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The stigma associated with the disease may be as subtle as avoidance, or dramatic as physical aggression. COVID-19 has begun to cause social disruption by growing disease-related stigma and xenophobia against some cultural, national, racial or religious groups worldwide.1 People of East Asian origin and those with facial features like them, or those with a travel history to areas affected by the outbreak, are especially being subjected to xenophobia in personal contact and online threats. COVID-19 has arisen as an unknown and newly emerged highly contagious infection that has spread rapidly across the globe and is associated with high mortality, leading to fear of encountering those infected.2 Leaders across the world have taken strict measures such as lockdowns and shutdown of various vital services that have caused chaos in people’s lives and increased concerns about the disease.3 Box 1 lists the factors leading to stigmatisation towards those infected with COVID-19.
Causes of stigmatisation towards those affected by COVID-19
Drivers of stigma: fear of infection, fear of social ramifications, lack of awareness regarding spread, social judgement, blame, prejudice, stereotypes.
Role of online social media posts and forwarded messages in the spread of misinformation related to COVID-19.
Association of COVID-19 with a certain ethnicity (eg, referring to it as the ‘Wuhan virus’ or ‘Chinese virus’, and so on).
Politicisation of the outbreak: for example, using pro-China or anti-China political statements or defaming the Muslim community due to the Nizamuddin outbreak in India. Some news coverage agencies and press statements by prominent leaders have been severely criticised.
Using terminology like ‘patient zero’ and ‘superspreaders’ for identifying the individuals who were the first case in a country.
Lack of adequate research on transmission-related factors and preventive therapeutic approaches, which raises apprehension among the public, leading to mistrust in healthcare services.
Inadequate dissemination of the latest information by local governmental agencies regarding news or updates related to COVID-19.
Stigmatisation has raised the suffering of those affected by COVID-19 significantly.4 There have been many newspapers reporting where people have avoided healthcare seeking when they had symptoms of influenza or had a history of travel to disease-affected areas, some of them not wanting to be social outcasts. This leads to difficulties in getting health authorities and related agencies to effectively contain the disease outbreak.5 Economic losses have risen because people are avoiding the disease-affected geographical areas. The stigmatised individuals and targeted communities are being subjected to physical violence, social isolation, denial of employment and basic essential goods in shops or even accommodation.6 There has been mistrust in healthcare treatment, because of no effective preventive or treatment strategy leading to lower healthcare seeking by the public.
Overall fear and anxiety have risen because of the exponentially increasing flood of false information endlessly being thrown across the world through social media and news coverage, which has fuelled mass hysteria and increased stigma, marginalisation and xenophobia. Those affected by COVID-19, either by being infected or suspected of having contracted infection, have been found to be facing multiple psychological issues like sleep disturbances, feelings of loneliness, anxiety, panic attacks, depression and risk of forming adjustment disorder and chronic post-traumatic stress reactions.7
This had led to the engagement of mental health professionals in addressing the psychological well-being of specific groups during the COVID-19 outbreak.8 Table 1 highlights the strategies that mental health professionals can use to address the stigma associated with COVID-19.
In summary, during outbreaks of infectious diseases, social stigma grows but is often not emphasised. Discussion regarding measures taken to ensure effective discouragement of stigmatic behaviours should be undertaken. Social drivers of stigma should be brought forward and addressed publicly, online media posts and sensationalised reporting should be monitored by appropriate authorities and experts so that they are not laced with hateful content. There should be mutual agreement and a ‘think before you speak’ policy for political leaders so as to curb their role in spreading mass hatred and inadvertent stigmatisation of specific communities. Mental health professionals should actively address the psychosocial consequences like stigma reduction in conducting research and gaining insight into the public perception regarding stigmatising behaviours. They could educate the masses regarding stigma-related behaviours and their relevant sources can allay the prevailing anxiety and fear by raising awareness regarding seeking mental healthcare services at the time of need.
The authors thankfully acknowledge the guidance of faculty staff and the support received from the Department of Psychiatry, Pt BD Sharma PGIMS, Rohtak.
Shobhit Kumar Prasad is a third year post graduate M.D. Psychiatry resident at Pt B.D. Sharma PGIMS Rohtak, Rohtak, India. He completed his bachelor’s degree of M.B.B.S. from Kasturba Medical College, Mangalore affiliated to Manipal University in Manipal, Karnataka, India. His main research interests include substance use disorder, bipolar disorder, depression, and consultation-liasion psychiatry.
SKP and AK are joint first authors.
Contributors SKP, AK, PS and RG conceived and designed the original article. All authors were involved in planning, conducting and reporting of the work described in the article. SKP submitted the article. SKP and AK are joint first authorship in the article. SKP and AK wrote the first draft of the manuscript with PS. All authors contributed to the subsequent and final drafts. PS and RG served as guarantors and had full responsibility for the work and/or the conduct of the study, had access to the data and controlled the decision to publish.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.