How are our attitudes to Covid-19 helping (or hindering) prevention efforts?
By Naveed Rozais
The impact of Covid-19 on all our lives has been felt time and time again this past year. From the anxiety and uncertainty a spike in infections brings, to the total lockdown we went through in March, this pandemic has left no one unaffected.
The recent second wave has brought a lot of emotions boiling to the forefront, with Sri Lanka exceeding 5,000 reported infections.
Chief among these emotions have been anger and finger-pointing, whether at the first reported Covid-19 patient of this new cluster, or the company she was associated with. Covid-19 has become the new taboo and while this is understandable, it is a highly infectious disease, the long-term implications of which are unknown. So, at what point does the anxiety and fear around Covid-19 become a stigma? Is it helping? Or is it making an already bad situation just that much worse?
What causes this stigma?
Stigma is essentially bias that leads to discrimination and/or unfair treatment. It is the inherent tendency from the majority of society to view someone in a specific situation or with a specific illness negatively. National Institute of Mental Health (NIMH) Senior Consultant Psychiatrist Dr. Pushpa Ranasinghe explained that in many cases, stigma stems from fear. “One thing is that people fear that they will be discriminated against, that they will be segregated, and people will distance themselves. They also fear that their movements will be restricted. Lots of people also feel that it is inevitable that they will get it (Covid-19) because there is no vaccine or clear way to prevent it.”
A report published by the World Health Organisation (WHO) on the social stigma associated with Covid-19 shared that the stigma surrounding Covid-19 stems from the fact that Covid-19 is a new disease which comes with many unknowns. The unknown and uncertainty are some things that frighten the vast majority of us, and it is easy to associate that fear with “others”, and in doing so, blame those “others”.
Vaccines and Infectious Diseases Forum Sri Lanka President and consultant paediatrician Dr. H.T. Wickramasinghe shared that in our society, not just in Sri Lanka, but globally, there is always a stigma that comes with infectious diseases. Dr. Wickramasinghe said: “The Covid-19 stigma has been created without people even knowing that they’re doing it; even at the Government and law enforcement level. Take the Minuwangoda cluster for example, the worker who was first reported to have had Covid-19 has said that when she came to know she had it, the Police had allegedly come and shouted at her as if she was a culprit. But this is absolutely not the case. She is simply the victim of an illness. Now we know that many other people in the same place had Covid-19 as well, very likely before she had it herself. She was simply the first known case.
“We need to understand and remember that Covid-19 is an illness. A communicable illness, which means it can be spread from one person to another. Anyone can get it, regardless of their circumstances; Amitabh Bachchan and members of his family, Donald Trump, and Boris Johnson have all got it. It’s not something that affects only certain people.”
The impact of Covid-19 stigma
The basic fear and uncertainty of getting Covid-19 is being compounded by a layer of social stigma and discrimination. Stigma in any situation makes things difficult. It prevents open discussion and promotes insularity. It makes people less receptive to dealing with the situation, from both sides of the equation, be it accepting the problem and coming forward with it or dealing with it carefully and safely finding solutions.
Covid-19 is no different. “The whole problem is society has created this impression that stops people from coming forward,” Dr. Wickramasinghe commented, adding: “Looking at the first patient from the Minuwangoda cluster, horrible things were said about her in the media, some going so far as to designate her a prostitute. Do you think anyone will be willing to come forward with symptoms? They will be more worried about the kinds of things society will say, and their families needing to deal with such things.”
The WHO also noted that stigma can often lead to situations where the virus is more, not less, likely to spread. Stigma can drive people to hide their symptoms and stop them from seeking effective healthcare immediately. It can also discourage them from adopting healthy behaviours that in other situations would help reduce the spread of the virus. For example, they may keep showing up to work despite knowing they’re not well because they can’t tell anyone they’re not feeling well and take two weeks to a month off without drawing attention to themselves. This puts them at risk of passing the virus on to their co-workers who can spread it on to their families and close contacts and so on.
Beating the stigma: The power of our words
Beating stigma is a war that needs to be fought on multiple fronts. One very important tool to overcome stigma is our words. “The language people use is very negative,” Dr. Wickramasinghe said, adding: “In Sinhala especially, they say things like thawa ekkenek ahuwuna (another one has got caught). Why use words like caught? Even in the papers, words like ‘suspect’ are used. Why use the word suspect? The attitude of treating victims of Covid-19 like culprits is very present and this needs to change. They’re not criminals. Society using language like this has made it so that people don’t like to go to the hospital or even admit they have symptoms. Threats by the Government on legal action and confiscating properties and similar things of those who don’t come forward are also adding to the problem. We need to remember that people who have Covid-19 haven’t done anything wrong. Anyone can get Covid-19.”
The WHO report also stressed the importance of language, encouraging the use of phrases like “people who have Covid-19”, “people who are being treated for Covid-19”, “people who are recovering from Covid-19”, or “people who died after contracting Covid-19”, as opposed to phrases like “Covid-19 cases” or “victims”.
Instead of using terms like “Covid-19 suspects” or “suspected cases”, phrases like “people who may have Covid-19” or “people who are presumptive for Covid-19” should be used.
When speaking about people contracting Covid-19, we must not talk about people “transmitting Covid-19”, “infecting others”, or “spreading the virus”. This implies intentional transmission and assigns blame. More approachable ways of discussing this are through terms like “acquiring” or “contracting” Covid-19.
Beating the stigma: Being mindful
It is always important to be mindful. Misinformation breeds stigma. Be mindful of what information you see and share. Do a little research. Make sure the information you’re sharing comes from a reliable source. Don’t share highly technical information that is difficult to understand, unless you’re sharing it with people who you know will understand that terminology. Challenge myths and stereotypes that promote a negative sentiment.
Dr. Ranasinghe shared that one form of stigma is the perception that Covid-19 is rampant among those who are less fortunate, like, in the case of the Minuwangoda cluster, factory workers. “We have to accept that it is not a disease of a lower socioeconomic class or anything like that. It’s to do with your immune system. Anyone’s immune system can get affected.”
Dr. Ranasinghe noted that Sri Lanka’s death toll has been very low, indicating that we are able to overcome this and that Sri Lanka’s healthcare system is able to fight it.
Dr. Wickramasinghe commented on Sri Lanka in particular, noting that South and Southeast Asia, in general, have had lower mortality rates than the west. “The most rational explanation for this is that the strain of Covid-19 that we’re fighting is not as virulent as that in the US and Europe. There are also lots of other potential explanations; one could be our unique Southeast Asian diet, we eat a lot of turmeric and other spices that boost immunity.”
Dr. Wickramasinghe stressed the importance of being mindful with preventing the spread of Covid-19. “The problem with Covid-19 is that it is highly infectious and spreads rapidly, even though it is droplet-borne,” Dr. Wickramasinghe explained, adding: “The important thing is to take proper precautions. It is essential to follow the instructions issued by the Ministry of Health; washing hands, wearing masks, and avoiding crowds. One of the biggest causes of Covid-19 spread is from assembly, whether it is parties, meetings, etc.
“Social distancing is not in place simply to protect yourself, it is to control the spread of the virus. If the spread gets out of control, the number of people requiring concentrated medical care like hospital and ICU treatment will exceed our threshold and capacity. This puts doctors in the uncomfortable position of needing to prioritise who to treat and in eventualities, who to resuscitate.”
Dr. Wickramasinghe further explained: “This is what happened in Italy and Spain. Elderly people were not ventilated because the priority was to ventilate younger people. It was not fair, but doctors had no choice. Social distancing keeps the rate of infection plateaued, so it is manageable.”
The importance of being kind
The power of being kind is one that simply cannot be underestimated, and kindness and warmth is something Sri Lanka is known for the world over. Now, more than ever, is the time for that kindness to shine. Let’s band together to create a more understanding and welcoming society. Covid-19 doesn’t need to define us. Like everything else, it too shall pass.