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The Liberian Elbow Bump Is Your Good Friend During Flu Season

The Liberian Elbow Bump Is Your Good Friend During Flu Season
Leif Parsons for NPR
The Liberian Elbow Bump Is Your Good Friend During Flu Season

Lately I've been thinking a lot about the Liberian elbow bump.

When Ebola overtook the West African country in 2014, many people were afraid to shake hands and embrace in the customary way. That's understandable, because Ebola is spread by the exchange of bodily fluids during body-to-body contact.

So Liberians came up with a less touchy-feely greeting. They bumped elbows.


The reason I thought of the elbow bump was a comment made by a teacher in a hot yoga class I take. In a room heated to 96 degrees, the students work hard at their poses (and also lift weights and do cardio). (I know, it's wild!) After a strenuous set of exercises, the teacher called out, "High five your neighbor."

And I thought... really? Slap my sweaty and possibly germy palm up against the sweaty and possibly germy palm of a stranger? During a flu season that has been described as "severe."

Wouldn't an elbow bump be less risky?

So I spoke to a couple of experts. And I learned a few things about the way we get infected with colds and viruses. And about the advisability of high-fiving.

Your hands get you in trouble.

"A fact that a lot of people get shocked about is that 80 percent of all cold, flu and upper respiratory infections and diarrheal illnesses are passed along to us by your hands." That's what Dr. Mark Gendreau told me. He's the chief medical officer for Beverly and Addison Gilbert Hospitals in Massachusetts.


What happens is that a large infectious droplet from a cough or a sneeze (or maybe just plain talking or singing) lands on a surface, where it can survive "for up to 24 hours," says Gendreau. Then your hand makes contact. And then you do that thing that humans do 200 times a day or so — you touch your face. "If you introduce enough of the microorganism to your eyes, nose and mouth, you're going to get the infection," he says.

Good luck with not touching your face.

"It's very hard not to do it even if you're telling yourself not to do it," says Gendreau. "It's like in our DNA." I wanted to know why that is, and he said, "I don't think anybody really knows why."

So if you can't stop touching your face, then what?

First of all there is hand washing with sanitizer or soap "at least 15 to 20 seconds," says Gendreau. "The time is of the essence. The goal is to disrupt the cellular membrane of the microorganism [to] kill it."

And drink!

Sorry, I mean water, not booze. "There's a structure in the back of your mouth and nose and top portion of your lungs and trachea called the mucociliary complex, says Gendreau. They're like "little tiny air cells" that beat in an upward fashion nonstop to move stuff out of you. Stuff like germs. "They become less effective if you're dehydrated," he says.

Also perhaps try some North American ginseng and elderberry extract.

"They have really strong science behind them. They rev up your immune system, they have antiviral properties and they're safe," he says.

During an outbreak of the H1N1 swine flu pandemic, he says, the city of Calgary wanted to stockpile Tamiflu ("which is really iffy in terms of effectiveness" says Gendreau). But they couldn't find enough. So they went for ginseng instead. Gendreau cites a study of Canadian nursing home residents. All of them got a flu vaccine; then about 100 of them were given twice daily doses of 200 mL (about .05 teaspoons) of North American ginseng extract and another 100 or so got a placebo. In the ginseng group, there was only one case of respiratory illness versus seven in the non-ginseng group. That's a 90 percent reduction in risk!

As for "elderberry syrup," it was studied in Sweden, where researchers found gave a 15 mL dose (about three teaspoons) of syrup four times a day for five days to one group of flu patients and a placebo syrup to another group. The elderberry sippers had relief from their symptoms four days earlier than the others.

Maybe you should worry more about what's in the air than what's on someone's hands.

In a new study in PNAS, Dr. Donald Milton says that he found that maybe those big infectious droplets shed in coughs and sneezes aren't the big problem. The body is pretty good at warding them off, he says. But fine particles of infectious material that people simply breathe out when they're sick "will penetrate deeper in the lung," says Milton, a medical doctor and professor of environmental health at the University of Maryland.

In his study he found that "48 percent of the fine aerosol samples acquired in the absence of coughing had detectable viral RNA." So if you have a fever but aren't coughing or sneezing, maybe you should consider staying home, Milton suggests. He stresses that more research needs to be done about the potential risk posed by these fine particles, "but it has tremendous implications for hospital infection control." Not to mention what's hanging in the air in my yoga class!

As for my high-fiving dilemma...

Gendreau says the riskiest type of person-to-person contact is mouth-to-cheek (so be wary of air kisses and full body hugs). "The bro hug is moderate risk," he says. That's a handshake that leads into a hug with a back pat.

"Handshake or high five is probably mild risk. Palm to palm is slightly riskier than knuckle to knuckle," he says. "Bacteria tend to congregate on the palm."

"I can high five you but you should wash your hands afterward," says Milton.

As for the Liberian elbow exchange: "Smart thing," says Gendreau.

"A very good thing," agrees Milton. "I like elbow bumps."

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