health

Can we ever hug again?

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Humans need touch, and with the twin arrivals of springtime and COVID-19 vaccines, skin hunger borne from a year of social distancing and sequestration is becoming harder to bear. As more and more people become vaccinated and feelings of hope begin to unfurl as surely as a crocus peeping through the mud, I want to know what everyone wants to know: When can we hug people without worrying about coronavirus transmission?

“That’s the million dollar question,” says Beth Thielen, a physician-scientist at the University of Minnesota Medical School who specializes in respiratory diseases like the novel coronavirus. Thielen, like so many people, has restricted hugging to a select few in her COVID bubble. But when are we going to be able to embrace anyone we’d like, at ease?

Realizing your risk—to yourself and others—is key to coronavirus prevention

“I think it’s a little too soon to make a firm commitment as to exactly when we’re going to be back to hugging,” Thielen says, adding that we might not ever return to dispensing this once universal form of affection quite as liberally as we did before. For many people around the world, a cornerstone of the past 12 months has been a relentless check and recheck of one’s individual risk and the danger they pose to others. That mindset is unlikely to shift anytime soon—nor should it.

As a pediatrician, Thielen says, she’s witnessed the emotional fallout of isolation over this past year and understands firsthand the necessity of finding ways for people to safely meet the need for human contact. The question of when it will be safe to squeeze friends with abandon, Thielsen says, largely depends on the success of the vaccine rollout. Assuming vaccination rates continue to climb, and also presuming that the vaccines continue to be as effective against emerging coronavirus variants, we will soon get a better picture of when and how we can relax certain pandemic protocols.

For now, it’s crucial to weigh the risk you pose to yourself and others when you go in for a cuddle. Thielen says it’s necessary to assess the likelihood that the people you wish to hug have been exposed to COVID-19 and consider if either of you could get seriously ill if you contracted the novel disease—even if you’ve both been vaccinated, as it’s not yet clear whether these shots keep people from spreading the coronavirus asymptomatically.

Additionally, people must consider who else that hug might spread illness to, if transmission does occur. Unintentionally giving COVID-19 to your friend through a much-desired squish could have additional downstream effects if they have vulnerable family members or work in a public-facing job. It’s not just personal risk we’re talking about; it’s the threat to the community, too. “If it’s somebody who’s working in a bar or a restaurant, and particularly in places and parts of the country where they’ve decided to just completely do away with any mask mandates for example, those are going to be probably riskier areas,” Thielen says. “Likewise, if somebody’s older and hasn’t yet been able to get a vaccine, I think that I would factor that in.” There’s no one answer. A vaccinated pair of friends who practice social distancing, wear masks, and both work from home pose a much lower public health risk than, say, a vaccinated pair of friends who work at two different indoor restaurants and both have unvaccinated, elderly relatives. As frustrating as it may be, individuals will have to continue calculating such risks and making the best decisions they can for months longer.

[Related: Where are we most likely to catch COVID-19?]

Moving forward after the COVID-19 pandemic means treading in uncharted waters

This week, the CDC released new guidelines for fully vaccinated adults (vaccines for children are still being tested, and we should be careful to remember this in our discussions of who is vulnerable to infection and who can spread it). In the new guidance, the CDC says that fully vaccinated people can meet indoors with other fully vaccinated people, mask-free, and can even hug. The CDC also states that fully vaccinated people may gather maskless with unvaccinated people from a single other household, so long as no one in the home is at high risk for severe illness from COVID-19. This is because we don’t yet know if vaccinated people are able to spread the virus to others. Since there is still a risk of severe illness for unvaccinated people, those with the vaccine must maintain proper safety protocols and continue wearing masks to protect people who do not have bolstered immunity to the virus. If someone who is vaccinated is actually infectious, then, from a public health perspective, limiting their exposure to a single additional household should help blunt the potential spread. But if transmission is possible post-vaccination and every vaccinated person in America goes out partying, we’re in trouble.

The CDC’s proposed scenario is not a zero-risk situation, rather one of many risk management strategies that we’ve grown accustomed to while managing life during a global pandemic. We aren’t out of the woods yet, but there is reason to be hopeful.

After COVID-19, will hugging always be risky?

“As somebody who studies respiratory viruses, one of the things that has been really striking is how little of other infections we’ve been seeing,” says Thielen, noting that cases of influenza and respiratory syncytial viruses, or RSV, another common respiratory illness that can be deadly in infants and olders adults, are massively down. She says that in her mind, it raises the question of whether we should even attempt a return to full-contact normality as it once was. Should we preserve some of the safety measures adopted this year, given how successful they have been in reducing other infections? Should we ever go back to shaking hands?

“I think this is a really good thing that we should ask ourselves,” says Thielen. “There are cultures around the world where shaking hands is not the predominant mode of greeting, and from an infectious disease doctor’s standpoint and a public health standpoint, I think bowing or waves or even the elbow bumps that people are doing are healthier ways to avoid spreading infection.”

It’s not inherently dangerous to shake someone’s hand if you follow it up with good hygiene and are sure to wash up before touching your face or eating. But, as Thielen notes, “it’s just really an uphill battle to get people to really do the kind of hand hygiene to make those things safe.”

Speaking of hygiene, what about blowing out birthday candles? After a year of pandemic life, the idea of someone else’s spittle spraying over a shared dessert seems less innocuous than it used to. “We’ve tolerated people blowing out birthday candles all this time, but I think [the pandemic has] opened our eyes to all of these infectious disease risks,” Thielen says. “Maybe a silver lining of this is that people realize how much we’ve tolerated this burden of low-level viral infections, and that maybe we do actually have the implements in our toolbox to make that substantially better.” These days we have a chance to reconsider how much infectious risk we want to tolerate. That said, for some people, the transition back to increased social contact will come easier than others.

Susan Beth Miller is a psychologist who has written extensively about disgust and how it functions as a protective mechanism for the self. In the context of a year of pandemic living, our feelings of contagion-relation disgust might be off the proverbial charts, compared to how we felt about germs and social contact before a year in quarantine. “I called it the gatekeeper emotion because it establishes a barrier between the self and something outside the self,” says Miller.

She says that it’s likely that the most common and fundamental response to the pandemic is fear, “and for some people, disgust becomes a way to protect oneself.” For these people, re-entering the world after such a scary period of isolation might bring up new feelings of dread and anxiety, even once it is fairly safe to embrace our loved ones. “With the pandemic there will be some people who will make a conversion of fear into disgust, so that they will have a heightened level of disgust towards people,” she says.

This is no doubt a challenging addition to the suite of pandemic emotions that have plagued us this year, but it remains surmountable, if people are open to working on their stress. Miller recommends that, when it’s safe to do so, people with such anxieties find ways to lose themselves in pleasurable situations, such that “the pleasure starts to override the fears.” In other words, dancing in a club full of strangers might be a good way to stop feeling on edge whenever you have to be around groups of maskless people— but only once both scenarios are safe, of course.

The reality is that we are likely in for another year of pandemic risk-assessment, masking in public, and carefully considering our personal and public safety protocols. It’s also true that this year is different than last, and that things are changing with the advent of vaccines, opening new possibilities for reconnecting with loved ones.

While it may be tempting to throw caution to the wind and give urgent bear hugs to every single person you’ve missed so dearly, the reality is that careful, considered baby steps toward safe social contact will help preserve the gains we’ve made against the waves of death that have so relentlessly pummeled our communities.