Touch and COVID-19

‘The anticipation of touch is one of the most potent sensations on Earth‘

Richard J. Finch

Usually, around Christmas time I can set a record for the amount of hugs and kisses I can share amongst the population. However, COVID-19 has changed the way we interact with our family, friends, society, and our patients. What are the potential implications for not being able to touch as frequently as we would like? How do we normally use touch to communicate?

Understanding the role of touch in our lives may make us more conscious of how we can do things differently and not remove this valuable resource. Post COVID-19 it will hopefully make us reflect on what role touch may play in building our own wellbeing and that of our patients.

Background

Human beings have evolved to touch and be touched. Touch is the first sense humans develop⁽¹⁾. The skin is our largest sensory organ and thrives on the tactile experience of touch⁽¹⁾. Touch is bidirectional and reciprocal, most humans are hard wired to enjoy receiving and providing touch and it is a synergistic exchange^(1,2). It is an intimate form of connection and communication and is critical to the development and maintenance of a range of human relationships and interactions⁽³⁾. Touch was becoming more and more difficult to negotiate in the health care environment prior to COVID-19, in the pandemic world it has become almost a distant memory.

Prior to the pandemic healthcare professionals were scared to touch due to fears around being misunderstood and allegations being made and confusion around healthy touch and abuse of power and relationships. COVID-19 has been managed universally with social distancing which has further impacted our ability to touch and be touched. What are the implications of this?

First, it is important to understand what touch means to us as humans and as health care workers.

Human beings use touch to:

Connect
Build intimate relationships
Communicate: nudge for attention, pat on the back, kiss on the cheek
Affect attitude
Create bonds
Express love and affection
Govern emotional wellbeing
Punish or control.

There are ecological and contextual factors that influence how people experience and understand touch:

Our experience and history of touch throughout our lives
Personality
How people identify their gender
Age: children touch more than adults, touch relationships change as a function of maturation.
Culture
Religion
The specific characteristics of the person doing the touching and how it is received.^(1,4)

Touch and Development

We have known of the importance of touch on development and wellbeing since Harlow et al in 1959 reported on the regression and impact on mental and physical health of the rhesus monkeys when their nutritional needs were met, and they were deprived of touch⁽¹⁾. Isolate-reared rats who were rarely touched were more timid, apprehensive, hyperactive, easily distracted and less attentive to their own young⁽⁵⁾. Touch is an important modality for the facilitation and ongoing growth and development of human beings⁽⁵⁾. The need for touch does not dissipate as we enter adulthood.

Touch and Personality

There is suggestion that amount of physical touch individuals initiate and are open to receiving may be based on personality. In our own lives we will have noticed that some individuals are very tactile while others touch only those people, with whom they share intimate relationships.

Personality traits determine people’s perception and willingness to touch more than gender or relationship satisfaction, with individuals who display traits of openness and agreeableness more likely to have positive perceptions of touch⁽³⁾. It has been suggested that people who classify as extroverted tend to exhibit a stronger willingness for acceptance and initiation of physical touch⁽⁶⁾ though these findings are not universal⁽³⁾.

Touch and Social Interaction

Touch enhances communication, conveys emotions, affects people’s attitudes and modulates their tendency to comply with requests, creates bonds and strengthens intimate relationships^(1,2,7). Emotions and communication can be successfully conveyed by touch without any additional cues⁽⁷⁾.

Touch is essential for the survival of the human species yet appropriate and consenting interpersonal touch is being actively discouraged in society and within hospital cultures⁽⁷⁾. Some of the awareness of self-touching and self-stimulating (how many times do you touch your face?) raised by COVID-19 attests to the fact that we like to be touched by ourselves and others.

Touch and love have been called “indivisible”⁽⁷⁾. Physical touch is one of the five expressions of love and the amount and type of touch experienced between couples highly correlates with overall relationship and partner satisfaction ⁽⁷⁾. The skin plays a crucial role in interpersonal touch and interpersonal touch is known to impact the wellbeing and health of others.

Touch and Wellbeing

Experiencing touch has been shown to have positive physiological and biochemical effects including reducing heart rate, lowering cortisol levels, reducing stress, increasing oxytocin levels, building feelings of understanding, closeness and feeling cared for and promotes security^(1,2,7).

When words feel insufficient touch can assist in building compassion and understanding. There is research that supports that the physical overlap of touch leads to a stronger cognitive overlap between two people leading to relational-cognitive changes⁽⁷⁾.

Research has shown that people who are touched before a stressful event manage, they stress physically and behaviourally better than those who are alone^(1,7,8). Cohen et al (2015) found that being hugged regularly increased the immune system making people less susceptible to upper respiratory infection and illness⁽⁸⁾. Touch effectively convey social support from intimate partners and support networks building peoples sense of belonging and inclusion^(7,8).

Perceived availability of social support is a protective factor against psychological distress, depression and anxiety⁽⁷⁾. Touch has a powerful impact on our behaviours and emotions and directly impacts wellbeing. Understanding the soothing and healing experience of touch it is easy to understand why massage therapy or any skin to skin therapies (facials, manicures etc) may be so addictive as it is probably having a dual effect! Massage therapy has been demonstrated in research to reduce pain, positively impact mood, increase attentiveness and decrease depression ^1,2,7)

Touch and Patients

Touch has been found to reduce anxiety and pain, reduce stress, increase relaxation, and enhance wellbeing and sleep in hospitalised adults and children^(9-12).

Healthcare professionals report a secondary benefit to providing patients with something that makes them happy, that it was soothing and relaxing for both parties. Staff who provided massage in an aged care facility found it significant to ‘consciously take the time to do something for the patient’ that made them happy and calm and the benefits of this lasted a day⁽¹³⁾. Staff and patients reported increased sense of satisfaction and motivation after the massage, with nursing staff sensing an increase in empathy and sensitivity toward the patients⁽¹³⁾. Touch and connection between staff and patients can remain healthy and appropriate and build wellbeing in both groups.

Touch in health has already been under threat due to our interaction with devices and social media, changing public attitudes and a genuine fear of potential litigation long before COVID-19⁽¹⁾. Fields et al suggest that a shortage of touch and general tactile stimulation is causing many to have a ‘touch hunger’ which is impacting on human wellbeing⁽⁷⁾. There has been reports of moral distress for staff having to enforce a strict no visiting policy for COVID-19 patients and not being able to physically touch patients. Social distancing and the need for appropriate PPE should never be compromised however it is important to assess how we can creatively and safely maintain compassion and humanity in the absence of physical touch.

Some suggestions include:

Staff in full PPE could put a photo of themselves on their gowns so that conscious patients know who is caring for them
Staff can still touch COVID-19 patients with gloves. A pat or a reassuring rub on an arm or shoulder combined with a warm smile (even if only seen by the eyes) will still convey exactly what is intended.
Personal cares still must occur so taking the time to touch the skin with a warm cloth or towel will still be appreciated.
Messaging you care by playing music, or ensuring the patient is comfortable and informed.
For those patients in the ICU finding way to communicate with their loved ones and families.
Humour, curiosity, and compassion are ways we can touch others with words that still make connection and create a sense of intimacy.
Do not forget to touch your colleagues. Be mindful of those especially who live alone.
Touch and cuddle those who are in your COVID ‘bubble’ and love your pets!
Take time to touch your own skin, this does not have to be sexual (thought optional!). Using a face cloth in the shower or bath to rub legs, arms, tummy, neck, and face can also be invigorating!

So, as we enter into the Festive season and another year of life with COVID-19 reflect on what touch means to you and those around you. Use creative ways to touch those who have a ‘hunger’ for it. Touch people with your words and warmth and compassion.

Merry Christmas, I personally hope to see and hug many of you in 2022, it has been too long!

Liz