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LETTER TO THE EDITOR
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COVID-Stigma on the rise: A social challenge of public health concern for India


1 Department of Community Medicine, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India, Indi
2 Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India

Date of Submission24-Jul-2020
Date of Decision01-Sep-2020
Date of Acceptance21-Sep-2020

Correspondence Address:
Sweety Suman Jha,
37/3/1 Jaffarpur Road, 1st Lane, Barrackpore, West Bengal
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_409_20



How to cite this URL:
Lahiri A, Jha SS. COVID-Stigma on the rise: A social challenge of public health concern for India. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2021 Aug 4]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=310600



Dear Sir,

The pandemic of novel coronavirus (COVID-19) is evolving rapidly at a global as well as national extent. Associated with any crisis of such global magnitude are certain maladaptive human behavioral changes and resultant unhealthy practices. The COVID-19 pandemic has been engendering social stigmatization, more so in the Indian context. India is heading towards two lakh diagnosed cases as of May 31, 2020.[1] The country has quickly moved to the top seventh spot in the list of worst COVID-hit countries.[2] With the increasing burden, the related maladaptive response having a deep social impact has become even more important at this very juncture for the nation. As per Goffman (1963), stigma can be understood as an attribute that discredits and reduces the bearer of it from a whole and usual person to a tainted, discounted one.[3] An important social understanding behind this discrediting may be the prevalent social norms that emphasize on the fact that an individual must act in a particular socially acceptable way that is confluent with time and place. Thereby, the concept of “spoiled identity” successfully explains the origin of stigma in certain situations and the implications. In their stigmatization framework, Link and Phelan (2001) highlighted four steps, i.e., distinguish and labeling human differences, stereotyping the individual with undesirable characteristics, separation with respect to the characteristics, and finally, the stigmatization is complete with the individual losing status and being discriminated.[4]

The concept of stigmatization has been applied to many diseases such as leprosy, tuberculosis, HIV/AIDS, cancers, and mental illnesses. There are some published articles discussing stigma on the COVID-19-infected patients comparing to the HIV/AIDS situation.[5] The dimensions for these diseases in terms of causality, chronicity, and implications are drastically different. In the Indian perspective, stigma is gradually becoming socially engraved replacing the xenophobia that was the feature of the behavioral dimension of the pandemic. In the case of this emerging social stigma related to COVID-19 infection, the key step is stereotyping, since a mere propaganda of infection will set off subsequent panic and resultant discrimination. This is becoming more and more reported from different parts of the country. Not only the patients and their family members, the health-care workers (HCWs) and their families are also getting stigmatized because of the nature of their profession and are stereotyped to be the certain carriers of infection to the community. Throughout the country, the HCWs are battling stigma, for example, in an incident in the city of Hyderabad, a group of young doctors were forced to move out of their rented homes.[6] It is believed that in the present situation, when there is virtually no proven treatment for the disease, a panic is certain, and if not addressed with scientific content through proper health education techniques, the discrimination will nothing but increase.

The epidemiological trajectory of the disease is much discussed in scientific literatures, but the social problem, namely the stigmatization that has become a major problem, is receiving fractured attention. Social determinants are very important in determining the outcome of the health of a community and more so in the situations of emergencies, disasters, or pandemics. In low- and middle-income countries like in India, stigma is more often linked with poor disease outcome for the high-burden illnesses.[7] India has been forced to remain under lockdown with effect from March 25, 2020.[8] With rapid dissemination of information, which in many situations are not scientifically vetted, in the social media and mass media coupled with the restriction forced by lockdown has prepared the psychosocial basis for stigmatization and further adverse outcomes to occur. Lack of proper awareness is the root cause.

As the nation gradually starts to withdraw the lockdown amidst the rising trend of positive reports for COVID-19, combating the stigma in particular is not only challenging but also essential. This necessity is grounded on the fact that the disease is expected to become endemic. Presumably, awareness counteracts fear and panic thereby improves the overall care-seeking in all its components including patient-to-patient communication and community support.[9] However, the influence of typical socioeconomic and political factors should also be taken into account. While major emphasis is required to stop the development of the stereotyping stage, interventions proceeding this may also prove effective as long as discrimination is halted. Stigma leads to under-disclosure of symptoms owing to social desirability and thereby leading to poor treatment seeking and also increasing the undiagnosed or hidden burden of the infection creating a conducive environment for disease spread. For a nation now desperate to regain socioeconomic functions, stigma ultimately producing disharmony in the society is detrimental. Undoubtedly, to help the nation overcome the hurdle of this pandemic, to prevent the HCWs fighting in the frontline from getting demotivated, and nonetheless, to help those at risk, infected, or cured regain their social and economic role, a harmonious rational society is needed, which can be attained by taking stern measures in alleviating the epidemic of social stigmatization.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
India Coronavirus: 184,735 Cases and 5,253 Deaths-Worldometer [Internet]. Available from: https://www.worldometers.info/coronavirus/country/india/. [Last cited on 2020 May 31].  Back to cited text no. 1
    
2.
WHO Coronavirus Disease (COVID-19) Dashboard. Available from: https://covid19.who.int/. [Last cited on 2020 Jun 04].  Back to cited text no. 2
    
3.
Goffman E. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, New Jersey: Prentice-Hall; 1963.  Back to cited text no. 3
    
4.
Link BG, Phelan JC. Conceptualizing stigma. Annu Rev Sociol 2001;27:363-85.  Back to cited text no. 4
    
5.
Logie CH, Turan JM. How do we balance tensions between COVID-19 public health responses and stigma mitigation? Learning from HIV research. AIDS Behav 2020;24:2003-6.  Back to cited text no. 5
    
6.
While People Clapped for those in Front Line Fighting Virus, Telangana Landlords Leave Doctors Homeless. New Indian Express. Available from: https://www.newindianexpress.com/states/telangana/2020/mar/24/while-people-clapped-for-those-in-front-line-fighting-virus-telangana-landlords-leave-doctors-homele-2120839.html. [Last cited on 2020 May 30].  Back to cited text no. 6
    
7.
Kane JC, Elafros MA, Murray SM, Mitchell EM, Augustinavicius JL, Causevic S, et al. A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries. BMC Med 2019;17:17.  Back to cited text no. 7
    
8.
Ministry of Home Affairs. Order; 2020. Available from: https://www.mha.gov. in/sites/default/files/MHAorder%20copy_0.pdf. [Last cited on 2020 May 31].  Back to cited text no. 8
    
9.
Harper CA, Satchell LP, Fido D, Latzman RD. Functional fear predicts public health compliance in the COVID-19 pandemic. Int J Ment Health Addict 2020;Available from: https://doi.org/10.1007/s11469-020-00281-5  Back to cited text no. 9
    




 

 
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