Davina Nylander: How might the social stigma around covid-19 perpetuate the spread of disease?

We must pay attention to the social ills that are being disseminated in the wake of covid-19, argues Davina Nylander

 As the coronavirus pandemic gathers momentum, each day brings increasing numbers of cases and the frantic implementation of new prevention and containment methods in countries across the world. Covid-19 is causing a major global health crisis, and while much attention is being paid to the economic turmoil that has ensued, the simultaneously unfolding social crisis risks being overlooked.

It is important for us to consider the social consequences of this pandemic, and the prejudicial rhetoric that is emerging as rapidly as the virus. In what ways is social stigma perpetuated by covid-19, and what role does it have in the progression of disease?

The spread of coronavirus, and the knowledge that it originated in Wuhan City, China, has spurred feelings of xenophobia, fear, and anxiety that reinforce one another, manifesting in behaviours that induce as much terror as the virus that inspires them. Racist incidents are being reported all over the world: simply just appearing to be of Chinese descent has led to citizens being verbally and physically abused, shamed, vandalised, and shunned from public spaces. 

This behaviour in the context of public and global health emergencies is not unheard of. To name only two of many examples, this mimics the swell of racist attitudes and behaviour towards people of west African heritage during the Ebola epidemic of 2014, and towards Mexican and Latin American people during the swine flu (H1N1) pandemic of 2009. 

Anthropologists and social scientists have analysed past disease outbreaks and point out that the social repercussions often outgrow and outlast the spread of the pathogen. For example, during the Ebola outbreak, “health related stigma” in America led to individuals being excluded from school sports, rejected from colleges, and barred from work, despite being completely unaffected by the virus. For those who were affected by the disease, the consequences of stigmatisation persisted even after the epidemic had ended, with many people who’d survived Ebola continuing to be rejected from their wider and smaller communities long after they recovered.

Overt acts of racism and discrimination, as well as more covert feelings of hostility, are often driven by panic and uncertainty—emotions that will be riding high during a pandemic. These feelings can awaken prejudicial instincts and inspire the creation of scapegoats based on distorted perceptions of risk.

The social consequences of an epidemic cannot be separated from the global health crisis itself: both reinforce one another in a self-perpetuating cycle. Stigma, in the context of infectious disease, can be understood as a “biosocial phenomenon”it is a social issue that causes adverse health (or biological) outcomes. Discrimination promotes distrust in the healthcare profession, mass panic, and social marginalisation. These factors can lead to delayed case presentations, a distortion and misinterpretation of epidemiological facts, and neglect or a disproportionate allocation of resources, ultimately resulting in the obstruction of effective disease control.

Stigma is therefore more than just a negative consequence of epidemics and pandemics—it becomes both a factor that contributes to the outbreak, and an ailment in itself. It is therefore vital that, in dealing with covid-19, we pay attention to the social ills that are being disseminated in its wake; without doing so we risk encouraging social antagonism that potentially intensifies the spread of disease. 

As coronavirus spreads, more countries will move to containment measures that involve potential school closures, employees working from home, and the restriction of large gatherings. In the coming months we will inevitably distance ourselves from one another, leaving space for stigma, social disruption, and the consequences described above, to flourish. Societal cracks will continue to emerge as people retreat into their own smaller communities and private dwellings, with faces hidden behind masks that do more to conceal and divide us. 

The first thing we can do to limit the adverse effects of social stigma is to acknowledge its presence and its potential role in the spread of coronavirus. Furthermore, the media must take accountability for the dissemination of misleading and sensationalist headlines, which encourage this stigmatisation. Perhaps most importantly, we must acknowledge our own personal roles: we each have a moral and social responsibility to be mindful of the narratives that we engage with, and to make efforts to promote a culture of tolerance, public safety, and trust during this pandemic and thereafter.

Davina Nylander is a fifth year medical student at University College London. Twitter @davina_nylander

Competing interests: None declared.