As America continues to grapple with the coronavirus epidemic, people are taking extra precautions to prevent the virus from spreading—but some are wondering whether they're following the proper "etiquette for coughing and sneezing" in public, Eliza Goren writes for the Washington Post's "Wellness."

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'What is the etiquette now for sneezing?'

Looking for answers on the best way to cover their sneezes and coughs in public amid the epidemic, people have turned to Google—and even the Post—for clarification, Goren writes. For instance, she notes that Post reader Vicki Kapaun wrote in to ask: "What is the etiquette now for sneezing? Sneeze into my mask AND elbow? Remove the mask to sneeze into my elbow like the good old days? I've Googled this and can't find an answer. I find it disgusting to sneeze into my mask and then continue wearing it."

Unfortunately, according to Goren, public health experts say there isn't a clear-cut answer to Kapaun's question.

How you should cover your sneezes and coughs, according to public health experts

Goren explains that, after severe acute respiratory syndrome (SARS) emerged and spread throughout Asia, the Central Maine Medical Center in 2006 released a video showing people how to cough into their elbows to help prevent the pathogen's spread. Gradually, that approach caught on—and people began to cover their sneezes with their elbows, too.

Maria Sundaram, a postdoctoral fellow and principal investigator on Covid-19 epidemiological research at ICES Ontario, told Goren that people can continue to use their elbows to cover their sneezes and coughs amid the coronavirus epidemic—as long as they remember the act could deposit respiratory droplets on their inner arms. If those respiratory droplets remain moist and contain the novel coronavirus, someone touches them, there's a possibility that person could become infected, Sundaram explained.

As such, for people who decide to use the elbow technique to cover their sneezes, Sundaram recommends they avoid hugs after sneezing (which, as Goren points out, closely aligns with CDC's general social distancing guidelines, anyway).

People could also sneeze into tissues, as long as they cover their mouths and noses while doing so, Sundaram said. She explained that tissues should catch respiratory droplets and prevent them from spreading in the same way a mask would. However, Sundaram noted that after using a tissue to cover their sneezes, people should "[b]e sure to dispose of the tissue in a safe way [and] immediately clean [their] hands very well, either with hand sanitizer or washing with soap and water for 20 seconds at least."

Another option, according to Sundaram, is for people to sneeze and cough while wearing their face masks or coverings. She explained, "The reason we're asking people to wear masks is that we want to reduce the amount of [respiratory] particles that can travel really far away from you." Sundaram added, "While the cloth, homemade masks don't prevent every single little particle from spreading out in the air, they really interrupt the trajectory of a lot of those different particles."

But Goren writes that, according to the World Health Organization, the novel coronavirus carries a larger viral load and appears to spread more easily than other pathogens, which means people may need to take extra measures to contain its transmission.

As such, Eleanor Murray, assistant professor of epidemiology at Boston University School of Public Health, said whether it's safe for people to sneeze or cough in their face masks is "not a simple yes or no answer."

According to Murray, "[t]he goal is to keep your particles away from other people, and to keep other people's particles away from you. Whether that's through physical distancing or a barrier of some kind, either of those will work."

But Murray noted that face masks or coverings can get wet when people sneeze into them, and that diminishes their efficacy. Therefore, Murray recommended that people carry backup masks to replace their soiled masks when necessary.

Ultimately, though, the safest option may be to do your sneezing outside, Murray said, because the outdoor air could better disperse your respiratory droplets.

And if you don't have a mask to sneeze into when you're outside, Goren writes that you should "try to sneeze or cough somewhere that is at least 15 to 20 feet away from others" (Goren, "Wellness," Washington Post, 9/8).