made to teach the people to behave more hygienically. The housewife was given primary responsibility for putting the state’s healthcare policies into practice on the home front.

“Housewives were given a social task and allocated responsibility for the home – including hygiene in particular. They retained this task well into the 20th century because there was a widespread notion that this was their natural calling,” explains Kristensen.

But when traditional gender roles and the role of the housewife disappeared, even simple hygienic rituals disappeared with them. An EU campaign in the 1990s identified the dishcloth as the greatest threat to health in Europe, because the general public had lost their sense of kitchen hygiene. Dishcloths all over Europe were regarded as bacterial grenades just waiting to explode.

“The Corona crisis is a reminder that we need to return to basic hygienic precautions, but the strategy is different now than it was 100 years ago. These days we are all responsible. You’re responsible for taking care of yourself, but this responsibility is also the central element in the state’s healthcare initiatives for everyone else, too. You need to look after yourself for the sake of everyone else. The state can only care for the general public if it can delegate this task to each and every one of us,” says Kristensen.

No man is an island

According to Jon Dag Rasmussen, the Coronavirus doesn’t only threaten our health. It also changes our ideas about what it means to be an individual with a body in the world.

“Microorganisms like bacteria are small, invisible companion organisms that are an intrinsic part of our body. We are used to regarding our body as our own private territory, as part of our individuality in relation to the world around us. But according to conceptions of New Materialisms expounded by Donna Haraway (born 1944) and others, roughly 90 per cent of my body consists of cells not containing human genetic material, but of material that is passing through me, and which I share with the cosmos. In other words, the human ‘I’ consist mostly of material which is constantly passing through the world – for instance several kilos of bacteria in our intestinal system, which affect us in various ways,” he says.

Viruses are also microorganisms which pass through our bodies every now and then. But although not all bacteria are bad for us, there are no viruses that are good for us.

“The Coronavirus is a cruel reminder that my body is not just my own. We are all connected in a physical sense via the microorganisms that we exchange and share. In other words, the Coronavirus has taught the world that no man is an island. The phenomenon of globalisation is now evident in our bodies, and it’s clear that we’re all in this together,” says Jon Dag Rasmussen.

The crisis has also changed our understanding of what an individual is.

“You could actually say that we no longer regard each other as individuals, but as links in long chains of infection between people leading in all possible directions. We’re interwoven with each other, and need to behave carefully and responsibly all the time – as well as keeping an eye on the other links in the chain to make sure they’re doing the same. The virus has taught us that we are all connected across different generations and with our friends, colleagues, children’s friends, animals and so on. In anthropological terms, you could almost refer to this as a form of extended kinship. The links between us clearly extend far beyond our close family because anyone we meet is a potential source of infection when they sneeze or cough – and even when they get too close to us or breathe heavily as they cycle past us,” explains Rasmussen.

Disinfectant may be a mixed blessing

Adam Bencard is a Danish researcher in the field of medical humanities who believes that our level of hygiene, cleanliness and disinfectant use is now so high that it constitutes a threat to our physical and mental health, explains Jon Dag Rasmussen. And this was even before we started using hand disinfectant to combat the Coronavirus.

“Our skin is not some kind of insulating shell around us. It’s the largest organ in our body, and it’s open to the world. It’s true that the constant use of disinfectant protects us from bacteria and viruses. But it also destroys the body’s natural defence system, which is a paradox when we’re trying to deal with the Coronavirus,” says Rasmussen.

For a number of years now, educational theory in Denmark has maintained that it’s healthy for children to spend time outdoors getting dirty, he says.

“The mantra has been that it’s good for children to have contact with so- called good bacteria, messing about with the soil and getting microorganisms under their nails and into their systems by putting their fingers into their mouths. There’s no doubt that the Coronavirus is dangerous for us. But it might be just as dangerous – or even more dangerous) –to combat one particular microorganism by adhering to hygienic standards requiring us to wash and disinfect our hands to such an extent that we not only preclude any contact with good bacteria that can help to develop our immune systems, but also weaken our defences against other microorganisms in future,” says Rasmussen.

The era of social distancing

In our fight against the Coronavirus, we have adopted classical anti-epidemic strategies in a modern form. According to Jens Erik Kristensen, this is because although no two epidemics are the same, they are all social diseases.

“During the plague, people were told to stay home and refrain from meeting other people in public places. This was how any form of social unrest was dealt with back then. In the 18th century people of all ages were told not to gather in the town square. These days the focus is on young people, who are told not to meet in public places – which is their preferred way of socialising. When the state limits our freedom of assembly, the young people regard this as a blow not to their political rights, but to the very essence of youth culture,” he says.

Boris Johnson’s “Space” has become a mantra during the Corona crisis. We are told to keep one or two metres apart, and the maximum number of people in any one group is 10, 50 or 100 – depending on the current stage of the epidemic. According to Jens Erik Kristensen, it is striking that the focus on sexism in Denmark this autumn has occurred in the middle of the Corona epidemic.

“The social distancing rules imposed during the Corona crisis have found an interesting parallel in the sexism debate. Undesired erotic contact and harassment lie at one end of the scale of physical interaction; while handshakes, cheek kissing and friendly hugging lie at the other. Both these forms of physical contact have now been eliminated, each for very good reasons. But the result may be a more fundamental change in our way of interacting with other people. The two different forms of anti-tactility have a mutually intensifying effect,” says Kristensen.

At the end of the 19th century a hygienic sense of cleanliness and social order was installed in the population. And now we’re installing a sense of social distance, he believes:

“Mankind needs social interaction and physical contact. So social distancing may transform social relations in future more radically than we are willing to admit. Even after the Corona crisis, we will probably continue to keep our distance from other people.”

Personal bios

Jens Erik Kristensen is an associate professor of the educational history of ideas at the Danish School of Education, Aarhus University. His research field includes the educational history of ideas and the history of the teaching profession. He teaches on the Bachelor’s and Master’s degree programmes in education studies, and the Master’s degree programme in general education.

Jon Dag Rasmussen, PhD is an assistant professor at BUILD, Aalborg University. His research field comprises the everyday lives of elderly people, universal design and architecture. He is also interested in ethnographic method and the interfaces and overlaps that arise between science(s), literature, philosophy, art and aesthetics.