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Social stigma associated with COVID-19 infection

During the 2019–20 coronavirus pandemic, UNICEF states that people are likely to be labelled, stereotyped, discriminated against, treated separately or experience loss of status because of real or perceived links with the disease. As a result of such treatment, those who have (or are perceived to have) the disease, as well as their caregivers, family, friends and communities might also be subjected to social stigma. Due to the social stigma, individuals and groups could be subjected to racism and xenophobia. The people most vulnerable to social stigma are those of Asian descent, those who have traveled abroad and healthcare professionals.

Reasons and impact of social stigma

According to UNICEF, the level of stigma towards those affected with COVID-19 could be because of the fact that the disease is new and there are many unknowns surrounding the disease transmission and cure. People are generally afraid of the unknowns. It is easy to associate the fear of unknown with "others", leading up to stigmatizing those perceived as "others". The pandemic nature of the disease can lead up to confusion, anxiety and fear among the public, which also fuels harmful stereotypes. As a result of the stigma, social cohesion is undermined and there can be social isolation of the groups. This contributes to a situation where the virus is more likely to spread, leading on to severe health problems and difficulties in controlling disease outbreak. Due to social stigma, people could be driven to hide their illness to avoid being discriminated against. It can prevent people from seeking immediate healthcare and discourage them from adopting healthy behaviors. They could also be subjected to physical violence.

Addressing social stigma

In order to address social stigma, it is important to build trust in reliable health services and advice, show empathy to the affected individuals and adopting effective practical measures to keep people safe. The following measures are recommended to address social stigma by the UNICEF:

• Use of people-first language, that respects the individual and talking about the disease with a positive tone in all communication channels, including media, such as:
  • Not attaching ethnicity or locations to the disease, such as 'Wuhan virus' or 'Asian virus' and using only the official name COVID-19
  • Using 'people who have COVID-19' instead of 'COVID-19 cases' or 'COVID-19 victims' or 'COVID-19 suspects'
  • Using terminology like, people 'acquiring' or 'contracting' COVID-19 instead of people 'transmitting COVID-19', 'infecting others' or 'spreading the virus' as it implies intentional transmission and assigns blame
  • Refrain from using criminalising or dehumanising terminology in a way that might create impression that those with the disease have done something wrong, thereby feeding stigma
  • Speaking the facts about COVID-19 accurately, based on scientific data and latest official health advice
  • Not repeating or sharing unconfirmed rumors, and avoiding using of exaggerative terms like 'plague' and 'apocalypse' to denote the pandemic
  • Emphasizing the effectiveness of prevention and treatment measures, rather than dwelling on the negatives or messages of threat.
• Spreading accurate and updated facts, such as by:
  • Using simple language and avoiding clinical terminology
  • Engaging social influencers, such as religious or political leaders and celebrities to amplify the message in a geographically and culturally appropriate way
  • Amplifying the stories and images of local people who have recovered or supported a loved one through the recovery from COVID-19
  • Portraying of different ethnic groups, and use of symbols and formats that are neutral and not suggestive of any ethnic group
  • Practicing ethical journalism: Reports that overly focus on patient responsibility can increase stigma for people who may have the disease. News that speculates the source COVID-19 in each country, for example, can increase stigma towards such individuals.
  • Linking up to the other initiatives that address social stigma and stereotyping
• Observe communication tips:
  • Correct misconceptions, while acknowledging that people's feelings and subsequent behaviour are real, even if their underlying assumptions are false.
  • Share sympathetic narratives and stories that humanise the struggles of affected individuals and groups
  • Communicate support for those working in the frontline

Gendered impact of the 2019-20 coronavirus pandemic

Coronavirus disease 2019 is known to affect both men and women, but the impact of the pandemic and mortality rates are different for men and women. Mortality due to COVID-19 is higher in men in studies conducted in China and Italy. A higher percentage of health workers, particularly nurses, are women, and they have a higher chance of being exposed to the virus. School closures, lockdowns and reduced access to healthcare following the 2019–20 coronavirus pandemic may differentially affect the genders and possibly exaggerate the existing gender disparity.

Gender differences in mortality

As of April 2020, men die more often than women after being affected with COVID-19 infection. The highest risk for men is in their 50s, with the gap between men and women closing only at 90. In China, the death rate was 2.8 percent for men and 1.7 percent for women. The exact reasons for this sex-difference is not known, but genetic and behavioural factors could be a reason for this difference. Sex-based immunological differences, lesser prevalence of smoking in women and men developing co-morbid conditions such as hypertension at a younger age than women could have contributed to the higher mortality in men. In Europe, 57% of the infected individuals were men and 72% of those died with COVID-19 were men. As of April 2020, the US government is not tracking sex-related data of COVID-19 infections. Research has shown that viral illnesses like Ebola, HIV, influenza and SARS affect men and women differently.

Impact on health

During public health emergencies, women are at an increased risk of malnutrition.

Women as caretakers

Evidence from past disease outbreaks show that women are more likely to be caregivers for the sick individuals in the family, making them more vulnerable to infection. A majority of healthcare workers, particularly nurses, are women. They are on the frontline to combat the disease, which makes women vulnerable to exposure. 90% of the healthcare workers in China's Hubei province (where the disease originated) were women and 78% of the healthcare workers in USA are women.

Reproductive health

See also: COVID-19 in pregnancy

During an outbreak, healthcare resources are diverted to combat the disease, which results in down-prioritizing reproductive health of women. The physiological changes in pregnancy puts women at an increased risk for some infections, although evidence is lacking particularly about COVID-19. Women had a higher risk of developing severe illness when affected with influenza virus (which belongs to the same family as COVID-19), so it is important to protect pregnant women from being infected with COVID-19. Women nurses were reported to have decreased access to tampons and sanitary pads while also working overtime without adequate personal protective equipment during the 2019-20 coronavirus pandemic in mainland China. In addition, access to abortion was severely restricted in areas of the United States.

Clinical trials

Women are underrepresented in clinical trials for vaccines and drugs, as a result of which sex-differences in disease response could be ignored in scientific studies.

Gender disparity in leadership

There is gender disparity in leadership of COVID-19 outbreak responses. The White House's 12-person Coronavirus Task Force consisted entirely of men. 72 percent of the executive heads in global healthcare are men. According to ThinkGlobalHealth, "equality issues are only meaningfully integrated into emergency responses when women and marginalized groups are able to participate in decision-making". The Guardian has voiced that toxic masculinity of male leaders like Donald Trump and Jair Bolsonaro have motivated them to falsify and dismiss evidence about public health crises like the coronavirus pandemic.

Socio-economic impact

Women constitute a larger part of informal and part-time workers around the world. During periods of uncertainty, such as during a pandemic, women are at a greater risk of being unemployed and being unable to return to work after the pandemic is over. Quarantine experience can be different for men and women, considering the difference in physical, cultural, security and sanitary needs for both genders.

Gender based violence

See also: Impact of the 2019–20 coronavirus pandemic on domestic violence

Due to increased tension in the household during a pandemic, women and girls are likely to experience higher risk of intimate partner violence and other forms of domestic violence. In Kosovo, there has been a 17% increase in gender based violence during the pandemic. During periods of lockdown, women experiencing domestic violence have limited access to protective services. In the Netherlands, the number of calls to child abuse centers rose by 76% in February 2020 compared to the previous year.