Pandemics can produce contagion stigma in which specific ethnic, national, racial, or religious groups are targeted with blame. Targeted populations can be subjected to stereotyping, prejudice, discrimination, and social exclusion. Herek (2014, p. 121) provides historic examples of contagion stigma that illuminate potential risks from COVID-19:

“The 1832 U.S. cholera epidemic became a vehicle for expressing society’s widespread racism, xenophobia, and anti-Catholic prejudice. With cholera’s cause not yet understood, it was regarded by many as a divine punishment for moral failings such as alcohol consumption and sexual indulgence. Its victims— who were disproportionately likely to be poor, Black, or immigrant Catholics— were widely believed to have contracted the disease through idleness and intemperance.”

Recently, HIV/AIDS, tuberculosis, and leprosy have been the major sources of contagion stigma worldwide. These examples can shed light on risks for contagion stigma from COVID-19 and ways to mitigate stigma should it occur. As in Herek’s passage, contagion stigma commonly devolves into different sub-types of peril stigma (risks for death or disability), moral stigma (social unworthiness), or disruption stigma (illness hinders productivity in work and social roles).

Stigma is a social construction generated when a publicly recognizable “mark” identifies the bearer as unworthy as a person and fit for exclusion from society (Goffman, 1963). Examples of stigmatizing marks include skin color, hair texture, facial contour, accent, manner of dress, or other physical features. Risks that contagion stigma will emerge are largely shaped by the features or threats of bodily injury from infection that can serve as marks:

• Risk for contagion
• Risk for death or disability
• Disfigurement or other visible signs of bodily disease

COVID-19 is highly contagious, invisible during its incubation period, potentially lethal, and lacking effective prevention or treatment. These features foster population-wide fears that can lead to social stigma.

A number of U.S. lawmakers have been criticized for referring to COVID-19 as “Wuhan virus” or “Chinese coronavirus,” which propagates the misperceptions and spreads blame about the illness. In South Korea, perceived public shaming of persons with COVID-19 has led to statements that death from the illness is more desirable than living with the public criticism for spreading the virus. There have been reports of completed suicides among persons with COVID19. While globally, children have fortunately appeared to be spared high mortality rates associated with COVID-19, it is especially important to consider how children—particularly those of Asian descent—are at high risk of stigma from peers and adults, keeping in mind that many children will have other forms of the common cold and respiratory illnesses at this time of year.

Both the World Health Organization and the U.S. Centers for Disease Control and Prevention have provided resources on addressing the stigma related to COVID-19. These are useful resources to monitor personal behavior and to participate in myth-busting when hearing comments from others. For example, busting the myth that COVID-19 is transmitted through goods manufactured in China.

Historically, contagion anxiety has been “hijacked” by prior, often longstanding prejudices, discriminatory practices, and structural stigma, as in Herek’s passage above. There are potential risks that COVID-19 could activate racial or ethnic prejudices in U.S. society, although there is little evidence for this at present. This can be monitored as the pandemic runs its course.

Recommendations

• Monitor news channels and statements by public figures who make it a regular practice to stigmatize ethnic, national, religious, or racial groups. This can facilitate a rapid countering response should social stigma appear associated with COVID-19;
• Monitor well-being of those least powerful in our society, such as immigrants in ICE detention, as potential target of contagion stigma;
• Stay mindful that public expressions of support and solidarity can provide valuable support for the targets of stigma. However, such statements generally fail to stop the behaviors of stigmatizers
• Knowledge-based (educational) strategies to counter stigma have often been found ineffective in previous research;
• When contagion stigma of specific populations emerges, evidence-based interventions can be tailored to counter the stigma (Griffith & Kohrt, 2016; Herek, 2014).

By:,/p>

• James Griffith, M.D.,
  Professor and Chair,
  Dept. of Psychiatry and Behavioral Sciences,
  George Washington University
• Brandon Kohrt, M.D., Ph.D.,
  Associate Professor of Psychiatry and Behavioral Sciences,
  George Washington University