12.Namaste: An Etiquette For Disease Control

Namaste:An Etiquette for Disease Control

VetPubHealth Journal ISSUE 17 IVSA Standing Committe on One Health April 2020 Travel patterns and ages of exploration refer to period between 15th to 17th centuries. A new height was gained by technological advancement along with new products and new discoveries of land around the world.During this time, different people from societies around the globe began to integrate that resulted emergence of new diseases. The Earth is now a global village. We can travel from Australia to Ireland which is 9680 miles apart in 17.29 hours. Land, sea and air transport routes and networks are expanding day by day. Number of passengers and amount of goods that are being transported from place to place is increasing. With this the pathogens and their vectors are moving in large number further faster than ever. Global travel has resulted more new diseases than ever before in last five centuries before becoming potential pandemics. Human mobility has increased by 1000 fold in high income countries since 1880 (Wilson,1995, 2003).As world economy continues to grow aviation in particular has expanded. Global passenger number has grown by nearly 9% per annum since 1960. Moving from place to place makes people meet new people. Meeting someone after long time or in a new place with different situation compels a person to show respect towards the next person. We generally show respect and generate a level of etiquette to greet other people. There’s an amazing diversity of greetings customs around the world. In Tibet sticking out your tongue can be way of welcoming people. In some part of New Zealand, Mori greet each other by touching noses. In most of the western countries including Europe, people hug or kiss on cheek as their norms. It depends upon religion, culture and ethnicity. But, it all comes to handshaking habit of human beings in case of greetings. We often do handshakes while meeting other people. It’s considered as a gesture of peace. From life of a normal person to a high diplomatic person, handshake is very popular. We students go to college and hand shake, a leader from one country visits another country, meets some leaders and shakes hand with them during a formal meet. A celebrity attends a ceremony, meets other celebrities of his kind and shakes hand. In fact handshake is everywhere, from our home to school, college, offices, ceremonies, etc. It’s so ubiquitous that you may never have thought about why people shake hands. The history of the handshake dates back to the 5th century B.C in Greece. It was a symbol of peace, showing that neither person was carrying a weapon. During the Roman era, handshake was actually more of an arm grab. It involved grabbing each other’s forearms to check that neither man had a knife hidden up his sleeve. Some say that the shaking gesture of the handshake started in Medieval Europe. Knights would shake the hand of others in an attempt to shake loose any hidden weapons. But with the gradual change in the modern times, this culture is considered unsafe in case of hygiene. During handshake two persons grip each other’s palm accompanied by brief up and down movement, which develops direct contact between persons by the means of hand. According to several research studies, almost 80% of pathogens can transfer during a normal handshake from one person to another depending upon relative humidity. The number of microorganisms on intact areas of skin in the same person can vary from 100- Aashish Adhikari 35

VetPubHealth Journal ISSUE 17 IVSA Standing Committe on One Health April 2020 106/cm2 (Jumaa 2005). Inanimate surfaces found in day care centers, schools, office buildings, homes, public areas or hospitals can be reservoir for secondary mode of transmission with contaminated hands playing a critical role as route of exposure. If a person’s hand is well sanitized but shakes hand with another can cause serious problems of transmission of harmful microorganisms and can result infection. Spores of Clostridium difficile have been shown to be transferred via handshaking as have Enterobacteriaceae, Pseudomonas and Staphylococcus aureus. Inanimate objects, or fomites, are a potential reservoir in the transmission of pathogens either directly, by surfaceto-mouth contact, or indirectly, by contamination of fingers and subsequent hand-to-mouth, hand-to-eye, or handto-nose contact. Many people don’t take hand wash into consideration in day to day, even by health workers. This is resulting as a global threat to transmit infectious diseases from person to person especially; air borne. So, the handshake is such a terrible idea from an infectious disease standpoint. Discussing about the history of air borne epidemics and pandemics, 1889- 90 flu pandemic (also called Asiatic or Russian Flu) which lasted till 1995 in four different stages due to transmission killed one million people worldwide. Spanish Influenza Pandemic of 1918- 1919 AD commonly known as ‘Spanish Flu’ is considered as the mother of all pandemics which lasted from 1918 to December 1919. It affected one third of world’s population; nearly 500 million. Total death was estimated around 50 million and were arguably as high as 100 million (Taubenberger & Morens, 2006). Likewise, Severe Acute Respiratory Syndrome (SARS) came as an epidemic disease in 2002-2003 that affected 26 countries mainly China which caused 770 death out of more than 8000 (WHO 2020). Middle East Respiratory Syndrome (MERS) is another infectious disease, a viral respiratory infection caused by MERS-corona virus in September 2012. At the end of November 2019, total of 2494 laboratory confirmed cases of MERS including 818 associated deaths were reported globally, majority of cases in Saudi Arabia (WHO 2019). Swine Influenza also caused pandemic condition in 2009-2010 in almost 80 countries with more than 4100 death out of more than 340,000 confirmed cases. This influenza has caused problems several times since this pandemic condition by changing its antigenic properties. The causative agent of this influenza is considered to be new strain of Spanish Flu; H1N1 strain (WHO 2009). And now Novel Corona Virus has caused a global pandemic condition with a disease named Covid-19. It started from city of Wuhan, Central China and has reached 195 countries causing 16,231 deaths till this article was prepared out of 372,757 confirmed cases (WHO, 2020). The antidote for this disease is not discovered yet. These are some of the examples. There are many other outbreaks in the history that has caused chaos transmitting from person to person. Some are vector borne while many are air borne. There is no any alternative than taking measures to prevent such chaos from each and every sector. So to control infectious diseases which are mainly air borne, alternatives for handshake should be kept in mind at first which can be a simple but big step in preventing transmission of disease. We can prefer doing ''Namaste', a South Asian culture to greet people around you. It is a typical way to greet and respect people joining two palms in front of third eye, bowing head and bringing hand together down to chest. This is good tradition to show respect joining hands at the level of chest. It's quite easy and has many benefits over handshake. In this context of global threat of infectious disease, Namaste can be a useful replacement which transfers 0% microorganisms. There is no any contact between persons and we can do it maintaining considerable distance. Spiritual meaning of Namaste 36

conveys 'the divine in me respectfully recognizes the divine in you’. Today the world is in chaos caused by infectious disease like Covid-19. Novel Corona Virus has caused a havoc situation all around the globe with possible mutation in coming days. Human encroachment in wildlife and disturbances in ecosystem has result many infectious diseases. In this situation, handshake must be avoided from our daily habit. Instead, 'Namaste' culture can be adopted. Today leaders around the globe are adopting Namaste as a greeting culture instead of handshake to avoid possible danger caused by infectious diseases. Success against disasters is not possible unless we don't think wisely and realize that change starts from a small step. References: P.A. Jumaa (2005). Hand hygiene: simple and com- plex. International Journal of Infectious Diseases, 9(1), 3-14. doi. 10.1016/j.ijid.2004.05.005 Taubenberger, J. K. & Morens, D. M. (2006). 1918 influenza: The mother of all pandemics. Emerging Infectious Disease, 17(1), 69-79. doi. 10.3201%2Feid1201.050979. WHO (2020). Coronavirus disease 2019 (COVID-19) Situation Report – 62. Retrieved from: https://www. who.int/docs/default-source/coronaviruse/situa- tion-reports/20200322-sitrep-62-covid-19 WHO (2020). International travel and health dis- ease information on SARS. Retreived from: https:// www.who.int/ith/diseases/sars WHO (2009). Weekly epidemiological record. Re- treived from: https://www.who.int/wer/2009/ wer8447 37

WHO (2009). MERS monthly summary November 2019. Retreived from: https://www.who.int/emer- gencies/mers-cov Wilson, M.E. (1995). Travel and the emergence of infectious diseases. Emerging Infectious Diseases 1, 39-46 Wilson, M.E. (2003). The traveler and emerging infections: sentinel, courier, transmitter. Journal of Applied Microbiology 94, 1S–11S.