Touch in times of COVID‐19: Touch hunger hurts

The novel coronavirus, COVID-19, was first reported in Wuhan, China; in late 2019 and in March 2020, the World Health Organization declared the outbreak a pandemic (World Health Organization, 2020). What quickly became clear is that COVID-19 spreads rapidly between people who are in close contact (Nussbaumer-Streit et al., 2020) and so, in efforts to stem the tide of infection, public health messages about the importance of maintaining physical distance were consistent and clear. Initial government advice to vulnerable populations was to self-isolate and practise social distancing (Extance, 2020). Social distancing can and has involved the closure of business’, offices and schools, and restrictions around gatherings of people (Wilder-Smith & Freedman, 2020) alongside measures such as no handshaking, no hugging and instruction to stay 1.5 m or two arms lengths apart (Roser, Ritchie, Ortiz-Ospina, & Hasell, 2020). In this editorial, we discuss the wider implications of social distancing implications within the context of the COVID-19 worldwide pandemic and, in particular, the implications on human touch. Touch is fundamental to the human experience. It is an essential component of socio-emotional, physical, cognitive and neurological development in infancy and childhood (Hertenstein, Keltner, App, Bulleit, & Jaskolka, 2006) and an important form of nonverbal communication throughout life. As humans, we experience received touch and we reach out to touch others (Chang, 2001). Touch can be intentional (Connor & Howett, 2009) or functional (Bush, 2001) but is also used to convey affection, is central to the provision of comfort (Connor & Howett, 2009) and can be used to convey reassurance in times of distress (Holt-Lunstad, Birmingham, & Light, 2008). The importance of human touch can be seen in evidence that suggests the absence of affectionate touch or physical neglect can contribute to higher levels of aggression in adolescents (Field, 2002). Within health care, touch is also associated with conveying care, comfort, compassion and establishing connection and cooperating bonds between healthcare providers and patients (Connor, 2015). Social distancing rules invoked to help reduce the transmission of COVID-19 have put an end to many types of touch. For healthcare workers and patients, the pandemic has largely led to the elimination of skin-to-skin touch. Due to the ease of transmission and severity of COVID-19, the increased use of personal protective equipment (PPE) is a fact of life for health professionals during this pandemic. The use of PPE, while essential for patient and health professional safety, has been found to impede communication, situational awareness and decision-making particularly in emergency situations (Benítez et al., 2020) and while gloves provide a (necessary) physical barrier between nurses and patients for safety, gloved touch is not the same as skin-to-skin touch and can create an emotional barrier (Nist et al., 2020). When touch is limited or eliminated, people can develop what is termed touch starvation (Pierce, 2020) or touch hunger (Mortenson Burnside, 1973). Touch hunger impacts all facets of our health and has been associated with increases in stress, anxiety and depression (Pierce, 2020). Nurses and community health workers reported the difficulties caring for patients with Ebola during the outbreak in Liberia when ‘no-touch guidelines’ were in place. The no-touch guidelines not only made it difficult to diagnose a patient without touching them (Siekmans et al., 2017), but the isolation faced by Ebola patients was found to compromise the nurses’ ability to convey connection and provide comfort to patients in times of distress (Connor, 2015). Such measures, while intended to keep people safe, have concerning short- and longer-term implications on the health of already isolated individuals such as people who are ill, older people (Armitage & Nellums, 2020) and people with disabilities (Emerson, Fortune, Llewellyn, & Stancliffe, 2020). For some people, COVID-19 restrictions meant staying at home with loved ones. For many more, these restrictions meant being isolated and alone for weeks or months with no physical contact. Globally, the numbers of people living alone have increased significantly in the past 20 years from an estimated 153 million in 1996 to 277 million in 2011 (Klinenberg, 2012). This increased isolation and absence of touch perhaps partly explains the recent rush on animal sanctuaries who report increases in adoptions (Grey Ellis, 2020) with pet ownership being found to have emotional benefits for people living alone with pets providing love, affection and companionship (Zasloff & Kidd, 1994), and a safe means to give and receive touch. Touch is a powerful method used to relieve and reduce the suffering of others (Goetz, Keltner, & Simon-Thomas, 2010), and during this pandemic, there has undoubtedly been much suffering. Touch in times of COVID-19 is restricted for our own safety and the safety of others. In these times when we must stay apart, we look for ways in which we can remain connected and acknowledge that we may also have to recognise the pain and suffering caused by the absence of touch in our own lives and the lives of our friends, family members, colleagues and patients. Health professionals need to remain aware of the important role touch plays in a patients healing, even during pandemics (Connor, 2015), and while our ability to touch is temporarily hindered during the pandemic, we must remain aware that other methods of communication need to be enhanced in an effort to compensate for its loss. While we know we are all in this together, we need to acknowledge that it can feel very painful and lonely being so far apart and perhaps once this is over, we will have a new appreciation for how important touch is in our lives.