As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on topics that might affect employers or employees. This is a reprint of a blog post from KBGH:

Last Sunday at my church the congregation turned, as we always do, to greet one another. The pastor had a runny nose, but she repeatedly reassured all of us that it was from allergies, not an infection. I, too, was experiencing some rhinorrhea, mine exercise-induced from a hard bike ride that morning in the cool air. But as people started to reach for my hand I couldn’t block the results of an experiment from my mind. Bill Bryson wrote about it in his book “The Body: A Guide for Occupants.” The Mythbusters later re-created it. In the experiments, a confederate wore a device in his nose to a party. The device imitated a runny nose: it dripped at 60 mL per hour, roughly the same rate as someone with a viral cold. The fluid was clear, but fluoresced under black light so that investigators could track it later. The partygoers—who were unaware this was happening—went about their business, and at the end of the night everyone was examined with a black light to see where the fake, fluorescent snot ended up. Not surprisingly, everyone at both parties ended up covered in it. In the Mythbusters version, even people who had been instructed to “act like germophobes” had demonstrable contamination with the fluid. The one exception? A woman who had refused to shake hands with the drippy confederate.

With this information roiling around inside my head I ducked out of the sanctuary and into the bathroom. I washed my hands for twenty seconds and returned to my seat. With a worldwide viral pandemic unfolding, I wondered, is it time to retire the handshake?

I asked around. One of my medical school classmates told me he attends church with a lawyer who asks for a fist bump instead of a handshake. My neighbor, a realtor, told me that handshakes are such an integral part of the ceremony of his work that he can’t imagine changing. (Ironically, he was diagnosed with influenza A last week. Don’t worry. He’s doing fine)

So I dove into the literature. In spite of mountains of evidence that our hands are filthy, we are very into shaking hands: 78% of patients want their physician to shake their hand, and docs and patients shake hands 83% of the time. But maybe there’s a middle ground. Dr. Leonard Mermel from Brown University (paywall) points out that studies have shown that alternate practices of greeting, such as fist bumps and high-fives(!), decrease the transfer of organisms from one person to another by 50-90%. And some clinical sites have gone so far as to ban handshakes (paywall), comparing the challenge of the discontinuation of the handshake in clinics to the change in smoking practices among doctors in the 1950s and 1960s.

The handshake is a powerful signal. It can bring adversaries together in a moment of shared respect. It can give unequal parties a moment of balance and equity. It can help a person quickly project that she is trustworthy, confident, and prepared. But it can also transmit a stunning number of organisms from one person to another in a short amount of time.

So for this winter or the COVID-19 pandemic, whichever ends first, let’s fist bump instead.