Learning to live with covid-19 means covering up coughs and sneezes

As covid-19 restrictions end in many countries, we have a moral duty to cover our mouths and nose when we sneeze and avoid socialising when we feel ill, says Jonathan R Goodman

By Jonathan R. Goodman

A FEW weeks ago, my partner and I went out for dinner at a local restaurant. Shortly after we arrived, a couple sat down at the table next to us, and it quickly became apparent that they were both sick. One sneezed and coughed more or less continuously over the following hour; the other kept sniffling, and – in what felt like a personal assault on my sensibilities – dropped a used tissue on the floor.

Personal hygiene is linked with a wide array of reactions. Most people are now taught at school that you should cover your nose and mouth when you sneeze – preferably with your elbow, according to the US Centers for Disease Control and Prevention. There is, however, enormous variation in whether people actually follow this guidance. Research carried out in 2009 in New Zealand showed that, during an influenza outbreak, more than a quarter of people didn’t cover their mouth or nose at all when coughing or sneezing.

In contrast, there is little variation in how people react when encountering a used nappy abandoned in a public place. The bacteria that travel in human waste and the airborne particles released by coughing and sneezing – as we all know only too well from covid-19 – are both linked to disease transmission. Yet only with the nappy do we tend to be disgusted. With the coughs and sneezes, there are socially prescribed rules, which many of us don’t follow.

Now, as some countries across the world lighten or eliminate covid-19 restrictions, it falls on the public to consciously redefine the social norms around the transmission of infectious diseases. Coughing and sneezing in public can kill, just as exposing people to human waste can. We should, therefore, react with similar disapprobation.

Throughout history, human behaviour has adapted in response to disease. We learned how to avoid cholera, for example, when John Snow discovered its waterborne mechanism of transmission in 1854. Over time, and as social groups grew larger and more complex, humans have changed how they live, accordingly. Rather than instinct guiding us, we learned from our elders, in a process known as cultural transmission, how to prevent the spread of dangerous infectious diseases.

This pattern of adopting and passing on social conventions has been hugely beneficial for us. It seems strange, then, that when faced with diseases that are extremely infectious and potentially deadly, such as covid-19, many of us cough and splutter in public – despite the fact that this perpetuates the spread of infections. This makes each of us indirectly responsible for the deaths of hundreds of thousands of people a year worldwide.

One explanation may be that we have lived with respiratory viruses, including those that cause the common cold, for so long that we don’t typically regard them as a major threat. Any perceived wisdom against socialising during the cold season, then, might be ignored by people who regard contact with others as more important than the risk they might pass on an infection.

Now that many of the mask and isolation regulations linked to covid-19 are being shelved, we should rethink this outlook. With the continual risk that a new variant of covid-19 will arise, we need to take personal responsibility and distance ourselves when sick, avoiding mixing both at work and socially. Allowing the coronavirus to circulate freely raises the risk that it will develop mutations, allowing it to escape vaccines.

Coughing and sneezing in public should be reviled. Without effective laws, it falls to individuals to protect the health of those around us.

Jonathan Goodman is at the Leverhulme Centre for Human Evolutionary Studies, University of Cambridge, UK