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• I sincerely hope that our health authorities highlight this nasty  habit, and bring in suitable laws to safeguard the unwary general  public  
• Betel/tobacco/areca nut chewing is a leading cause of spitting in South Asia
• Spitting at public places should stop, not just to counter the spread of COVID, but also other respiratory diseases

 As I walk along the pavements outside my hospital I noticed, red patches scattered all over the ground. Even the drains on either side of the hospital are filled with red blotches of saliva. Spitting at public places should stop, not just to counter the spread of COVID, but also other respiratory diseases. This short article is not a one-sided debate about betel chewing and its harms, nevertheless, the spitting habit should be countered.  

A question that I ask myself often is why do people spit? Certain medical conditions provoke patients to spit. People with excessive phlegm may be tempted to spit, the phlegm being the end product of a lung infection. This is one of the key mechanisms of a respiratory infection spreading to another healthy individual. Certain psychiatric conditions are also associated with this habit. There is evidence that some individuals derive pleasure by “emptying saliva” through spitting. Some cultural beliefs promote spitting to chase away bad omens. Betel/tobacco/areca nut chewing is a leading cause of spitting in South Asia. The by-products of betel chewing are not edible hence people are provoked to “empty” the contents. A spit is said to happen when the oral contents are violently released to the surroundings with a bit of velocity.  

COVID virus touches the very basic personal hygiene ethics of humans. It also addresses issues like overcrowding, population expansion, and how certain cultures promote social interaction. COVID spreads through tiny body fluid droplets which contain the virus. Saliva is one body fluid that has a high COVID viral density. Two articles published by Chinese researchers (Xu et al. and Fini et al.) identified salivary glands as a key reservoir for the COVID virus. The spitting action creates saliva droplets of various sizes. Some may be released to the surrounding as an aerosol. These tiny droplets remain suspended in the air for some time. (i.e. airborne) Some will contaminate a floor surface and later enter another healthy person’s body through contact.   

Not just COVID but certain deadly diseases like tuberculosis (TB) have spitting habit as the behind-the-curtain culprit. It is no secret that TB kills more individuals than COVID annually. Despite having medication, a scientific issue called antibiotic resistance is one of the major issues against curbing tuberculosis.  

• It is no secret that TB kills more individuals than COVID annually
• This is one of the key mechanisms of a respiratory infection spreading to another healthy individual

So, should we bring up laws to ban spitting in public places? The law restraining smoking in public places was somewhat successful, as it brought this valid social stigma factor out of the closet. Will a similar ban on spitting be effective? Spitting within one’s dwelling cannot be prevented, but yes at public places, this ban might come in handy during the pandemic. Practicing saliva pots or even plastic disposables should be done with caution during the pandemic. Exactly a year ago the Indian government increased the fines for public spitting after taking into consideration the dangers. I sincerely hope that our health authorities highlight this nasty habit, and bring in suitable laws to safeguard the unwary general public.