Do tactics avert flu or reduce humanity?

For nine years, middle school director Russell Shaw has greeted and bidden farewell to each of his 160 charges with a cheerful smile and firm handshake.

Now, in a concession to this season of swine flu discontent, he has replaced the potentially germy clasping of palms with fist bumps and occasional elbow taps. Shaw's broad smile, of course, remains.

"Some have added their own choreography," he said before dismissal earlier this month at Abington Friends School in Jenkintown. A line of students, loaded down by backpacks, passed the director with fists extended. Shaw reciprocated. "I don't know whether fist bumps have been proven scientifically to significantly reduce the passing of viruses, but we're trying it."

As precautions against the H1N1 virus, or swine flu, spread across the region and elsewhere, physical contact in any number of public places is being increasingly discouraged, if not verboten. Even as some wonder whether the new limits on social interaction might strike a blow (by elbow, perhaps) to our humanity, others emphasize the need to practice sensible safeguards around a virus that is circulating like a chain e-mail.

In churches, congregations are bowing during Mass, rather than risk kisses or handshakes, and adjusting rituals around how to take communion. When out, senior citizens are being urged to wear rubber gloves. Everywhere, hand sanitizer is the lubricant of daily life.

"We're trying to get people to be more aware," said Anita Morro, a nurse who leads the Healing Ministry at St. Mary Magdalen Roman Catholic Church in Media. "It's very serious. [Swine flu] is going to spread like that." She snapped her fingers.

Medical experts note that seasonal influenza regularly kills tens of thousands a year, hitting the very young, the very old, and those with compromised immune systems the hardest. Swine flu, though not necessarily any worse, is expected to add to the toll.

Already from Aug. 30 to Oct. 10, 15,696 people nationwide were hospitalized for influenza or pneumonia, and 2,029 died - the vast majority from the H1N1 subtype, according to the Centers for Disease Control and Prevention.

Pennsylvania has seen widespread flu activity, New Jersey to a lesser degree, reports the CDC.

While swine flu appears not to pose as great a risk to the elderly as seasonal flu, it has hit local schools, where absentee rates have been high.

Some wonder, though, whether Western culture and its love of physical contact will suffer from social distancing. Won't we lose our ability to connect with each other?

"In the midst of all this, we lose our humanity," lamented Missy Stein. The Penn Valley parent has three children at the Jack M. Barrack Hebrew Academy in Bryn Mawr, where cautions include using elbows to open doors and greet one another.

For now, the school also forbids touching the mezuzah that hangs at each doorpost. Customarily, Jews touch the holy object and kiss their fingers before entering the room. Rabbi Steven M. Brown, head of the academy, said the careful response fit within district, state, and national guidelines.

But Stein, who said she and her family had swine flu over the summer and survived, finds the preventive practices "extreme. . . . That's who we are as human beings. We do shake hands. We do hug each other. We do kiss our friends on the cheek. If we let go of all that, then what do we have left? We're just walking by each other as strangers."

She still shakes hands, kisses cheeks, and refuses to use hand sanitizer, even though Har Zion Temple in Penn Valley, where her husband is the rabbi, recently installed dispensers after a member made the request.

The handshake champion - that would be Gov. Rendell, no? - said he hasn't cut down on the shake-and-grin, either. "No, after 32 years in politics," he said, "I've accumulated so much immunity that if a strange plague came from a distant planet, I would still be safe."

The CDC does not have guidelines for social contact other than to wash hands frequently, "especially after you cough or sneeze," and to avoid touching eyes, nose, or mouth.

And according to Thomas Fekete, chief of infectious diseases at Temple University, handshake substitutions alone likely have minimal impact on the virus' spread, reducing a person's risk by no more than a percentage point or two.

Rather, the alternatives "acknowledge a contagion risk and allow one another to have a little extra space," he said. "The elbow bump is kind of cute anyway."

Still, like many, George M. Wohlreich, director and chief executive officer of the College of Physicians of Philadelphia, said he has made sure to protect himself. He changed seats three times on a recent train journey because of hacking passengers who failed to cover mouths. He also carries a large bottle of alcohol-based hand sanitizer at all times and uses it after shaking hands or gripping a banister in a public space.

"Anybody offended by that has an issue," said the psychiatrist.

He also doubts that steps like elbow bumps will prove calamitous to relationships. "Part of being human and being emotionally healthy is touching and liking to be touched," he said. "I'm not worried about our instinct going bye-bye because for a period of several months we're being more cautious."

At Abington Friends, students said the fist bump was cool and hygienic. "You don't use this part of your hand that much," eighth grader Griffin Brown, 13, of Jenkintown, said of knuckles.

Students there also are encouraged to sneeze and cough into crooks of arms, and the morning circle, when it's time for a moment of reflection, has moved to linking elbows rather than hands.

"We are not operating in major fear mode," Shaw said. "We're doing little things to keep everyone healthy and have fun." (Alas, a few students have caught the bug.)

Senior Helpers, a national in-home-care provider with local franchises, has encouraged all its clients to keep a prevention kit stocked with hand sanitizer, multivitamins, baby wipes to clean surfaces, and a box of nonlatex gloves to use on grocery carts or when opening doors.

Client Robert Brodeur, 80, of Cherry Hill, said the publicity around swine flu convinced him that he should protect himself. He uses hand sanitizer constantly and rarely shakes hands with strangers. If he must, he washes up ASAP.

"It's not that I'm antisocial," Brodeur said. "It's a question of added precautions."

While some Catholic churches in Canada have emptied the holy-water fonts and replaced them with hand-sanitizer stations, the Archdiocese of Philadelphia has not gone that far. Instead, it has asked parishioners to suspend drinking from the chalice during flu season. Other congregations are grappling with rites. Eastern Orthodox Christians take Communion by dipping the same spoon in a chalice of wine; newly baptized infants are expected to partake - worrisome to some mothers.

Recently, about 80 parishioners gathered at the Adoration Chapel at St. Mary Magdalen to celebrate Mass and the Feast of the Holy Rosary.

After reciting the Lord's Prayer, the Rev. Ralph Chieffo advised, "Let's bow to one another as a sign of peace." Most in the pews made quick bends or nods. (One man had earlier joked that his wife could get used to him bowing to her.)

Linda Paoli of Newtown Square was relieved that she could abstain from contact during Mass. "You just don't want to get sick," she said.

Many of the same parishioners who bowed nevertheless hugged Chieffo and kissed his cheek.

"The God who we serve is our strength and protector," the pastor said afterward. "But you also have to use common sense. Be cautious. . . . [Still] if you get too hyper about protecting yourself, you live in a vacuum."