[NFBC-Info] Covid-19 article:

[Paul Howard]

-- 
Paul C. Howard


FYI, Written by Nicholas A. Giudice, Ph.D

As a congenitally blind person, it has become obvious to me that my
reliance on touch as a primary mode of experiencing the world puts me
at odds with current best practices for avoiding the coronavirus. The
principle guidance for safeguarding against COVID-19 is to (1) curtail
physical contact with those around us (or the things they touch), (2)
limit touching of our body (especially of the face), and (3) maintain
a minimum proximity bubble during social interactions (ideally of
6-feet or more). In this essay, I discuss how an unanticipated
consequence of following this tri-part guidance for staying ‘safe’ is
the effective demonization of touch, which has led to many unforeseen
challenges for more than 12 million people in the U.S. (and over 285
million people worldwide) who are blind or visually impaired (BVI).

When you cannot see the world, touch picks up the slack for vision by
taking on a dominant role in how it is explored, understood, and
interacted with. For BVI people, perception inherently involves touch,
either with the hands or the long cane. This physical contact provides
critical knowledge about all matter of things: monitoring if one’s
hair is a mess, identifying what is in the immediate vicinity,
orienting to people or objects in the surrounding environment, etc.

Indeed, touch and vision communicate much of the same information
about the world. Feeling or seeing the curve of my coffee mug, the
90-degree edge of my desk, the relation of my computer to my phone,
and many other spatial attributes can all be perceived similarly from
both sensory inputs. This sensory equivalence helps explain why touch
fills many of the same ‘shoes’ as vision for blind folks, albeit at a
much closer distance. Thus, in many ways, asking a blind person to
curtail touching is analogous to asking a sighted person to go about
their day wearing a blindfold.

In the remainder of this essay, I will discuss my perspective on the
relation of touch to each of the three pillars of COVID-19 protection.

1. Touch and Physical Contact:

The guidance to limit physical contact with any public-facing surfaces
and to not touch those around us is incredibly difficult for BVI
people. Part of the challenge is logistical, when your hands take on
much of the work of your eyes for apprehending the world, it is simply
not possible to not touch doorknobs, railings, tables, and the like.
This is concerning, as it is precisely these common-use surfaces that
are most likely to be vectors of COVID-19.

The best advice for anybody exposed to such things is to immediately
wash their hands, for at least 20 seconds each time. Unfortunately, I
have found that an unexpected outcome of this frequent hand washing
regimen is that the prolonged exposure to water desensitizes my
fingers, resulting in me becoming functionally illiterate after the
process. Reading braille inherently involves high resolution touch and
the endeavor is rendered useless when done with prune-like fingers.

My friends keep telling me to wear gloves when I go out in order to
reduce the need for hand-washing. This represents a reasonable
suggestion for most people but turns out that donning gloves is a poor
solution for BVI individuals, as any barrier between the skin
receptors and the surface, even if thin, desensitizes the fingers and
greatly masks what is being felt. The result is roughly analogous to a
sighted person wearing blur glasses as they go about their daily
activities.

For BVI people, physical contact plays many roles. Sometimes, it is
purely functional. For instance, many BVI individuals hold on to the
elbow or shoulder of a sighted guide during navigation. Whether it be
because they have left their dog at home for an evening out at a
concert, are not using their cane on a romantic walk with a partner,
or that they simply prefer this mode of guidance, the process
inherently involves physical contact.

In the BVI community, touch also represents an important component of
building rapport and developing inter-personal connections. Similar to
how a sighted person may feel they are not fully engaged or clearly
communicating if they don’t make eye contact when talking, BVI people
often derive the same sense of connection by touching the arm or
shoulder when communicating.

This contact conveys emotional engagement, but it also provides the
BVI communicator with a sense of physical presence and immersion that
is important for directing attention and staying focused. The fact
that so much communication is happening remotely nowadays has
definitely limited my ability to fully engage. I hear the relief of my
sighted peers when their video kicks in and they can see the other
video-equipped participants in a Zoom meeting, but I have no way to
experience a similar remote replacement for physical contact.

The fear and distrust of touch has crept into even the most mundane of
my daily activities. In the past, a friend or colleague might touch my
arm to get my attention, guide my hand to check out some interesting
thing we are walking past, touch my shoulder to direct me to move one
way or another, or even draw the shape of something on my arm as part
of an explanation. These subtle forms of physical contact, often done
unconsciously, are important to BVI individuals for supporting
efficient communication of information and navigation of their world.
The loss of these small but significant forms of contact because of
pandemic-related concerns often leaves me feeling adrift, unfocused,
and less connected to those around me.

We all use touch as a mode of inter-personal communication and
emotional expression (handshakes, fist bumps, hugs, etc.). This
physical contact during social interactions has other benefits for
blind people that may not be immediately obvious to their sighted
peers.

For instance, shaking a person’s hand confers information about
exactly where they are in relation to me, which is extremely helpful
for self-orientation. This is important for promoting natural social
interactions (realizing I am looking in the wrong direction when
talking to somebody because I didn’t know that they had moved is
incredibly awkward).

A hand shake also provides important knowledge about the other person
that is readily perceived through sight. For instance, hand size and
structure tells me something about general body type and weight, the
elevation of the hand, in conjunction with voice, provides me with
information about height, the texture of the skin, feel of the finger
nails, and presence/nature of rings imparts information about style
and self-grooming practices, intensity of the grip provides
information about physical strength and confidence, etc.

When you cannot see the person you are interacting with, a battery of
other sensory cues substitute for vision in building up an image of
them. These subtle handshake cues are just one example of how
nonvisual information (often through touch) conveys relevant
information about the physical characteristics of a person that is
both informative and interesting. I find that the new touchless modes
of meeting and social interaction have left me more ‘blind’ to the
world than vision loss, which I have learned to compensate for.

There are some less obvious aspects of touchless communication for BVI
people that are worth considering. Of note, the pandemic-induced
increase of handshake-free greeting by waving and nodding, touchless
hugs, and air pats on the back are largely meaningless when done
without vision. Not only is it hard for me to tell if I am gesturing
in the right place, I cannot appreciate or benefit from these gestural
interactions by others toward me (I have never understood why people
still flip me the bird).

The move toward other types of non-hand contact can even be dangerous.
In a recent elbow bump accident, I missed my friend’s elbow and caught
her on the chin (she is significantly shorter than me). This has led
me to curtail all elbow and fist bumping activities. I cut out high
fiving years ago due to a similar experience where a particularly
exuberant hand-slap went amiss, and I almost broke a buddy’s nose.

Often, physical contact occurs unintentionally, such as accidentally
bumping into somebody when navigating a busy area or inadvertently
touching the barista’s hand when reaching for the change. These
commonplace instances of accidental touch are normally trivial,
resulting in an “excuse me” and then moving on.

However, when the same inadvertent contact has occurred over the past
couple months, people respond with fear and panic. Although I
cognitively know that this response is about a fear of the coronavirus
and not about me or the accidental contact, the result is that I feel
shamed by my affiliation with touch and my need to rely on this
modality.

2. Face Touching:

The guidance to limit body contact, and to especially not touch one’s
face, represents a specific example of the above point posing
particular challenges for BVI people that many sighted folks may not
have considered. In many ways, a blind person uses exploration with
their hands for self-monitoring much like a sighted person might use a
mirror.

My hand(s) are the surrogate mirror each morning when I want to check
whether my beard is trimmed in a straight line, or if I have bed head,
or to ensure that I don’t have a smidge of toothpaste on my lip, or
something gross crusted in the corner of my eye, or some nastiness
around my nose from my allergy drip, and a myriad of other self-care
activities that we all do but rarely talk about. This basic
self-monitoring, whether performed using touch with the hand or using
vision with the mirror, is important for daily grooming and for
maintaining one’s hygiene. In the COVID-19 reality, these normal,
unassuming activities of daily life, when performed using touch, now
represent heightened risks.

Can touching of one’s face expose you to the coronavirus, absolutely.
But…should I stop engaging in self-monitoring and
information-gathering tasks by means of touching my face, mouth, eyes,
and nose, absolutely not. Regardless of one’s visual status, everybody
will have the occasion of doing such things and blindly reducing our
hands, and our use of touch, as little more than conveyance agents of
the coronavirus is neither helpful nor scientifically accurate.

If we are to act (and react) realistically, face touching will
inevitably happen in the course of daily life. This is okay, it
represents a normal activity that does not inherently increase the
risk of COVID-19 infection when done prudently. The point is that
rather than fearing a normal action and the sensory mode that supports
that action, we should focus on the virus itself and how we can be
best protected. With respect to face touching, this can be easily done
by limiting contact to instances of information gathering rather than
habit and being vigilant about washing our hands (even if they become
shriveled and prune-like).

3. Social Distancing:

Beyond direct physical contact, the key safeguard for avoiding
COVID-19 infection is to maintain good social distancing behavior.
Following these guidelines, which involve keeping a 6-foot radius
between yourself and anybody around you, is trivial when performed
using sight but if you try doing so with eyes closed, you will quickly
find it is extremely difficult.

I generally only become aware of another person in my vicinity when I
hear them talk, when I touch them with my hand, or perhaps if close
enough, when I smell their presence (yes, most people have a distinct
“smell” which is agnostic to being bad or good but that most people
immediately assume is bad). The breadth and depth of what can be
perceived from these nonvisual modalities is much less than vision and
as a consequence, the experience of the perceived world for BVI folks
occurs at closer range than for their sighted peers.

Touch occurs within arm’s length, which can be extended out a yard or
more if using a cane but still violates the magic 6-foot corona
bubble. Hearing can occur at much greater distances but in reality,
recognizing someone’s voice and talking to them at normal
conversational levels also occurs within a 6-foot radius. Importantly,
if anybody in the surrounding environment is silent, they essentially
do not exist to a BVI person.

The challenge of maintaining appropriate social distancing behavior
without vision is two-fold: (1) difficulty in gauging the distance of
nearby people (assuming they are detected at all) and (2) challenges
in maintaining this distance during movement.

I find myself frequently violating the 6-foot corona bubble as I have
no easy means to monitor its boundary, which is elastic and constantly
changes in real-time with my movement and the movement of those around
me. While I can imagine technological solutions for addressing this
social distancing problem, the standard tools of long canes and guide
dogs are not up to the task as canes are too short and guide dog
training is not consistent with following social distancing
procedures.

For instance, my dog guide, Bernie, was trained in New York and as was
normal until the pandemic, was taught to operate in crowded situations
by maximizing use of any available space. This includes going through
any gap big enough for him and me to fit through, meaning that we
often get very close to people as we navigate. Although I am trying to
re-train him to appreciate accepted social distancing behavior,
maintaining lots of empty space around us makes little sense to Bernie
and he is loath to do so.

This is increasingly problematic. As I approached an intersection on a
recent walk, I heard this obviously freaked out person start yelling
at me to “watch out” and “to not get any closer or I’ll kick your
ass”. Besides the logical incongruity of inviting a blind guy to watch
out for who is around them, their threat to physically attack me would
seem to be a blatant violation of the no contact rule of social
distancing that they so vehemently want to uphold.

I understand that this incident, like so much associated with COVID-19
responses, is based on fear rather than logic but…it doesn’t make
dealing with the problem any easier. However, I have found that people
exhibit less concern if bubble violations occur when I am verbally
instructing the dog.

So, if I am aware of people around me when walking I tell Bernie to
“stay left/right” as I pass. This doesn’t generally result in any
actual change in his behavior or creation of additional distance, but
it seems to put people at ease. It can backfire though, as sometimes
people dart one way or another to pre-emptively create space and
Bernie interprets this odd, fast moving behavior as encouraging of
play, which sometimes induces him to veer toward the person, causing
additional angst (and renewed hurling of invective).

With respect to touch, two things strike me when thinking back over
the past three months of living in the COVID-19 world. First, although
I knew that I relied heavily on touch, I didn’t realize its true
magnitude in supporting my own self-monitoring behaviors, its role in
how I interact with others and engage with the surrounding
environment, and its impact on my emotional and social wellbeing until
these interactions became associated with negative consequences.

Second, while I appreciate the value of the safety guidance being
advocated, and understand people’s concerns around physical contact, I
cannot comprehend why people are not more troubled about the growing
fear and distrust of one of our primary sensory channels that of
touch. If the sensory tables were turned and the primary safety
precaution from the CDC involved significant limitations on use of
visual perception; for instance, use of blindfolds in public, the
result would be very different.

Rather than apathy, as is the case with touch, there would be an
outcry about the cure being worse than the problem. The majority of
people would inevitably ignore this guidance, preferring to risk
infection over safety.

The reality is that most people have a deep-seated, visceral fear of
losing their vision but as is obvious from the gee-wiz response to
COVID-19, they possess little concern about giving up their access to
the richness of touch. As a blind guy, I do not share this fear of
vision loss, but I’m petrified about losing any of my other senses.
The realization that touch, the closest sense to vision and a primary
means of how I perceive the world, is now something to be feared and
distrusted, is existentially disturbing to me.

What has been lost in the pandemic panic is that following good safety
practices and appreciating touch are not mutually exclusive. This
seems obvious to me but at the end of the day, logic has very little
to do with people’s responses to the coronavirus.

Unlike the standard flu, there is currently no vaccination and there
is a much higher risk of dying. However, what I argue is most
threatening, we are under attack via an invisible disease vector that
may be on anything we touch or that could emanate from anybody around
us. The issue is of classic transference. We cannot see the COVID-19
coronavirus, but we can certainly see people who may have it. We have
been told (and have internalized) that our greatest risk of
contracting the virus is through close proximity or physical contact
with these people, so our fear is erroneously transferred from being
afraid of COVID-19 to being afraid of touch.

This transference is dangerous as rather than focusing on virus risk
mitigation, people’s attention is misdirected toward castigating a
sensory modality as a proxy for disease. The outcome, albeit
unintended, is stigmatization of an entire sensory modality and fear
of anybody who still dares to use it rather than simply adopting
healthy practices around touch.

Touch is not the culprit here. Physical contact should not be vilest;
the virus is the problem but unless we figure out a better way to
disentangle the two, I worry that touch as we know it will be the
first candidate for inclusion on the Endangered Senses list.

Given the transmission characteristics of COVID-19, there is no simple
fix for saving touch in the court of public opinion. I do believe
there is a solution, but it is more about changing our mind set than
our behavior.

Put most simply, we need to stop conflicting touch with disease. Doing
so is not only inaccurate, it perpetuates an irrational fear of a
general method of perceiving the world rather than a healthy concern
for avoiding contracting a specific virus.

Touch may be a path of conveyance but as with many other correlated
action/response pairings, the result is contingent on many factors,
most of which are imminently under our control. We don’t villainize
the sun because it can give us skin cancer (we simply put on sun
block) or distrust welding because the bright flashes can damage our
eyes (we wear protective glasses), or avoid rock concerts because they
can damage our hearing (we don ear plugs), or fear skiing in winter as
we might get frost bite (we put on gloves). There is no need to throw
the baby out with the bath water regarding our sense of touch and
COVID-19 protection. As with our use of sun block, protective glasses,
ear plugs, and gloves, we can best protect ourselves by understanding
the real risks associated with this pandemic and not becoming blinded
by perceived proxy threats.

The best approach is to be mindful of minimizing touching of people
(especially those we do not know or feel safe around) and to limit
contact with public surfaces. When these physical interactions occur,
there is no surrogate for prudent use of sanitizer, thorough
disinfection of frequently touched areas, and assiduous hand washing
(braille reading and literacy be damned).

However, it is important to keep these things in perspective. Simply
touching your face to scratch an itch, shaking hands with a colleague,
hugging a family member, or coming within six feet of a friend is not
synonymous with contracting the coronavirus. If you interact with a
BVI person, don’t freak out if there is physical contact, accidental
or deliberate, don’t avoid assisting an older person who has tripped
and needs a stabilizing arm, or shy away from helping a child up who
has fallen. These actions are what makes us human and what supports a
civilized society.

Such behaviors should not be conflated with disease or increased
health risks. Touch is not bad, being physically close to others is
not bad. Experiencing these things and being safe are not mutually
exclusive and can absolutely exist harmoniously in our COVID-19
culture when we follow appropriate safety procedures. Fear-driven
responses and mindless adherence to guidelines is neither healthy for
one’s psyche nor for promoting meaningful social interactions.

While I can make this point until the cows come home, the reality is
that the best practices for reducing the risk of COVID-19
contamination are contrary to many of the ways that BVI people
experience and interact with their world. If you cannot see, you
touch, but if you cannot see and you cannot touch, the world quickly
becomes impoverished and wanting (the current situation is even more
dire for my deaf-blind friends).

This is not to say that specific COVID-19 accommodations should be
made for BVI people but since this demographic is not going to stop
touching their world, it does raise the specter of their potential
alienation living as part of the new touchless normal. I know I am not
alone in increasingly feeling like a pariah when in public, keenly
aware that my way of experiencing the world is now fundamentally at
odds with the majority of those around me.

I usually embrace the notion of being unique, of diversity through
difference, and of opposing points of view. But…the growing aversion
to touch is very different than if I were to be disliked for having
contrary political views than somebody else, or were judged for what I
am wearing.

It is unrelated to my conscious decisions; the fears and avoidance I
am experiencing are based on my fundamental method of perceiving and
interacting with my surroundings, which I cannot change. In some ways,
and this is admittedly irrational, the growing societal rejection of
touch feels like an aggregate rejection of Me.

At the end of the day, it doesn’t really matter if the negative touch
response (or its impact on me/others) is an unintended consequence, or
due to transference, or over reaction the COVID-19-induced backlash
against touch is real. Troublingly, this response is likely to
escalate as the economy starts to open, more people go outside, and
social interactions (planned or otherwise) become the norm as people
return to living their lives, albeit in a socially distanced,
touch-minimized manner. The result for BVI people is that many of the
issues discussed here will persist and even increase, meaning that the
new touchless normal is going to continue as the awkward abnormal for
the BVI community.

	I am accustomed to a world that minimizes the role of touch, as it
will always be the underappreciated younger sibling to vision, but a
touchless future where we no longer shake hands, hug, or express
physical affection is not a future I feel excited about.
Unfortunately, I worry this trajectory will continue unless we accept
the mind set that safe and healthy behavior is possible without
catastrophizing physical contact and bastardizing the sense of touch
by equating it with disease. Until then, I mourn the loss of the
world’s feel around me.