Greeting Etiquette in the Age of Ebola

Do not greet people with hand-shaking, avoid body contact with others
until the crisis is over. ~ World Health Organization

There is irony in the cultural lore of handshaking having originated in Europe during the Middle Ages as a lifesaving measure to demonstrate that neither person was carrying a weapon in his hand or up his sleeve, and today’s declarations from medical experts that handshaking could possibly be a life-threatening gesture because it can transmit deadly viruses and bacteria.

With the current threat of Ebola spreading, the handshake seems to be fast becoming a health liability rather than a social asset. But this isn’t the first time that handshaking has been targeted as a conveyor of dangerous viruses and bacterial infections; remember H1N1 and MRSA? And those who are considerate of others regularly decline to shake hands to avoid spreading the common cold and seasonal flu viruses.

But, it won’t be easy to make the shift away from routine handshaking, which in the Western part of the world has evolved into an essential form of greeting and communication in social situations and has been de rigueur in the practice of business etiquette. Handshaking is also a demonstration of one’s character, savvy and strength. A person is often judged by his or her handshake because it’s so intimate a gesture. You’re actually touching someone in an acceptable manner; in doing so you obtain the measure of a person through the firmness of the grasp, dryness and warmth of the skin, proper engagement of palm and thumb, amount of pressure applied, angle of the hand, etc.

The power of a handshake is such that we will often remember it even if we forget the possessor’s name and when and where we met him or her! Whether a job candidate is hired or a business deal is closed is frequently influenced by the impression made by the handshake.

And, in the past century or so, through intercontinental trade and global travel for business and pleasure, the tradition of the handshake has reached around the world to other cultures.

Take away the handshake and we lose a critical component of obtaining an impression of someone.

Etiquette Rules Adapt To an Ever-Changing World

That is precisely, however, what is occurring in our society in the wake of the H1N1 pandemic scare of 2009 and its resurgence in 2014, the resistance of the MRSA bacteria to the usual antibiotics, and now the threat of Ebola in the U.S., Canada and Europe.

But it is the news of Ebola reaching beyond Africa that is currently commanding everyone’s attention. And because there is more to be learned about Ebola — even prominent doctors and scientists disagree with each other on all the ways that the virus can be transmitted — it’s wise that everyone keeps up with the latest news and errs on the side of caution in preventing its spread. That includes limiting or forgoing handshaking.

According to a CNN Health report, ”People in West Africa are avoiding hugs and handshakes because the virus can be spread through the sweat on someone’s hand. The uninfected person would have to have a break in the skin of their hand that would allow entry of the virus, CNN’s Dr. Sanjay Gupta says. ‘We all have minor breaks in our skin. And there is a possibility that some of the virus can be transmitted that way.’”

In addition to some medical experts fearing that the Ebola virus can be spread more easily than is being assumed, there also could be loopholes in some of the preventative procedures. For example, while we’re being assured that travelers are being checked at airports for fevers before boarding flights, an LA Times article quotes an expert as saying that “a person could pass body temperature checks performed at the airports by taking ibuprofen or any common analgesic.” Therefore, it’s essential that every person take responsibility and initiate her or his own precautions, which might include the adoption of alternative forms of greetings other than handshakes.

Aside from the current Ebola threat, here are some other reasons that people might avoid shaking hands:

  • Transmission of temporary illnesses, such as the common cold and seasonal flu
  • Spread of other life-threatening germs, such as MRSA that is resistant to the usual antibiotics
  • Injuries to the hand
  • Chronic diseases, such as arthritis, that make handshaking painful
  • Loss of arm, hand
  • Use of a prosthetic arm or hand that is unable to grasp
  • Religious or secular customs that discourage or prohibit shaking hands

Following are some popular and viable alternatives to handshaking:


Namaste is the lovely and quite formal greeting that originated in India. Nirmala Lalvani, Etiquette Trainer from India, says, “The namaste in India is a secular greeting and used by one and all, but it is also widely used in countries where Buddhism is prevalent, such as Thailand, Vietnam etc.”

This approach is a departure for many Westerners who like to demonstrate great energy and enthusiasm in their greetings, especially when they are making first impressions. However, this very respectful form of greeting could well be appropriate in certain circumstances where one wishes to make a quietly powerful presentation.  


Business etiquette expert John Daly knows people who in lieu of a handshake have started using the Japanese form of greeting. Says Mr. Daly, “I think for the safety and health of all citizens that some other form of greeting might be advisable until this potential epidemic threat is conquered.”

Like the Indian greeting this lovely, deeply respectful and comparatively gentle alternative to handshaking might take some getting used to for Westerners, but with practice it could be the perfect alternative.

West African Greeting

Business etiquette consultant, trainer, speaker and columnist Arden Clise likes the West African “clasped hand head bow approach.” “It’s not religious,” Ms. Clise says, “and I like that it’s obvious by clasping one’s hands you’re not going to shake someone’s hand.”


This is a surprising one, but it might make sense. After all, this isn’t the first time healthcare authorities have cited the elbow in preventing the spread of germs; it’s suggested that you bend your arm and use the inside of your elbow to catch your sneeze when you cannot transport a tissue or hanky to your nose and mouth in time to do so. Image expert and consultant Clare Maxfield recently referred participants on a LinkedIn forum to a radio interview on WGN (Chicago) in which infectious disease expert Dr. Aileen Marty recommended a greeting that appears to be using elbows.

Fist Bump

Historically used by boxers, bikers and baseball players to greet each other, the fist bump is enjoying a growing popularity in many informal as well as business occasions. It’s enthusiastically advocated by the healthcare community as a gesture that spreads far fewer germs than handshaking. You might already be on board with proper fist bumping; but, if not, why not prepare yourself so you’re ready should a fist bump come your way?

Some Cautionery Advice

Okay, you say, it’s fine that we stop shaking hands, but which of these alternatives should we adopt? With all the choices, what happens if in a group of people being introduced one person bows, another fist bumps and another makes a go for your elbow? Yes, that’s quite a visual and I can see an SNL sketch or a Tonight Show monologue forming! But, in reality, the initial awkwardness will likely be the extended hand to shake yours and you instead bow, explaining your shift in greeting etiquette. However, once the word spreads about the alternatives to the handshake, groups of people in specific situations will begin to adopt an appropriate greeting that fits the people involved as well as the occasion. We’re just starting the conversation and it is, as they say, a process.

Another issue to consider in your shift from the handshake to other greetings is to develop an awareness of what certain gestures mean in different countries and cultures so you can avoid making a faux pas. This Huffington Post Business feature contains helpful tips on that score.

Art Imitates Life: Contagion, the Movie (Spoiler Alert!)

As an example of art imitating life, in the movie, Contagion (with an all-star cast that includes Matt Damon, Kate Winslet, Jude Law, Laurence Fishburne, Marion Cotillard, Bryan Cranston and Gwyneth Paltrow), which was made in the wake of the 2009 H1N1 scare, a woman contracts a deadly virus and unknowingly ignites a mega and rapid-fire epidemic. At the end of the movie it’s revealed that this human disaster resulted from two people engaging in hand-to-hand contact.

Can We Do It?

I think this quote in the Psychology Today article by Dr. Alex Lickerman, Internist and former Director of Primary Care and current Assistant VP for Student Health and Counseling Services at the University of Chicago, reflects the conflicted feelings of many regarding the handshake and spread of illness: “So here I am, making a case to change one of the most cherished traditions in Western culture. I don’t have much hope that my plea to stop all this handshaking will be heeded, though. I don’t think I can stop even myself. I like shaking peoples’ hands. Touch cements trust, an important feeling the handshake has long symbolized. Yet we can’t deny that a handshake has become, in one sense, a modern-day health hazard with the capacity to spread infectious diseases at an alarming rate.”

Until next time,


5 thoughts on “Greeting Etiquette in the Age of Ebola

  1. Stephen Spencer says:

    The age of Ebola has not quite reached the United States…yet. So far, it is contained to a few isolated cases. I know my church has people wave to each other rather than shake hands during flu season only, but then does return to handshaking. Currently, no need to alarm ourselves in the United States and most other countries. However, Ebola should not be underestimated, either. Although it is said by the CDC that the virus in not an airborne virus and is only transmitted by contact with the infected person's saliva and blood, and waste, with an epidemic such as in Liberia and neighboring countries at an alarming rate, that's a lot of spit-swapping. I would still treat it as an airborne virus, particularly when there is sneezing. And contagion is underestimated as well. Although it is highest when symptoms are present, they still have the virus and there is still the low possibility of transmission through coughing, sneezing, and such. However, to be fair, one of the major contributors in Africa to the epidemic is the original host carrying the virus, which is the fruit bat in Africa. They have tested positive to the virus, and do eat or suck on fruit that the people use for food. This is an easy mode of transmission from host, to food, to the general population. The solution would normally be to eliminate all fruit bats one way or another and repopulate the terrain with mosquito-eating bats, as we have here in the United States. However, care must be given the two species of bats do not mate and produce a bat that does both. That is an extreme possibility, and tracking down fruit bats in Africa would be difficult. The solution is an Ebola vaccine, which at present there is none. If Ebola does hit the United States, giving up handshakes would be highly recommended, as well as quarantine and isloation methods to counter the spread of the virus. Sadly, we really do need to restrict travel to these infected regions with the exception of humanitarian care and supplies.


  2. Elaine Gagne says:

    It's so funny you wrote about this today! As I watched the news this morning, I was thinking I would adopt the Japanese greeting. However, after reading your article, I think I'm going to follow the West African greeting. I like that it shows the double respect of both the bow AND a "self" handshake. I think it's also a nice gesture and reminder that we should continue to send our thoughts to that country. What a wonderful tribute.Thank you, Jeanne, for taking care of our health as well as our minds and careers!Elaine


  3. Scott D says:

    I like the fist bump. Not only is it more hygienic than a handshake, it is also less stressful. I don't have to worry if my fist bump is not firm enough, etc. There is no art to the very efficient fist bump.


  4. Jeanne Nelson says:

    Thank you for your comment, Ahona. I agree with you about the Namaste. I also agree with you regarding the difficulty we'll encounter in making the switch from handshaking, which I prefer; but over time I believe we can learn to be comfortable with the various alternatives. I doubt that the handshake will ever go away, but I believe we must be aware and sensible about those times when it's not advisable to use it.


  5. ahona says:

    Yes, Jeanne, the Indian 'Namaste' or 'Namashkaar' is the safest gesture of acknowledgement, of course, with a warm smile, it can be disarming! A formal loose "hug" (only if appropriate) is better than the skin contact! It would be difficult for the Western world to not to extend a hand, it's a bit of a reflex action and then one cannot withdraw and ' join hands' in a "namaste"! Even we, over the years, have imbibed this culture because it is accepted "global"The big question is 'can we do it?'


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