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I'm vaccinated. Is it safe to hug others who aren't in my bubble if they're vaccinated, too? What about shaking hands with a stranger, say, at work. I'm eager to get back to the way it was ... but slightly nervous.
You must remember this
A kiss is just a kiss
A sigh is just a sigh
The fundamental things apply
As time goes by
The lyrics of As Time Goes By are pretty famous – yet no longer hold true. A kiss, even a kiss on the cheek, in the time of a pandemic makes people nervous. Early on in this global health crisis, French President Emmanuel Macron suggested curtailing the country's beloved cheek kiss to avoid spreading COVID-19.
Now we're in a new era – the vaccine era. It's not an equitable era in terms of vaccine rates. But people are getting their shots around the world.
The French have reportedly begun cheek kissing again – although not everyone feels comfortable resuming this venerable tradition.
And kissing isn't the only person-to-person contact that has come in for a pandemic rethink. There's hugging and handshaking, too.
In Nigeria, says Dr. Ifeanyi Nsofor, "most Nigerians have moved on as far as COVID-19 is concerned. Both the vaccinated and unvaccinated hug and shake hands freely. A few people still fist-bump though."
He says he'll hug a friend who is vaccinated but otherwise prefers a fist bump.
So the question looms: For those who've been vaccinated, how up-close and personal can you get?
The answer depends on various points.
First, let's consider how you catch COVID-19. "The data itself hasn't changed," says Dr. Jill Weatherhead, assistant professor of adult and pediatric infectious diseases at Baylor College of Medicine. "This virus is transmitted through respiratory and aerosol droplets. So we know closer contact with infected individuals will increase your risk of becoming infected."
But vaccination does offer protection. A vaccinated person who's infected will breathe out far fewer particles with pathogens and has greater barriers against getting infected. "Although, as we've learned with delta variant breakthrough transmission, infection is still possible in the vaccinated — although much less likely," Weatherhead notes.
Then there's the matter of how much time goes by during a close contact with someone. We've all heard from public health agencies that the longer you're exposed to somebody who might be contagious, the greater the risk that you'll get infected. A lot of people talk about 15 minutes of close contact putting you at risk – either a chunk of time or 15 minutes spread out.
That's a bit simplistic, says Seema Lakdawala, an associate professor at the Center for Vaccine Research at the University of Pittsburgh School of Medicine. Even less than five minutes of close exposure in a packed indoor room might be all it takes to catch COVID-19. "If the person is extremely infectious, being up-close to them indoors is very high risk," says Dr. Abraar Karan, an infectious disease doctor at Stanford University. "Hugging is as close as you can get."
By contrast, if you're outdoors, where airflow disperses those particles of pathogens, 15 minutes or more of contact might not be risky.
So that brings us back to the question: to hug or not to hug?
"I am a hugger by nature," says Lakdawala. "If I know the other person is fully vaccinated and I'm fully vaccinated, I'll give them a hug. I'm OK with that level of risk." She would generally wear a mask, although says she would hug her sister with no mask. Knowing her sister's routine, she says, "I am willing to take on her level of risk."
But she would take circumstances into consideration. "In a crowded bar, no," she says. Too many risks – you're inside, you're up-close with lots of other people as well. "Outdoors, I'm OK."
A greater risk than a hug would be "sitting in an enclosed space with somebody you don't know," adds Charlotte Baker, assistant professor of epidemiology at Virginia Tech.
Baker, who is immunocompromised, is OK with hugging, too, with a couple of provisos: "As long as people are masked up and I know where you've been, I don't really have a problem with hugging."
As for the "where you've been" point — if the hugger or huggee say, was on a six-hour flight the day before or very recently attended an indoor concert — that might make you reconsider or make sure that you and the person you're hugging are wearing masks.
Then there are people outside your close family/friend "bubble" whom you might want to hug – but may have jobs in fields that expose them to lots of potentially contagious folks, such as health care, education or the service industry.
"Their risk for getting COVID is different than mine. I don't think I'd walk up and just hug them," says Baker. "That would be a circumstance where I don't know your risk, and you don't know mine."
To sum up: The new reality is to share your personal status and preferences.
"I think most people at this point ask first – because everybody has a different tolerance level," says Weatherhead. "If you are the hugger, ask if people are comfortable: 'I'm vaccinated and would love to give you a hug.' "
It would have been really weird pre-pandemic to ask "are you vaccinated against, say, the flu?" before hugging (or cheek kissing or shaking the hand of a stranger).
Now, she suggests, it is part of the new normal. "It's not an unreasonable or awkward thing to state anymore."
And that kind of open dialogue is important before hugging a kid, too.
"Ask the parent," says Baker. "And the parent should likewise ask any person the kid wants to give a hug to."
It's important to consider precautions when hugging children as well as adults, Baker adds: washing hands before and after, staying away from anyone who has been sick or exposed to a COVID patient.
The relationship of the adult and the child is also something to consider in weighing risks: "I would definitely rate grandparent hugs over neighbors."
Here's a rundown of potential risks from other up-close-and-personal interactions. In every case, it's your own tolerance of risk and other personal details that will inform a decision.
The cheek kiss: Being vaccinated offers protection, and the cheek kiss is fleeting. "Unless you took your hand and wiped your cheek and wiped your mouth," says Weatherhead, you'd likely be at very low risk of any infection.
The air kiss: "You're blowing air in someone's face," says Lakdawala. "I think a hug is less risky than an air kiss," says Lakdawala. Blowing a kiss from across an uncrowded room doesn't concern her. But "if you're a foot away from somebody and [want to] blow them a kiss, why not give them a hug?" she says.
The handshake: Getting germs on your hands doesn't make you catch COVID-19. But the risk isn't zero. Say the person you're shaking hands with is a stranger you're meeting at work. It is possible the person has been infected and shows no symptoms. Maybe they sneezed or coughed on their hand. Then you touch their hand. And ... you bring your hand to your face, because all of us touch our faces far more often than we think.
One solution is to hand sanitize after a handshake. So that little bottle of hand sanitizer you may have carried early on in the pandemic is still a useful item for your purse or pocket.
Another solution: Give up handshakes! "I don't handshake anymore," says Lakdawala. "People touch their faces way too much – to adjust their glasses or mask." If someone sticks out their hand she'll say something like, "Oh yeah, we're going to elbow bump or fist bump because it's COVID time."
The elbow bump or fist bump. An elbow bump is pretty, pretty low risk, especially if you're not breathing in each other's faces while bumping. So the other person would have to have pathogens ON THEIR ELBOW OR FIST and you'd have to pick up those germs ON YOUR ELBOW OR FIST and then BRING YOUR ELBOW OR FIST to your eyes, nose or mouth to become infected. Unless you're a professional contortionist, this seems like the unlikeliest of scenarios to catch a virus. Ifeanyi Nsofor, the fist-bump-loving Nigerian physician, is definitely onto something!
P.S. If you're just an extraordinarily cautious or vulnerable soul, there's always the air hug!
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