We are now well into a pandemic, and you are likely aware that, among other measures recommended to stop the spread of the novel coronavirus, we are all supposed to stop touching our faces.
You are also aware, by now, that it is extremely difficult to stop touching your face, as many, many public officials have recently discovered. One study found that, on average, people touch their faces 23 times an hour. We know fetuses touch their faces in utero, which means we all got into the habit before we were even born. Why we do it remains an open question. There is some research suggesting that face-touching may help us to regulate emotions, Wired reports; it’s also possible it could serve some kind of social function.
It is, collectively, our favorite hobby, face-touching, and we didn’t even know. Most of the time, it is unconscious, which is part of why it is so hard to give it up. How can you quit what you don’t even know you’re doing?
And yet — along with social distancing, thorough hand-washing, and staying home when sick — the Centers for Disease Control and Prevention says avoiding our faces is one of the key actions we can take, on an individual level, to stop the spread of disease. “Avoid touching your eyes, nose, and mouth with unwashed hands,” instructs the agency website, along with recommendations for practicing hand hygiene and avoiding close social contact.
But as the days wear on, and threaten to wear on for the foreseeable future, rules that once seemed straightforward have started to feel markedly less clear. Can I, for example, touch my face in my own home? Can I scratch an itch on my forehead if I make a concerted effort to avoid my nose? Would it be better if I used my sleeve?
For answers — and face-touch prevention strategies — I turned to a handful of doctors and psychologists.
Why we can’t stop touching our faces
There are a lot of reasons for our constant face-touching, but one of them is: There is legitimately a lot to adjust up there. “First of all, we have a nose. A lot of times people will touch their nose — something doesn’t feel right up there,” says Douglas Woods, a professor of psychology at Marquette University who studies habitual behaviors. “Maybe you need to rub your eyes, you adjust your hair. And our hands habitually go to our mouth when we eat, and so on.” Basic bodily maintenance like brushing a crumb or scratching an itch involves a lot of face-touching, and from there, it often becomes a habit.
“When we do something, it gets rewarded,” he explains — it feels nice to scratch an itch — “and it just keeps getting rewarded, and pretty soon, we’re doing it without the reward even happening. We’re just used to the behavior occurring.”
“We’re human,” Anne Liu, a professor and infectious disease physician at Stanford Health Care, reassures me. “That’s how we operate.”
But touching your face can contribute to the spread of the virus
Like most respiratory viruses, SARS-CoV-2 — the virus that causes the disease Covid-19 — enters the body through the respiratory tract, explains Benjamin Singer, an attending physician at Northwestern Memorial Hospital and an assistant professor at Northwestern’s Feinberg School of Medicine.
There are two primary ways this can happen. The first is through direct person-to-person contact: Someone with the virus coughs or sneezes near you, and you inhale those particles. This is the reason you’re supposed to stay six feet apart.
The second way, though, is through touch, and this is where casual eye-rubbing becomes a problem. We don’t yet know exactly on what surfaces the novel coronavirus can live and for how long, but a preprint (meaning not yet peer-reviewed) paper from researchers at the National Institutes of Health, Princeton, and UCLA suggests it can survive on a variety of surfaces for hours, and in some cases days.
“The idea is that we touch a lot of things,” says Singer, “and the droplets that these viruses inhabit are possibly on the surfaces we touch — on our phones, our tablets, our remote controls. We touch those and then we touch our face, and that’s the route of infection.”
Right now, touching a doorknob and then your face is not thought to be the main way the virus spreads, the CDC says, but they also say not to touch your face.
Your whole face, though?
The CDC is specifically concerned with touching your eyes, nose, and mouth because, Liu explains, those are “mucosal surfaces where these respiratory viruses can attach very efficiently and become a site of entry into the body.”
But your forehead is not a mucosal surface, so what’s the harm in a quick scratch? In theory, potentially nothing, says Gabriela Andujar Vazquez, an infectious disease physician and associate hospital epidemiologist at Tufts Medical Center. “As long as you don’t put the same hand that’s dirty in your eyes, nose, or mouth, then you’re good. We think it won’t stay on other parts of your face for long.” But if you’re touching other parts of your face? “You probably are touching your eyes, nose, and mouth,” she says.
As far as we know, the virus can’t jump around a surface on its own, Liu says — viruses don’t normally behave that way, and so it’s not going to leap from your hairline into your eyes — but you could move it there.
The bottom line, Singer agrees: “Any time you’re kind of contacting that area near a portal of entry here, you’re putting yourself at risk.”
Okay, but what about ears?
“They’re not a point of entry for the virus,” Andujar Vazquez tells me definitively. Ears don’t have the same virus-friendly cells that eyes and noses do.
Still, you probably should at least try not to scratch them. “I think anything above the neck is something that would be close enough to a portal of entry,” she says, so it’s worth attempting to avoid extra contact.
Can you touch your face at home?
In an ideal world, sure. “If you’ve just been at home, and you know who’s been there, and you know what’s been cleaned, and you’ve been cleaning your own surfaces, and you’re home alone? Go ahead and touch your face,” says Liu.
But if you’re trying to change your behavior in general, then it may be best to aim for consistency, suggests Fred Penzel, a psychologist in Huntington, New York, who treats body-focused repetitive behaviors. “You’re retraining yourself,” he says. “So if you keep going back to what you’re trying to retrain yourself out of doing, that’s probably not going to contribute much to your effort.”
So how do you quit?
Frustratingly, there is no secret to cutting yourself off from the reflexive pleasure of touching your own face. “I think you have to start off with the idea that you’re not going to be able to achieve it perfectly,” says Penzel. “That’s kind of a foolish goal to set for yourself.”
But you can do better. “The biggest thing is awareness,” Woods advises. “The whole point of a habit is that it happens on autopilot, and you’re not consciously aware that it’s happening.”
In the past several weeks, a lot of us have become acutely aware. This is step one. (If you are still working on awareness, he recommends videotaping yourself for 20 minutes as you go about your day.)
Once you’re aware, it’s up to you to take action. “Every time you start noticing your hand going to your face, just make a little mark on a card, or something like that. Pretty soon, when your hand starts to go up to your face, you’ll be like, ‘oh, it’s happening again,’ and you’ll start to put it down,” he suggests.
You can look for replacement behaviors to keep your hands occupied: fidget-spinners, bubble wrap, kneadable rubber erasers. Penzel will have patients go through hardware stores and toy stores, looking for “little manipulable objects that feel right for them.” (In this particular moment, the internet may be your best bet.) Some people find it useful to write reminders on Post-Its. Last week, the Atlantic published an article arguing that if you can’t make yourself stop touching your face for your own health, you might have better luck reframing it in terms of keeping other people healthy.
Another tactic? Wear a mask. We’re still in the midst of a supply shortage, and N95s and surgical masks should still be reserved for those who need them most — medical professionals and people at high risk — but some experts say that any face covering at all could still have an impact. “A nonmedical mask will not protect you from a direct cough or sneeze from an infected person,” wrote Shan Soe-Lin and Robert Hecht of the nonprofit Pharos Global Health Advisors in a Boston Globe op-ed, “but if you’re practicing good social distancing, any type of face covering is great protection from your biggest threat: your own hands.”
It’s worth noting: not everyone is in total agreement about this. As the Wirecutter notes, the actual data supporting the idea that masks help prevent face-touching is “limited,” and as Liu points out, no mask (or bandana or scarf) is going to do much if you’re still rubbing your eyes. The main point is: Any steps that get you to stop touching your face are good.
So you should try, and keep trying. But also — to some extent — you’re going to fail. Which is why it’s so important to wash your hands. “Touching your face is part of human nature,” Singer says. “And that’s why you can take the empowering step of washing your hands actively, so that when you do inadvertently touch your face, you have a much lower risk of getting the virus.” And soap, as we know, is distinctly well-suited to annihilating the coronavirus.
What if you use a tissue or a sleeve instead?
In an ideal world, your face would only itch uncontrollably when you are sitting in your disinfected home with very clean hands. And, on the bright side, it seems as though we’re all about to be spending a whole lot more time that way.
But there are times, even now, where you’re out and your nose itches, and in those times, there are steps you can take to mitigate risk. Giving your hands a quick rub-down with hand sanitizer first would be great, if you’ve got it. If you have a tissue on hand, that “probably helps,” says Singer. “I can’t tell you for sure how much, but it probably helps to some extent.” And if all you’ve got is your sleeve, well, “it’s definitely better than using your hands,” says Andujar Vazquez.
So I’m still touching my face, but I’m touching it less — does that help?
Even if you feel like you’re messing up all the time — and you probably are — it’s worth keeping up the good fight. Because, as Liu explains, the likelihood of getting the virus depends on how much exposure you have. “How many times you touch your face will increase the probability of transmission occurring,” she says. It’s not that any one face-touch is likely to infect you, but the more times you touch your face, the more probable it is that you’ll pick it up. So you’re not perfect. That’s fine. The goal is to minimize the number of opportunities you have to get it, and so yes, keep trying. And more than anything: wash your hands.
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