Joe Biden and Bernie Sanders start with an elbow bump as they face off in a Democratic 2020 debate

Joe Biden and Bernie Sanders began their first one-on-one Democratic debate with an elbow bump instead of the traditional handshake, bowing to concerns about the spread of the coronavirus.

The candidates were placed six feet from one another in accordance with Centers for Disease Control and Prevention guidelines, and there was no live audience.

The outbreak was first topic posed to the two men, who being in their 70s, are in the higher-risk category for the disease.

Both candidates addressed concerns about testing, the lack of hospital beds and the question of supplies.

‘My heart goes out to those who have already lost someone or those suffering from the virus. This is bigger than any one of us. This is a national rally into everybody move together,’ Biden said.

Sanders also pushed his universal healthcare plan.

‘I, obviously, believe in Medicare for All. I will fight for that as president. But right now, in this emergency, I want every person in this country to understand what when you get sick, you go to the doctor. When you get sick, if you have the virus, that will be paid for. Do not worry about the cost right now. Because we’re in the middle of a national emergency,’ he said.

Fears about the spread of the coronavirus have transformed the event. Its location has been moved from a convention center in Phoenix, Arizona, to a soundstage at CNN’s studios in Washington D.C. where there will be no studio audience for the candidates to react to. 

Additionally the candidates were six feet apart, as recommended as part of ‘social distancing.

But within the first 15 minutes of the debate, both candidates had used the crisis to tout their health care plans and get in hits at one another.

Biden criticized President Donald Trump’s administration for not taking coronavirus test kits from the World Health Organization.

‘We refused them. We did not want to buy them. We did not want to get them from them. We wanted to make sure we had our own,’ Biden said.

He argued the response effort ‘should be directed from the White House, from the situation room, laying out in detail like we did in the ebola crisis and we beat it.’

And then he got in a swipe at Sanders’ Medicare for All plan. Biden has advocated an expansion of the Affordable Health Care Act.

‘With all due respect for Medicare for All, you have a single payer system in Italy. It doesn’t work there. It has nothing to do with Medicare for All. That would not solve the problem at all. We can take care of that right now by making sure that no one has to pay for treatment, period, because of the crisis,’ he said.

Biden also fumbled as he described how the United States dealt with past public health emergencies.

‘We have been through this before with the coronavirus. We have — excuse me with dealing with the virus’s that the H1N1 and as well as what happened in Africa,’ Biden said. He was vice president in 2009 when the H1N1 flu hit.

Sanders defended his call for universal health care.

‘The bottom line here is in terms of Medicare for all, despite what the vice president is saying, what the experts tell us that one of the reasons that we are unprepared and have been unprepared is we don’t have a system. 

‘We got thousands of private insurance plans. That is not a system that is prepared to provide health care to all people,’ the Vermont senator argued.

Biden swiftly hit back.

‘That has nothing to do when you’re in a national crisis. The national crisis says we’re responding. It’s all free. You don’t have to pay for a thing,’ he said.

‘That has nothing to do with whether or not you have an insurance policy. This is a crisis. We’re at war with the virus. We’re at war with the virus. It has nothing to do with copays or anything. We just pass a law saying you do not have to pay for any of this, period.’

Sanders pointed out some of the health care industry was funding Biden’s campaign.

‘1 out of 5 people cannot afford the prescription drugs they need. They suffer, some die. I consider that a crisis. 

‘Bottom line is we need a simple system, which exists in Canada, exists in countries all over the world,’ he said. 

‘The trick is do we have the guts to take on the health care industry, some of which is funding the vice president’s campaign. 

‘Do we have the courage to take on the executives at the prescription drug industry. Some of whom are funding his campaign.’

‘This is a national crisis. I don’t want to get this in back and forth in terms of politics,’ Biden responded.

The bickering between the two rivals was limited and missing the level of vitriol that was seen on stage in the 2016 primary, when Hillary Clinton and Sanders went one-on-one in a series of debates throughout the nomination process.

Some believe Sunday night’s debate could be the last. A poor showing by Sanders in Tuesday’s primaries will increase the pressure on the Vermont senator to exit the race.

Sanders used the opening moments to push his progressive plans like universal health care and then pivoted to helping the most vulnerable populations during the pandemic.

‘One of the things we want to remember here is that we have a lot of elderly people in this country who are told to stay home. Don’t leave your house. Who is going to get food to them?,’ he said. 

‘You got schools all over this country now being shut down. How are we going to make sure that the kids do well in this crisis, not become traumatized? What do we do about the parents that have to stay home with kids and can’t go to work? 

‘Bottom line here is that in this crisis, we have got to start paying attention to the most vulnerable. That includes people who are in prison right now. People in homeless shelters right now. 

‘What about the half a million people who are homeless tonight? Who is going to respond to them?’

Biden agreed those populations had to be taken care of but pointed out: ‘But first things first, the first thing is take care of the immediate needs we have now.’

The former vice president focused on his previous White House experience, using it to tout his credentials to take the top job. He used his answers on the coronavirus to push a presidential image.

And both Democratic contenders have canceled campaign rallies in favor of virtual events to try and stem the spread of the disease. 

The Vermont senator used his address to make another push for his universal healthcare – Medicaid for All – plan. He also called for free treatment for the virus and for expanded anti-hunger initiatives to help the poor.

Biden’s plan calls for free testing and additional treatment options. He also called for paid sick leave for anyone affected by the virus. And he pushed for a ‘health crisis food initiative’ that would benefit children who receive free meals at schools, which have now closed. 

Both men also struggled to remember to call it the coronavirus crisis.

Sanders talked about the ebola crisis when he was talking about the virus.

‘The ebola crisis, in my view, exposes the dysfunctionality of the health care system and how poorly prepared we are despite how much money we spend. The ebola crisis is also, I think, posing the cruelty and the unjustness of our economy today.’

But he caught himself, pointing out that Biden called it the ebola crisis and ‘got ebola in my head. As a result of the virus here, the coronavirus, what we have got to do also is understand the economy and how unjust and unfair it is that so few have so much and so many have so little.’

Biden responded: ‘People are looking for results, not a revolution.’

And he then referred to the coronavirus as SARS before correcting himself.

Sunday’s debate could be the last in the Democratic primary process. 

The two white men in their 70s are the last candidates standing in a Democratic primary field that started out with more than 20 candidates that contained a mix of gender, race and age.

Sanders, 78, and Biden, 77, talked about the steps they are taking to avoid contracting the coronavirus, which includes virtual rallies, having staff work at home, avoiding hand shakes and lots of hand washing.

Moderator Dana Bash pointed Sanders is even more at risk because of his heart attacked and asked the Vermont senator what he was doing to protect himself.

‘A great deal,’ Sanders replied. ‘Last night we had a fireside chat, not the rally. I love doing rallies and we bring thousands of people out to the rallies. 

‘We’re not doing that right now. In fact, our entire staff is working from home. So on a personal level, what we’re doing is I’m not shaking hands. Joe and I did not shake hands. 

‘And I’m very careful about the people I am inter acting with. I’m using a lot of soap and hand sanitizers to make sure that I do not get the infection. And I have to say thank god right now I do not have any symptoms and I feel very grateful for that.’

Biden, when Bash turned the question to him, pointed out he doesn’t have an underlying heart condition like Sanders.

‘Fortunately I don’t have any of the underlying conditions that you talked about,’ he said, adding he was ‘in good health.’

‘I’m taking all the precautions anyone would take whether they are 30 years old or 60 or 80 years old,’ Biden said. ‘And that is I’m going to make sure that I do not shake hands any longer.’

He added that: ‘Our staff is all working from home. We are not doing rallies. We’re doing virtual rallies and virtual town hall meetings. We’re in a situation where now I do not – we encounter people, we’re not going into crowds. So I’m taking all the precautions everyone else should be taking. 

‘I wash my hands god knows how many times a day. I carry with me, in my bag outside here, hand sanitizer. I don’t know how many times a day I use that. I make sure I don’t touch my face and so on. I’m taking all the precautions we’re telling everybody else to take.’

Biden and Sanders bickered a second time about campaign finances and their super PACs. And it then descended into a who said what and where on Social Security.

Sanders attacked Biden for having billionaire donors to his campaign, an argument he used against other Democratic contenders in earlier debates. Sanders has touted his small dollar donations and refusal to hold high-dollar fundraisers.

‘Who has the power?,’ Sanders said. ‘I’ll tell you who has the power. It’s the people who contribute money. The billionaires who contribute money to political campaigns. Who control the legislative agenda. Those people have power.’

Biden hit back hard, pointing out Sanders outraised him – which the Vermont senator did last year in every quarter – and yet he won Super Tuesday anyway.

‘My average contribution is $44. Just this month I raised $33 million. Average contribution is $51. The idea that this is somehow being funded by millionaires. In the the last Super Tuesday and before that, Bernie outspent me 5 to 1 and I still won. I didn’t have any money. And I still won,’ Biden said.

Sanders shot back Biden had a super PAC running ads against him.

‘Why don’t you get rid of your super PAC?’ he said to Biden.

When Biden chuckled, Sanders told him not to laugh about it. ‘I don’t have any super PACs. Come on. Give me a break,’ Biden said.

‘I won’t give you a break on this one,’ Sanders responded. ‘You condemn super PACs. A super PAC is running negative ads.’

The two then got into an argument about whether Biden said he was opposed to Social Security. The two men, both in their 70s, got so heated talking about the entitlement program that they talked over one another repeatedly in their defend and parry on the subject.

‘You’re running an ad saying I’m opposed to social security. It’s a flat lie,’ Biden snapped at Sanders.

‘I want you to be straight with the American people. I am saying that you have been on the floor of the Senate time and time again talking about the need to cut social security, Medicare and veterans programs,’ Sanders said.

‘I never voted to cut social security,’ Biden said.

‘Go to the youtube,’ Sanders advised viewers. ‘Were you on the floor for whatever reason talking about the need to cut social security and Medicare?,’ he said to Biden.

‘No, I did not talk about the need to cut any of those programs,’ Biden responded.

‘All that I would say to the American people, go to YouTube. It’s all over the place. Joe said it many times. I’m surprised you can defend the change your mind on it, but you can’t deny the reality,’ Sanders said.

The two men together have 49 years of history in the Senate and both of them went after each others voting recordings in the chamber.

They fought over who voted for the Defense of Marriage Act, the financial bailout, and other matters as they fighting focused on policy matters and not personal.

Biden made an appeal for party unity – and got in a joke about his and Sanders bickering.

CNN’s Jake Tapper asked him how he would win over Sanders supporters if he is the nominee. Biden represents a more moderate wing of the Democratic party than Sanders’ progressive side.

‘He’s making it hard for me right now,’ Biden said of Sanders. ‘I was trying to give him credit for things.’

He then went on: ‘Look, I think that I want to make it clear. If Bernie is the nominee, I will not only support him, I will campaign for him. And I believe the people who support me will do the same thing. Because the threat to the United States of America is Donald Trump. It’s critical. I would hope that Bernie would do the same if I’m the nominee.’

Sanders agreed Trump must be defeated.

‘I hope to win the nomination, but if I don’t win the nomination, I and I think every other Democratic candidate is prepared to come together to do everything humanly possible to defeat Donald Trump.’

And the debate is the last chance for them to make their case before four states – Arizona, Ohio, Illinois and Florida – go the polls. 

Biden leads in polling in those four states and a series of wins there would increase pressure on Sanders to drop out in order to allow the party to rally around a nominee to take on President Trump this fall. 

Biden enters the debate as the front runner for the nomination and the pressure will be on the former vice president to give a commanding performance when he has flubbed in previous settings. 

But Sanders faces his last chance to appeal to Democratic voters before Tuesday’s contests.

Additionally, he has indicated he will push Biden hard on a number of issues that concern his progressive base of supporters.

The Vermont senator showed his hand last week when he said in a speech he’d like to question Biden on healthcare costs, immigration and climate change.

And, in a ‘fireside chat’ on Saturday night, Sanders, seated next to a fireplace with his campaign manager Faiz Shakir, said he would blast Biden for his support from wealthy donors, an attack line he has used effectively against other Democratic candidates.

‘Joe has been part of the establishment for a very long time. Joe, what role have you played in trying to make sure we end this massive level of income and wealth inequality?’ Sanders said. 

Sunday’s night debate will be a stark contrast to the last event.

There were seven candidates on stage at the last debate, which took place in Charleston, S.C., on Feb. 25. 

Since then, five have dropped out: Mike Bloomberg, Pete Buttigieg, Amy Klobuchar, Tom Steyer and Elizabeth Warren. 

Bloomberg, Buttigieg, and Klobuchar have all endorsed Biden.

The former vice president has made a play for liberals – and the blessing of Warren – when, in a virtual town hall on Friday night, he announced his support for Warren’s bankruptcy plan, which would simplify the bankruptcy process,

Biden pointed out the Massachusetts senator’s’ plan is ‘one of the things that I think Bernie and I will agree on.’

Warren has yet to endorse but her blessing would give either candidate a major boost – giving Biden the support of liberals or Sanders more staying power in the race. 

Hawaii Rep. Tulsi Gabbard remains in the Democratic primary race. But the Democratic National Committee tightened the qualifications for Sunday’s debate and said a candidate needed at least 20 percent of the delegates that have been awarded to qualify.

Gabbard only has two delegates.