Dr. Mark Anderson, an infectious disease specialist with Infectious Disease Physicians of Chattanooga and current president of the Chattanooga Hamilton County Medical Society, said people can take some simple precautions daily to reduce their chances of getting the flu.
• If you have a fever or a cough that's hard to control, you shouldn't go out of the house for the protection of others.
• Although you probably were taught to sneeze or cough into your hands, you're now advised to sneeze or cough into your sleeves due to the possibility of spreading germs through your hands.
• If you have a chronic heart and lung illness, where catching a respiratory virus could lead to your system being further compromised, you have to be particularly careful during flu season and probably should stay at home as much as possible.
To shake or not to shake, that is the question. As the mid-winter flu rages through cities nationwide and is often passed from person to person at large gatherings of people, church officials are wondering whether traditional hand-to-hand greetings should be replaced with fist bumps, waves or nods. It may not be as personal, but neither is it as infectious.
Stephanie Mangum Hudman said her fellow congregants at Woodland Park Baptist Church were encouraged by pastors to hand-bump instead of shaking hands.
"But," she said, "I don't think many changed. We still hugged and shook hands."
While some local clergy have offered suggestions on curtailing contact to handle the situation, others have allowed adherents to use their judgment in avoiding the virus.
At Ridgedale Baptist Church, members "typically stand up and greet each other" with handshakes or hugs during the worship service, said the Rev. Bill McGinness, minister of education and families at the church, but now they're asking congregants to wave, smile or say a kind word instead.
"We tell everybody we want to share -- but not our influenza germs."
The Centers for Disease Control and Prevention are calling the current flu wave one of the worst seasons in 10 years and, for the week ending Feb. 2, 38 states reported widespread influenza activity, eight Southern states -- including Tennessee, Georgia and Alabama -- reported only local or regional flu activity, according to the CDC.
Nationally, according to the CDC's latest FluView report, flu activity remains elevated and widespread across every other part of the country except for Nebraska and Washington, D.C.
Tim Vaughn, a former Chattanoogan who is pastor of the nondenominational Life Church of Athens, Ga., said he encouraged members recently to "nod enthusiastically" at each other during their time of welcome.
"Some thought it was a bit weird and extreme," he said. "Others thanked me afterwards."
Rabbi Susan Tendler of B'nai Zion Synagogue said her previous congregation in Norfolk, Va., installed anti-bacteria machines during an H1N1 -- swine flu -- threat, but she was not aware of anything that had been done at B'nai Zion.
"In a community in which we are so accustomed to physically greeting," she says, "it is surprising."
Shirley Baugh, a longtime member at Jones Memorial United Methodist Church, said she doesn't think about germs in relation to hugging and shaking hands.
"Maybe that is why I have a respiratory virus right now," she said.
While a time of greeting occurs in many faith services, a Passing of the Peace -- in which parishioners clasp hands and occasionally exchange kisses on the cheek while offering a statement of "peace be with you" -- is part of the traditional Catholic and Episcopal services, giving the flu viruses multiple avenues for infection.
Deacon Sean Smith, chancellor and chief operating officer of the Catholic Diocese of Knoxville, an area that includes Chattanooga, said there is no diocesan policy regarding the greeting during flu season. If the pastor wants to ask parishioners to touch someone's shoulders instead of shaking their hand, he has that right, Smith said.
"The best practices are based on the pastor," he said. "He knows his faithful and the flu conditions [in his area]."
Vicki Myers, communications director for the Episcopal Diocese of East Tennessee, which includes Chattanooga, said the diocese posted resources for individuals, churches and dioceses during the H1N1 epidemic several years ago.
Among those were materials on how churches could be prepared, a checklist for families and how individuals could protect themselves from getting the flu.
However, she said, "parishes may set their own policies."
The use of communion elements, especially drinking wine or juice from a communal cup, also may frighten church members when the flu is at its most contagious.
In January, the Catholic and Episcopal dioceses of Dallas sent guidelines to clergy designed to slow the spread of sickness through their congregations. In a two-page letter, Bishop James M. Stanton, head of the Episcopal Diocese of Dallas, counseled clergy on the importance of hand washing and use of sanitizer and on proper methods of washing and storing the chalice and plate used to serve Holy Communion. He also suggested parishioners not be allowed to drink wine from a common chalice during communion or dip their wafers in wine.
But Dr. Mark Anderson, an infectious disease specialist with Infectious Disease Physicians of Chattanooga and current president of the Chattanooga Hamilton County Medical Society, says the cup used at communion is relatively safe.
"Those bugs don't live," he said. "It's more the nasal secretions than saliva anyway. If the cup is carefully wiped off, the risk is very low."
But the doctor, a Catholic, said that "when I have a cold, I don't partake of wine when I go to Mass."
Catholic priests also have a variety of options in how to offer communion.
"He has the ability, if he does not want to offer the precious blood," Smith said. "The bishop allows him to make the decision."
The faithful, he said, are only required to receive one of the elements, the body or the blood. Either way, he said, "it's still Jesus."
Anderson said there's no problem with someone who's well shaking hands with anyone as long as they don't touch their eyes, nose or mouth without first washing their hands. But he said that's easier said than done.
"I have to remember to follow it myself," he said.
But pastors should remind people who are sick with a cough or fever not to be around crowds in places like churches, he said.
"If people followed that perfectly," he said, "that would stop a lot of [germ] transmission."
The Rev. Betty Latham, rector of Church of the Nativity Episcopal Church in Fort Oglethorpe, and the Rev. Lou Parsons, rector of St. Francis of Assisi Episcopal Church in Ooltewah and a spokeswoman for the Unitarian Universalist Church of Chattanooga, said their churches make wide use of hand sanitizers.
But Latham and Parsons said they haven't asked parishioners to alter their greetings.
"I know some churches that pass the peace without shaking hands," said Latham. "We're not one of them."
"To be honest, I can't say as a church we do anything much differently," said Parsons. "I don't see people greet each other much differently."
When hand sanitizers are used, said Anderson, the thick liquid should be slathered on, "covering all the surface of your hands."
"Washing your hands thoroughly with soap and water or using an alcohol gel [hand sanitizer]," he said, will go a long way to preventing the flu for any individual.
Even with the fear of the flu hanging overhead, some members of local churches said they probably won't make any changes to their church traditions.
Melinda Meyer said she still plans to shake hands and hug at Trinity Fellowship Church in Rock Spring, Ga.
"I haven't even thought to do any differently," she said.
The Associated Press contributed to this report.