COVID-19 and stigma

According to the World Health Organization, stigma in the health context is the negative association between a specific disease and a person or a group of people who share its characteristics or suffer from it. When stigma comes into play during a disease outbreak, epidemic or pandemic, it can have repercussions. 

Because of a perceived or existing link with the disease, people may be labelled, stereotyped, discriminated against, treated separately and may even experience a loss of status. Such treatment can affect the physical wellbeing as well as the mental health of the target, while it can also have a negative affect on their loved ones, caregivers and even communities. 

Extreme outcomes of stigma in the health context have been previously observed in the cases of many infectious diseases in history. Venereal diseases in the late 1800s saw the rise of lock hospitals, segregation of people considered to be “diseased” in certain parts of cities London, Bombay (Mumbai) and Calcutta (Kolkata). Stigma attached with leprosy heralded the segregation of patients in leper colonies, where they lived with next to no healthcare in complete isolation from the rest of society. The spread of HIV/AIDs in the 1980s saw a similar rise of stigma against patients and the stereotyping of all homosexuals as potential “spreaders” of AIDS. 

Going by the way COVID-19 affects the lungs of patients, this new disease is perhaps most comparable to tuberculosis. TB stigma is usually associated with HIV, poverty, low social class, malnutrition, and most importantly, rapid transmission and infection. This has historically had immense repercussions for patients of TB, who find it very difficult to be accepted into society, let alone families and friend circles. If the highly contagious nature of COVID-19 is anything to go by, the stigma attached to it and its repercussions can be equally immense.

There are three main reasons why the COVID-19 pandemic is also causing stigma:

• This is a new disease and a large part of the information about it still falls under the “unknown” category.
• People are always scared of the “unknown”.
• Fear of the “unknown” usually creates a negative link with people who have the most in common with this “unknown”.

Fear, anxiety and confusion among the public is rampant during the COVID-19 pandemic, and it’s often fuelled by the misinformation and the creation of myths around the disease. These are, in turn, leading to the creation of harmful stereotypes in the popular imagination, which in turn is leading to stigma.

Stigma attached to COVID-19 is already causing harm, especially in India, where cases have emerged about people from North-Eastern states being discriminated against (even spit on in one instance), doctors and healthcare professionals being stoned and chased out of a neighbourhood at risk of COVID-19 transmission, a doctor being harassed by neighbours and landlords for serving at a hospital treating coronavirus patients, etc. Going by these reported incidents, stigma about COVID-19 has already reared its ugly head. 

The impact of this type of stigma can be huge in all nations, including India. A pandemic is one of those times when unified and cohesive attempts to contain and eliminate a disease on the global scale needs to be the target. Stigma, on the other hand, can lead to the social isolation of individuals, families, communities and even people from certain ethnic or religious backgrounds. In such a scenario the virus is more, not less, likely to spread and lead to more severe health issues. 

The rise in stigma attached to COVID-19 can lead to the following unhealthy outcomes that can cause disease transmission and other health problems to rapidly increase:

• Stigma can drive people to hide the symptoms of COVID-19, or any other disease that shares symptoms with COVID-19, out of fear of discrimination. 
• It can also prevent people from seeking healthcare immediately if they have even mild symptoms. This, in turn, can lead to severe symptoms of COVID-19, which is associated with higher risks of mortality.
• Stigma can also discourage people from adopting healthy behaviours like washing hands regularly, practising respiratory hygiene, etc. People who follow these preventive measures can also be eyed with suspicion of being infected.
• Stigma can also drive people to deny basic human as well as healthcare rights to those infected or presumed to have been infected. The latter category also includes doctors, healthcare workers and caregivers.
• In extreme cases, stigma can subject current or cured patients, healthcare professionals and even certain communities to physical violence.

All evidence and prior experience with infectious diseases show that rise can stigma can arrest the cohesive response against the disease instead of arresting the disease’s spread. According to the WHO, building trust in reliable health services and advice, showing empathy with those affected, understanding the disease itself, and adopting effective, practical measures so people can help keep themselves and their loved ones safe can go a long way in reducing the risk of stigma and the harm it does.

Proper communication also plays a very important role in this regard. The creation of an environment where all concerns about COVID-19 can be addressed openly, honestly and effectively can stop fuelling fear and the rise of stigma. The burden of this fight against the stigma associated with COVID-19 does not fall on just governments, healthcare institutions, doctors, health workers and the media. This is an aspect of the fight against COVID-19 which everybody can contribute towards by adopting measures recommended by the WHO.

The first thing to understand is that the way you talk about COVID-19 - particularly your vocabulary - can leave an impression on people you’re communicating with. Negative words will have negative connotations and might fuel suspicion, anger and stigma. The WHO recommends the following vocabulary changes:

• Talk about COVID-19 without attaching any location or ethnicity to it. Avoid the use of words like “Wuhan virus”, “Chinese virus” or “Asian virus”.
• Humanize the people who are presumptive of, confirmed of or have recovered from COVID-19 infection. Do not refer to them as “victims” or cases” but as people.
• Instead of referring to people as “suspected” patients, call them presumptive patients instead. Suspicion is a negative word usually assigned to criminals, and the use of this word can fuel suspicion in turn.
• When talking about the disease, talk about people contracting or acquiring the disease instead of saying “spreading the virus” or “infecting others”.
• Speak with accuracy based on information provided by scientists and official health advisors instead of using hyperbolic language based on rumours, myths, and fear of a “plague” or “apocalypse”.
• Talk positively and focus on the fact that the disease will be overcome collectively as long as everybody follows the preventive measures. Don’t use any negative language or connotations.

The following are some measures recommended by the WHO that everybody should implement to reduce the spread of stigma about COVID-19:

• Spread the facts: Lack of knowledge can stimulate the growth of stigma, especially where a new disease is concerned. Rely on healthcare officials, scientists and new sources which have a reputed fact-check team in place for your information, then disseminate it in the simplest of languages. 
• Engage social influencers: Popular social leaders of every community can become influential voices against the rise of stigma, and can help spread awareness as well as facts about COVID-19.
• Amplify the voices: Let people who’ve contracted the disease, their caregivers, family, healthcare providers, etc., talk about their experiences on popular platforms and media. Amplifying their voices and portraying them as “heroes”, especially where healthcare professionals and essential service providers are concerned, can go a long way in reducing stigma.
• Portray diversity: All materials aimed at reducing stigma and spreading awareness about COVID-19 should portray people of all ethnicities, regions, religions, etc., as equal participants in the global efforts against COVID-19 pandemic. 
• Promote ethical journalism: Media outlets that speculate, give airtime to rumours and myths, or use negative vocabulary to describe patients or any group of people should be avoided because sensationalism and hyperbole can fuel stigma. Instead, promote media sources that follow ethical journalism practices.
• Link up: There are multiple types of movements working towards eradicating COVID-19, fighting stigma, raising awareness, etc. Join one or more of these movements to make your contribution.