Touching distance

Touch is important from the very first moment of our lives. All round the world babies are  placed in their mothers’ arms as soon as they are born, and so the process of bonding begins. This initial contact can be a life-changing moment and often women who did not feel particularly maternal in pregnancy suddenly feel a rush of love and a fierce protectiveness. Touch is one of the five fundamental senses but our modern society has problems in balancing the benefits of humans touching each other with the prevention of inappropriate touching that crosses accepted lines.

During the coronavirus lockdown the fact that we have had to conduct our lives almost without touch has led to an appreciation of its value in relation to seeing and hearing. In video chats with grandchildren we can see and hear them but a virtual hug is scant consolation for the reward of reading a story with the child nestled in close to you or a hug to celebrate some new achievement. On two occasions during recent months my wife and I have taken the precaution of sleeping in different rooms. The first was a week before lock down in the UK when I had a dry persistent cough albeit with no temperature, which at that time were the two major indicators of possible Covid-19 infection.

With the data gathered through the King’s College, London symptom survey led by Professor Tim Spector ( https://covid.joinzoe.com/), the list of symptoms associated with coronavirus infection have increased and include loss or taste or smell ( added to the NHS coronavirus symptom list on 18 May). But the sensible course was to stay part until we knew that the infection was non-covid. During this period neither my wife nor I slept well and we missed the reassuring and calming small touches that mean so much.

Our individual attitudes to touching and the general view of society change over time. Growing up in the 1950’s, my parents kept to the customs and attitudes of their peers. This meant my father greeted me with a formal handshake not a hug, whereas my wife’s family came from an environment where touching was an important demonstration of affection and belonging. Over the last 20 years it has become the norm for men to greet female friends with a kiss on two cheeks. My children have grown up in a world where hugging between men is normal and in team sporting events there is a mass clasping of bodies in mutual congratulation on scoring a goal etc. The 2005 series of Ashes tests (cricket matches between England and Australia) have recently been made available to view again. At key moments, the players rush to congratulate a teammate who has made a telling contribution, smothering him in hugs and pats, so he is submerged from view. Not something we are likely to see again for a long while.

In fact, handshake greetings have become so habitual, that when the advice to stop greeting came to be part of official coronavirus guidance in February, people including politicians and royalty found it difficult to break the habit. Stopping kissing, hugging and handshakes was implemented in Europe, well before lock down started (UK 23 March). It was ironic that at an early White House press conference, announced with much fanfare, on how the US was going to tackle the coronavirus President Trump shook the hands of several of the participants.

Touching distance for two adults is roughly 1.5m, within the 2m social distancing we are recommended at present in the UK. The exact safe distance is still being debated with WHO suggesting 1m is safe but all recommendations are based on studies of other coronavirus particles in air and the risk of aerosol transmission. Professor Werner Bischoff, from Wake Forest, North Carolina, speaking on BBC Radio 4 on May 19 (link) explained that large expelled droplets (larger than 5 microns) travelled less than a metre. Small droplets travel further but have a lighter viral load and so pose less risk. However, the time of exposure is also important and as argued below it is probably the overall dose of virus particles that is the important factor.

An interesting post by Dr Erin Bromage discusses the relative spread of virus particles through air as a result of breathing, coughing , sneezing and singing (link). Whilst the large number of particles released by coughing is well known, Bromage cites two examples from the scientific literature where low levels of virus excreted over a prolonged period of time indoors caused high rates of infection. The article emphasised the role of asymptomatic carriers and argued that the accumulative dose was the key factor in aerosol spread. One consequence of this argument is that social distancing measures, based on short exposure times are insufficient for indoor situations, particularly where airflow such as air conditioning is transmitting virus particles to neighbours.

With regard to touching, the rapid transmission of bacteria and viruses between humans has been known for many years. In undergraduate teaching classes a simple experiment where a harmless bacterium was put on one person’s hands and then passed onto the next person by shaking hands was used to show that a small dose can be transferred effectively through a number of different people successively being in contact with each other. Similar experiments using harmless tracer viruses, carried out at the University of Arizona, showed that virus particles could be transferred from one object such as a door knob to other objects such as computer keyboards, toilet handles and table tops. Within 2-4 hours the virus was detected on 40-60% of such surfaces and human workers were contaminated.  

As we touch our faces frequently, the possibility of transmission of Covid-19 from hands to face and then entering the body through the nose and mouth is obvious. Hence the advice of frequent hand washing with soap or wiping with alcohol, both of which kill the virus by disrupting the viral coat.

The social consequences of all this is that the comfort and assurance that we are used to receiving daily through touching is disrupted in many ways such as meeting and greeting friends and relations. While meeting in person has been replaced partially by video chats through systems, such as ZOOM and Skype,. that allow “virtual meetings”, the element of touch is still missing.

In the Netherlands one care home has introduced the use of glass cabins where relations can see their elderly relatives and talk to them using speakers though separated by a glass partition (link). This system works for patients with dementia who could not cope with video chats.

The moist poignant need for touch right now is when a person is in hospital, infected with Covid-19 and close to dying. Both the ill person and those close to them want to be at their bedside at this pivotal moment for mutual comfort. For many this has been impossible and doctors used to witnessing deaths have been affected  by these cases of patients dying, literally in isolation. In a moving programme on Radio 4 (diaries of the NHS workers – cronavirus behind the mask) doctors and nurses related some of the difficulties they face every day.

https://www.bbc.co.uk/programmes/m000j22z

One commented that it was hard to watch people say good bye, especially if they are doing so remotely from Facebook or on Face time. At the Royal London Hospital, in an act of courage and humanity, Dr Rupert Pierce decided to offer relatives the chance of saying goodbye in person, protected by PPE. For medical staff and relatives alike this was a big decision; demonstrating how to put on and take off PPE safely and knowing that these people would be taking a risk.

Being in touching distance was important enough to take the risk.

Written May 20th 2020