 What's up YouTube? This is Dr. Ali Hader, interventional cardiologist. Thank you for checking into the channel. If you have not subscribed, please hit that button and smash that like button for this video as well. What I want to ask today is the handshake a thing of the past. You don't ever shake anybody's hands. That's clear. Amidst this COVID-19 crisis, we've resorted to social distancing and quarantining to try and prevent the spread of this contagious disease. Whenever we're out in public, we're wearing masks. We're trying to stay six feet away from each other to distance ourselves, which by the way, is not easy at the grocery store. So it's no surprise that the most common and perhaps the least hygienic gesture of human interaction is getting the stink eye. I'm talking of course about the handshake. Once thought of as the most routine, common and expected way to greet people, now makes people cringe at the thought of acquiring COVID cooties from actual human contact. Now I'm sure when many of us now even see this endangered gesture occur, we can't help but to think when was the last time that hand had a 30 second soap and water wash or a hand sanitizer recession before touching that other person. Oh the mere thought of actual human skin contact and all the pathogens that could come with it. So of course it's gone from a completely expected and normal thing to a big no-no. But what is going to happen now? Is the handshake gone forever? Are we forever destined for fist pumps, elbow bumps, namaste and salutes? Now I was a little curious where exactly was the origins of the handshake. Now the first obvious evidence we have of a handshake dates back to the 9th century BC, the Assyrian king, Shalman Isara III grasping hands with a babbling ruler to seal an alliance. Now many ancient civilizations utilized the handshake as a show of peace and to prove that they're not holding any weapons and be no harm to the other party. These days we basically use handshakes in various different scenarios of daily living. One of course is to greet other people and to serve as an introduction for people you know and for people you don't know. The second is a way of coming to an agreement, striking a deal, whether it's business or politics, etc. And it is used as a sign of respect. Even for those who are your adversaries or foes, whether it be in politics or in sports, it is universally a sign of respect. In fact the handshake is probably one of the most common physical gestures we use as humans. And now enter COVID. Now it's not like this is the first contagious virus or bacteria we've dealt with. However, COVID is indeed a deadlier disease, a more contagious disease and are more rapidly spreading one than we are used to. Now there are plenty of people out there who never really shake hands. We refer to them as the germaphobes. I even have a partner in my practice who refuses to shake hands and he sticks to elbow bumps especially during influenza season because they don't want to acquire flu or a virus or anything else that may be floating around society. And we used to make fun of them. But who's laughing now? Now I also asked a question, is there actually evidence that a handshake is actually dirtier and worse than let's say a fist pump? Or perhaps we can compromise and do a high five. I'm not giving up on this guy. Prop his hand up. What? I said prop his hand up. And really how dirty is a handshake? So recently a study actually came out in the American Journal of Infection Control. And what they wanted to do is to figure out how dirty in fact was a handshake compared to a fist pump and compared to a simple high five. And they actually looked at various durations of contact and how strong a particular handshake was to figure out transfer of bacteria to see what was dirtiest. Now these were experimental conditions. It wasn't actually real life. So again take it with a grain of salt. What they did was they had a subject take a sterile glove and they dipped that sterile glove into basically a pool of E. coli bacteria. Disgusting, I know. And they had another subject wearing a clean sterile glove. And once that bacteria sort of dried in cake door, they engage in three different gestures. And what they found was that the fist pump had the least amount of transmission of bacteria. It also had the least amount of surface area of contact. The handshake on the other hand had 20 times more bacteria transferred than the fist pump. This actually increased with a stronger grip handshake. The high five was somewhere in the middle. But still significantly less than the handshake. The longer the duration of contact for the fist pump and the handshake also showed an increase in bacterial transmission. So what does this tell us? Well three things went into the risk of transmission. One was the surface area of contact. Two was the duration of the contact. And three was the strength of the contact. Okay, so we prove what we expected we would find that a handshake is probably the dirtiest gesture of greeting people. So what now? Well, let's be real. Seeing that society is going to eliminate the handshake and go simply to fist pumps and elbow bumps doesn't really seem realistic if you ask me. Now certainly an elbow bump is a little silly. It's awkward. And I really don't think that is going to replace anything. A fist pump however is very reasonable. It allows you to maintain eye contact. It's ergonomically favorable. And it's pretty cool. So what does this mean? Do we replace the handshake with a fist pump? Also, I think it's important to note that most people are using the inside of their hands when they touch object, etc. So in general, the back of your hand such as a fist pump is probably going to have less pathogens than the palms of your hands or your fingertips. Now perhaps in some settings such as hospitals for example, the handshake should be eliminated. Hospitals clearly have more concentration prevalence of pathogens. And doctors and nurses are interacting with patients and surfaces. And not to mention that studies have shown that doctors 60% of the time are not really practicing proper hand hygiene, believe it or not. So maybe we should rethink the handshake in the hospitals. I mean, what is the appropriate way for doctors to even greet each other? So I vote in places like hospitals and nursing homes where there's high risk and concentration of disease transmission. Forget about the handshake. Let's stick with the fist pump or elbow bump or air pound. However, in the world of business, politics, personal relationships, handshake has an important role. So what are people going to do? For a lot of people, I think things are going to go back to normal and they're not going to think twice when they shake hands with people. For another group of people, there's going to probably be a whole new era of germaphobes that are born. However, for others, myself included, I'm not ready to give up on it. What we may need to do is just be hyper vigilant with our hand hygiene. So instead of just meeting someone and shaking hands, perhaps we should, in front of each other, hand sanitize and then shake hands, replace the shake with sanitize and shake. I'd also like to see hand sanitizers universally in schools and office buildings, etc. and all public places where people have to greet each other. And frankly, if that's what it takes to keep the handshake alive, I'm all for it. Until then...