If you don’t already, you will soon know someone who has been ill with Covid-19 and survived. They will be our friends, our family, our neighbors, and our colleagues. History will judge us by the way we treat them.
Unfortunately, as my and others’ research makes clear, stigma has exacerbated the suffering from every major infectious disease epidemic in our history, and it will certainly play a role in the current Covid-19 pandemic. Stigma is an evolutionary response: We are hard-wired to physically distance ourselves from others who could infect us. We have an entire suite of evolved reactions, called “parasite avoidance,” to prevent us from maintaining contact with others who may carry communicable diseases. These reactions are what make us feel disgusted by signs of sickness, such as vomiting or skin lesions, whether or not these signs represent an actual threat to our own health.
There is a moral as well as physical component, as well. We tend to believe that bad things happen to bad people. This “just-world fallacy” tricks us into thinking that people who are infected with a disease may have done something wrong to deserve it. Maybe people who have become infected with Covid-19 didn’t wash their hands long enough, touched their face too much, or didn’t socially distance enough. This belief is comforting, helping us believe that we are in control of our own fate. It tells us that if we do everything right, we won’t become infected. Yet, we simply don’t live in a just world: We could do everything right, wash our hands for 60 seconds instead of just 20, and still become infected with Covid-19.
The Toll of Stigma
My decades of research show that stigma harms the mental and physical health of people with the disease. This stigma can take the forms of social rejection, gossip, physical violence, and denial of services. Experiencing stigma from others can lead to elevated depressive symptoms, stress, and substance use. Alarmingly, people don’t have to experience stigma from others to be negatively affected by it. Just anticipating stigma from other people — perhaps because you’ve already seen sick people be ostracized or judged for their illness — can lead to anxiety and stress. Infected people may also internalize stigma, believing that they did something wrong or are a bad person because they became infected with a disease. The fact that many Covid-19 patients are medically isolated compounds the problem — patients under such separation orders have been shown to be at greater risk of distress.
Stigma does not only impact people who are sick, but extends to people who have an actual or perceived association with a disease. Family members of people with disease and healthcare providers caring for people with disease are at high risk of experiencing stigma from others during epidemics. In the context of Covid-19, stigma has additionally been directed at Asian Americans and people who have traveled to areas affected by the pandemic.
Stigmatizing anyone during a pandemic poses a threat to everyone. Research from HIV, Ebola, Hansen’s Disease, and other infectious disease epidemics shows that stigma undermines efforts at testing and treating disease. People who worry that they will be socially shunned if they are sick are less likely to get tested for a disease or seek treatment if they experience symptoms. Because of the just-world fallacy, they may also not believe that they could have a disease — after all, they’re a good person who has taken precautions to avoid the illness.
Social Distance, Not Social Isolation
The good news is that scientists working in diverse disease contexts have identified tools that can be leveraged to address stigma during Covid-19, including strategies for both reducing stigma and strengthening resilience, so that even if people are exposed to stigma they may not be as negatively affected by it.
Education is one of the most popular tools to deconstruct stigma. It can dispel harmful stereotypes, such as that Asian Americans are more likely to have Covid-19. Local and national leaders who fall ill to Covid-19 should be open about their diagnosis to help normalize the disease. When NBA star Magic Johnson announced he was HIV positive, HIV testing rates increased dramatically across the nation. In this regard, social media posts from celebrities who have the disease are also likely to help lift the taboo. I’ve been reminding colleagues and friends: If Tom Hanks and Rita Wilson can get Covid-19, we all can.
Corporate leaders can clarify that organizational values of inclusion, acceptance, and diversity extend to people who are affected by Covid-19. In some instances, enforcing anti-discrimination policies may be necessary. A patient who is fully recovered from Covid-19 is no longer infectious and should not be treated any differently from his or her colleagues. Corporate leaders can also create clear and confidential guidelines for reporting and responding to Covid-19 cases among employees, so that employees feel safe reporting if they become sick and secure that they will have a job when they have recovered. Organizations should also invest in wellness programs that promote resilience to stigma and other stressors. For example, mindfulness activities help to improve resilience to a wide range of stressors and there are a variety of platforms facilitating access to them.
While leadership is important, we all play a vital role in removing stigma during a pandemic. Indeed, one of our best reduction and resilience tools is simple social support. Employees can schedule virtual coffee hours, lunches, and happy hours with their co-workers to check in on them. We can call and send texts to our neighbors, especially those who have been sick, to update them on our lives and express hope of re-connection after social-distancing measures are lifted. We should also talk openly about the mental health struggles we are all facing — opportunities to talk with others about stressors including stigma can promote positive coping and mental well-being.
Although stigma is an evolved reaction to disease, it is not an inevitable one. Stigma divides and turns us against each other, but pandemics remind us of how connected we all are. Our shared vulnerability to this virus is a source of solidarity. We must remember that the virus — not people with Covid-19 or affected by Covid-19 — is the enemy.