PolicyLab

The iconic article “Cuddlers, Touchers, and Sitters” (formerly entitled “Modes of Transmission of Respiratory Syncytial Virus”) by Hall and Douglas1 stands to this day as one of the simplest recitations of the behavior of respiratory viruses and children. With an elegant and simple study design, Hall and Douglas vividly demonstrated that it’s the interactions between susceptible and infected persons that drive much of viral transmission. For those who do not recall this study, Hall and Douglas examined the likelihood of transmission from an infant infected with respiratory syncytial virus (RSV) to an adult caretaker who either sat with the infant on their lap, touched the infant while they laid in their crib, or sat next to the crib. We can now predict the outcomes—cuddlers were the most likely to get infected. While the classic diagram of the “chains of transmission” helps us break down some the factors that determine onward transmission, many respiratory viruses rely on time, proximity, and contact to spread.