|Year : 2021 | Volume
| Issue : 1 | Page : 24-29
COVID-19-related social stigmas in India and the approaches to mitigate them
Independent Public Health Researcher, Bhubaneswar, Odisha, India
|Date of Submission||02-May-2020|
|Date of Decision||27-Jun-2020|
|Date of Acceptance||27-Jul-2020|
|Date of Web Publication||31-Mar-2021|
Dr. Janmejaya Samal
C/O- Mr. Bijaya Ketan Samal, At-Pansapalli, Po-Bangarada, Via-Gangapur, Ganjam - 761 123, Odisha
Source of Support: None, Conflict of Interest: None
Coronavirus disease-2019 (COVID-19) is a pandemic and a public health emergency of international concern as declared by the Word Health Organization. The entire world is affected by the scourge of this disease and has created equal amount of tension in the social spheres as in science and medicine. There are reports of racism, xenophobia, discrimination, and ostracization in several communities throughout the globe, both urban and rural owing to the social stigma associated with it. Stigma can result owing to a lack of knowledge about COVID-19 and can lead to more fear and anxiety in the society. It can cause harm and allow myth and rumor to gain traction in societies. Thus, it becomes imperative that during this international crisis period, all human beings should stand together to fight against this menace and be informed correctly about the disease from appropriate sources, not from social media, and help each other. The concerned stakeholders such as community, media, and government agencies need to play their role which would ultimately bring about change in the society and ward off the social stigma and discrimination. It is ultimately the community that suffers a lot from such pandemics, thus every community member should stand with solidarity and help each other; the media should bring about the appropriate information from appropriate sources and help creating awareness to prevent racism, biasness, and xenophobia. At this crisis moment, the government agencies should bring about notices, circulars, and public information and lay down the roles and responsibilities of different government departments to curb this menace.
Keywords: Bias, coronavirus, discrimination, fear, prejudice, racism, xenophobia
|How to cite this article:|
Samal J. COVID-19-related social stigmas in India and the approaches to mitigate them. Indian J Soc Psychiatry 2021;37:24-9
| Introduction|| |
The historical background of coronavirus disease-2019 (COVID-19) traces back to December 2019 when several cases of pneumonia of unknown etiology were reported in Wuhan city, Hubei province of China. Wuhan city is a major transportation hub with a population of 11 million, and most of these affected people visited the local fish and wild animal market during the last month. This fish and wild animal market also deals in live animals such as poultry, marmots, bats, and snakes. In a press conference, Dr. Jianguo Xu, who led the scientific team announced that a new type of coronavirus tentatively named by the World Health Organization, as the 2019-novel coronavirus, has caused the outbreak. Scientists then started working on this new virus to figure out the source and the first genome of COVID-19 was published in January 2020 by a research team led by Prof. Yong-Zhen Zhang. The early investigation showed that the susceptibility of this disease is associated with age, biological sex, and other health conditions and the early patterns have shown similar trends like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses. The COVID-19 has been declared as a Public Health Emergency of International Concern by the World Health Organization (WHO) on January 30, 2020, on a second meeting of international health regulations (2005) emergency committee regarding the outbreak of nCOV-19. [Table 1] shows the global data on COVID-19 as of July 4, 2020.
|Table 1: Coronavirus situation report as reported by the World Health Organization on July 4, 2020|
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What is Coronavirus Disease-2019
Coronavirus disease is a global threat now. This virus mostly affects the respiratory system. The previous episodes of coronavirus include the SARS-coronavirus (SARS-COV) and the MERS-COV and have proved great public health challenge to the humankind. The history of COVID-19 dates to December 2019 when a cluster of cases of pneumonia with unknown etiology were admitted to a hospital who were epidemiologically linked to a seafood and wet animal wholesale market in Wuhan, Hubei Province, China. The transmission of the disease is through person-to-person contact and through droplets spread through coughing and sneezing from an infected person to a healthy individual. The incubation period of the disease has been estimated for up to 14 days at this current stage of epidemic. The initial clinical manifestations were not clear; however, it ranged from mild to severe with some cases even resulting in death. The most commonly reported symptoms of the disease include fever, cough, myalgia or fatigue, pneumonia, and complicated dyspnea, whereas less commonly reported symptoms are headache, diarrhea, hemoptysis, runny nose, and productive cough. The suggested diagnostic procedures for COVID-19 refer to conducting a real time-RT-PCR from respiratory samples. Current research and evidence suggest that to prevent and control the spread of COVID-19, several public health measures need to be implemented that include isolation, identification and follow-up of contacts, environmental disinfection, and use of personal protective equipment. In addition to these measures, social distancing has emerged as the most significant and hyped mode of prevention of COVID-19 with imbedded merits and demerits. Furthermore, hand hygiene using soap and water and alcohol-based hand rub has also been strongly recommended as a part of COVID-19 prevention.
What is Social Stigma
According to Link BG and Phelan JC in their article “Conceptualizing Stigma,” they delineated stigma as the occurrence of labeling, stereotyping, separation, loss of status, and discrimination in the context in which power is exercised. Furthermore, as stigma incorporates concepts of labeling and stereotyping, it is different than discrimination. Stigma, in the context of public health, is a well-evidenced hindrance to health-seeking behavior, engagement to care, and treatment adherence across a range of health problems globally. According to Goffman, stigma enables a variety of discriminations that culminates in denial of social acceptance to an individual or a group, reduces opportunities, and fuels social inequality., Furthermore, stigma adversely influences the health outcomes by worsening, undermining, and impeding several social processes such as psychological and behavioral responses, relationships in social sphere, stress, availability of resources, and aggravation of poor health. There are certain factors that influence the outcome among the affected individuals, groups, and institutions that ultimately impact the health and the society because of stigmatization. These factors include drivers and facilitators, stigma “marking,” and stigma manifestation. The drivers vary with the health conditions; however, they are mostly the negative ones and may range from fear of infection through contact for communicable disease, loss of production in chronic conditions, to authoritarianism, social judgment, and blame. On the contrary, facilitators could be either positive or negative influences; for instance, the presence or absence of personal protective equipment may minimize or exacerbate the stigmatizing behavior toward people with an infectious disease by health-care providers. The drivers and facilitators determine the “marking of stigma” to specific individuals or groups. Once stigma is applied, it manifests in a range of experiences and practices. The manifestations could be “self-stigma,” “perceived stigma,” “anticipated stigma,” and “associative stigma.”,,,
| The Plight of Social Stigma Associated with Coronavirus Disease-2019 The Indian Scenario|| |
SARS-COV-2 emerged as a greatest public health emergency with its own set of medical and psychosocial issues. More specifically, the control and containment measures of COVID-19 such as quarantine, isolation, and social distancing reinforced the social distancing in communities both rural and urban. In addition to this, lack of knowledge about this disease also exacerbated the stigma in communities. There are evidences in news dailies that social stigma has affected many parts of the society owing to COVID-19. One of the most pertinent events that gathered thousands of missionaries in New Delhi, India, is Tablighi Jamaat. The religious congregation that took place in Nizamuddin Markaz Mosque in early March 2020 is labeled as a super spreader as >30% of them tested positive who were associated with this event. Reports suggest that >9000 missionaries may have attended the events from different Indian states and 960 attendees from 40 different foreign countries., By April 6, 1445 of 4067 tested positive representing 17 Indian states and Union territories. Around 22,000 people including Tablighi Jamaat members and their contacts have been quarantined across the country. This event created widespread stigma and discrimination in different parts of the country with blame and shame on the Muslim community on organizing such events during this global crisis where social/physical distancing has been strongly advocated as a measure of prevention. One person in Prayagraj, Uttarpradesh, was shot dead owing to comments against Tablighi Jamaat. A man hanged himself owing to discrimination by fellow villagers for having met with Tablighi Jamaat missionaries. Several Muslim drivers were allegedly beaten up in Arunachal Pradesh. Responding to the spate of attacks on Muslim people in the state of Karnataka in relation to Tablighi Jamaat, the Chief Minister had to issue a stern warning. In the south Indian city of Vijayawada, reports suggest that, health workers working in COVID-19 care, people linked with Tablighi Jamaat are not only ill treated by outsiders but the family members were also found to behave in the same manner, as one of the security guards was not allowed by his wife and son and the police had to intervene and counsel the family.
Moreover, stigma associated with COVID-19 not only touched the affected group of people but also involved the health-care providers who served as the frontline soldiers in mitigating the menace of COVID-19. At the crisis hour under the clutch of the global pandemic, there are reports of doctors, nurses, and paramedics, who are at the forefront of the battle against the deadly COVID-19, of being shunned by the community for the fear of being infected including threats of eviction from apartment and general ostracism. Even though the Prime Minister of the country, Mr. Narendra Modi, has asked the citizens of the country to express gratitude toward the health workers by clapping their hands, clanging the vessels, and ringing the bells, the discrimination does not really stop against the health-care workers. Frustrated with this, the Federation of Resident Doctors Association in West Bengal had to seek help from the Indian Health Ministry for Protection and Safety. There are several of such reports in different parts of the country where doctors and other health-care workers are facing serious discrimination as they treat and work in COVID-19 hospitals. Two lady doctors in the capital city of India, New Delhi, were accosted by a local resident accusing them of spreading the infection. Although the doctors persuaded him of practicing social distancing and other precautionary measures, the man assaulted them, fled, and was arrested with charges of sexual assault and criminal intimidation and others. There are many such threats against the health-care workers, especially the doctors, who received threats of eviction from rented houses, and anecdotal evidence also shows threats of rape and death as well.,,
Furthermore, there are very disturbing news reports that have come to surface during this crisis period because of stigma and discrimination to COVID-19. Activities like spraying of disinfectants-Sodium Hypochlorite solution on people through sanitation tunnel and stone pelting, mob lynching, and not letting the funeral of one of the doctors in Chennai to happen where his close friends had to dig a grave with bare hands to bury the doctor, are some of the examples of wide spread stigma and discrimination among people. Stigma and discrimination at both these situations hinder the fight against the scourge of COVID-19 as stigma at the community level will affect the health-seeking behavior and stigma at the level of health-care providers may hinder in serving the community effectively.
| Considerations in Mitigating Social Stigma in Coronavirus Disease-2019|| |
Combating the stigma and discrimination to COVID-19 is of utmost significance as the same has serious concerns for the prevention and control of the disease. Technical and scientific agencies have laid down certain principles and guidelines to ward off social stigma in the community. Agencies such as the World Health Organization, American Psychological Association, and Ministry of Health and Family Welfare (MOHFW) are some of the prominent organizations that have laid down guidelines for the same and are very much relevant in the Indian context. The following few steps should be adhered to mitigate the stigma and discrimination to COVID-19 which would aid in management, control, and prevention of the disease.
| Avoid Stigmatizing Labeling|| |
Social stigma is very strongly associated with labeling and is done using certain words and phrases that are derogatory for the society. One of the best examples of using the right words and languages to avoid stigma and discrimination against people in the context of HIV/AIDS can be referred from the UNAIDS guideline. Similarly, in the context of COVID-19, it is better to use the term “COVID-19/SARS-COV-2” instead of “Wuhan Virus, Chinese Virus” which would avoid discrimination against ethnicity, “people who are being treated for COVID-19” instead of “COVID-19 suspects and COVID-19 cases,” and “risk of COVID-19” instead of “Plague and Apocalypse.”
| Accurate Information from Accurate Sources|| |
Inaccurate information from different sources, more clearly from social media, is strongly associated with stigma and discrimination. Many a time, social media information is not linked with appropriate sources, can be fabricated, and be posted with some vested interest in favor of or against specific groups which would cause racism, xenophobia, and biasness in the community. The recipients of information about an emerging health-related threat, mostly, have limited or no knowledge about that threat which enables them to consume the information as quickly as possible from different accessible social media sources. One of the best examples during Zika virus emergence is that people who were more closely associated with social media had increased risk perception; however, increased information in traditional media led to protective behavior among people. Thus, it becomes imperative that correct information reaches to people from appropriate sources to allay the anxiety, clarify the confusions, and avoid stigma and discrimination. In the context of India, appropriate sources are the MOHFW Portal, Indian Council of Medical Research portal, and the WHO Portal.
| Every Cloud Has a Silver Lining|| |
It is needless to mention that pandemics bring gloomy pictures in the society; however, every cloud has a silver lining. COVID-19 has significantly contributed to disease morbidity and mortality and is the saddest part; however, the speedy recovery rate among patients is the silver lining and can bring about smiles and is a great impetus to ward of stigma as well.
| Surface the Success Stories|| |
The COVID-19 pandemic has brought about a new crisis across the globe where countries followed the lockdown to adhere to physical/social distancing principle to prevent the transmission of the disease. Multiple stakeholders are involved in this initiative such as to bring about law and order situation under control the police department is involved, and the entire medical fraternity is working on COVID-19 clinically managing cases at the hospital, working at RD labs for specific therapeutics and vaccines. These success stories should come to the surface to avoid stigma and discrimination against these specific groups who are involved in the fight against COVID-19 as warriors.
| Role of Media Houses|| |
Mainstream media has a strong role in mitigating the social stigma in the community. As an anchor of mass media, journalists should avoid labeling and using words and languages which would create stigma and discrimination.
| Role of Citizen Charters and Public Health Leaders|| |
In a civilized society, it is the responsibility of each citizen of a country to behave responsibly. Everybody, in a position of responsibility, should correct the myths, rumors, and stereotypes. A public health leader, leader of a national public health agency, should be able to own the responsibility and correct misconceptions and spread the right message. The same is applicable to politicians and bureaucrats holding responsible positions in the country.
| Challenge Groups that Spread Bias, Stigma, and Hatred in Society|| |
The society should be a right mix of egalitarianism and elitism, however, sometimes, a prominence of elitism brings about bias, stigma, and discrimination in the society. These issues are public health threats and damage the health, mental health, and well-being of stigmatized groups. Once established, they make it harder to contain any current or future epidemics. As responsible citizens, as we adhere to preventive measures such as handwashing, social distancing, and respiratory etiquette, similarly we should behave appropriately when it comes to respecting and embracing diverse people and communities. No one should be allowed to use any language, ways, or means that separate communities and promote biases.
| Conclusion|| |
Social stigma in COVID-19 is multifaceted which are by default of certain measures that public health and national agencies took to contain the disease, and many are due to lack of proper knowledge about the disease. The stigma not only affected the affected groups but also affected the health-care providers who were at the forefront of providing medical care to these affected people. Thus, it becomes imperative, at the level of the society, to raise awareness about the disease and make people understand that the containment strategies such as quarantine, isolation, and social distancing are meant to contain and control the spread of the disease and not to reinforce and exacerbate the stigma and discrimination in the community.
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Conflicts of interest
There are no conflicts of interest.
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