• February 28, 2020 |

    insights on coronavirus

    sniffles, sickness, and stigma

    article by , illustrated by

    A few days before the start of the spring semester, I walked up the steps of Brown’s Health Services building. I pried open the heavy doors, escaping the frigid Providence weather. As I entered, I sniffled and blew my runny nose, a side effect of the trek across campus. A stranger in the waiting area looked up at me, seeming wary, and I fought to ignore a fear that had grown throughout January: a fear of someone thinking I’m sick. Specifically, of someone thinking that I’d contracted the 2019 coronavirus disease (COVID-19)

    Aside from my time spent in airports traveling from my home in Minnesota back to campus in Providence, there was little to no reason for anyone to consider me at-risk for contracting SARS-CoV-2, the virus behind COVID-19. First reported in Wuhan City, Hubei Province, China, according to the Center for Disease Control and Prevention (CDC), COVID-19 had not even had its first confirmed case in the United States when I climbed the stairs of Health Services to visit the campus pharmacy. Even as I write this a month later, there are only 60 confirmed cases of COVID-19 in the United States—the virus remains concentrated primarily in mainland China

    Nevertheless, I am half-Asian. Therefore, even though I have never traveled to Asia and my Asian heritage lies in Laos with the Hmong people, I cannot escape the suspicion others now have toward my every sniffle. I worry, as I did entering Health Services, that I will be stigmatized—or worse. 

    This is not to say that concerns about COVID-19 in general are unwarranted. According to the CDC, “the clinical spectrum of COVID-19 ranges from mild disease with non-specific signs and symptoms of acute respiratory illness, to severe pneumonia with respiratory failure and septic shock.” According to the World Health Organization (WHO), it has a case-fatality ratio (total number of deaths divided by the number of confirmed cases) of 2.3 percent within China as of February 24, with a lower estimated ratio outside of China. Yet, with a wide range of contributing factors, including geography, healthcare access, disease course, and transmissibility, case-fatality ratios only represent one of many ways to measure an infectious disease’s threat, current or potential. 

    Still, SARS-CoV-2 is a novel coronavirus, meaning it has never before circulated in a human population—and its severity shouldn’t be understated. Several health officials—like Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Disease—have predicted that the virus will become a pandemic (the worldwide spread of a new disease). I discussed the virus with Dr. Richard Bungiro, a Senior Lecturer in Molecular Microbiology and Immunology at Brown who teaches BIOL1550: Biology of Emerging Microbial Diseases (among other courses). He voiced a similar concern of a pandemic: “[COVID-19] does have that capacity—it spreads very effectively. It seems to be capable of being spread even when a person is asymptomatic, which is obviously troubling because it’s not like you can just isolate people who are symptomatic and contain the virus, because there are going to be people that aren’t.” Dr. Bungiro cited the 2009 strain of H1N1, a novel strain of the influenza virus originating in Mexico, as one recent example of a novel virus turned pandemic. At the same time, while the prospect of a pandemic may feel panic-inducing, it is important to remember that in 2003, many experts also predicted that SARS would become a pandemic—possibly an annual one like the flu—but the outbreak was contained before it could infect a global population. Unfortunately, wide gaps remain in the scientific community’s knowledge of COVID-19, and in many ways the virus’s future path remains unknown.

    Although the COVID-19 outbreak is a serious matter, the paranoia and panic that have arisen from it are not necessarily proportionate. Dr. Bungiro said, “I think we have to be careful not to forget what traditionally have been infectious diseases that have infected a lot more people and killed a lot more people than new coronavirus [sic]…I think that [COVID-19] should be taken in context of the larger picture of global infectious disease.” For instance, the influenza virus causes annual pandemics, with 9 million to 45 million illnesses and 12,000 to 61,000 deaths per year, but public responses to influenza rarely echo the panic surrounding COVID-19. Additionally, while measles has much greater infectiousness than COVID-19, many still choose not to vaccinate or treat the disease seriously. 

    Ekim Luo, a psychology student at the University of Southern California and my friend from high school, encountered the consequences of COVID-19 panic firsthand. She described her experience visiting family in Shanghai after the WHO declared COVID-19 a global emergency on January 20: “At this point, all public places (malls, grocery stores, restaurants, temples, etc.) were closed down. We were technically free to go outside, but the streets were empty…Face masks were all sold out, and some businesses jacked up the prices, but the [Chinese Communist Party] stepped in and I believe people went to jail for it.” She continued to describe how the closures and panic resulted in a mild food shortage as well as price spikes, heavily impacting China’s working class. Ekim observed people losing their jobs and businesses going bankrupt with no customers to visit them. 

    This frantic rush to secure resources is not limited to China. News sources like the New York Times have reported a worldwide scramble to obtain surgical masks in the wake of COVID-19, with pharmacies in the United States selling out for weeks on end despite evidence that such masks don’t actually protect healthy individuals from contracting airborne diseases—they only prevent sick individuals from spreading them. Ekim managed to fly out of China just a few hours before a travel ban went into effect, but her family and friends remain behind. She described her correspondence with them, telling me, “For now, it’s still really grim over there, and most places remain closed. China is probably going to suffer economically in the long term, so the primary concern for most people is how they will be able to sustain financially in the recession that follows.”

    This pervasive and sometimes irrational fear in response to outbreaks is, lamentably, nothing new. Dr. Bungiro offered a historical perspective, explaining, “In disease outbreaks in history, there have been people who have died not because of the disease itself, but because of the fear of the disease, they might not have been able to get services, get food, what have you. So the fear, in some cases, can be worse than the disease itself. You can look back on just about every major infectious organism we’ve dealt with and see fear.”

    Disease panic can often be characterized by xenophobia and stigma. The article “Stigmatization Complicates Infectious Disease Management” in the American Medical Association Journal of Ethics describes the danger of stigma within public health: “Stigmatization looms large in global health ethics because it prevents those with disease from seeking care, engenders fear of those who have disease, causes prejudice against entire groups or communities, and has, in some cases, led to violence against the stigmatized group.” In the case of COVID-19, Ekim witnessed a wave of prejudice in China directed against those from Wuhan. In Beijing, some citizens have taken it upon themselves to track and register those from Wuhan with local authorities. South of Beijing, the local government of Zhengding county even offered 1,000 yuan ($145) to individuals willing to disclose information about unregistered people with suspected links to the Hubei province.

    In the United States and many other countries, the panic around COVID-19 has reignited a not-so-old form of xenophobia and racism: yellow peril. This racist ideology discriminates against those of East Asian descent, though individuals of other Asian descents are often included. In the case of COVID-19, yellow peril depicts Asian people as disease-carrying “others” who could contaminate the rest of the world. Ekim shared her perspective: “What’s happening now rings a bell to when the first wave of Chinese immigrants/indentured laborers came to the US. There is nothing original about xenophobia, and I still believe misinformation and the lack of education play a big role.” With the spread of COVID-19 and the resulting panic, incidents of yellow peril remain abounding: a man assaulting a woman with a face mask on a New York City subway, people throwing rocks at Chinese students in Southampton, high schoolers assaulting a boy and accusing him of having COVID-19 in California. As Ekim mentioned, yellow peril doesn’t follow reason, but prospers instead off of unawareness and historic intolerance. 

    Beyond the occasional look of suspicion, like when I picked up my prescription at the Brown pharmacy, I’ve been mostly spared from direct stigmatization. However, I have little cousins, also Hmong, who have been teased in elementary school for “spreading coronavirus.” I have a friend from home whose grandmother ordered her not to sit next to Chinese people. In my position as a physician’s shadow, I have watched patients at Rhode Island Hospital refuse or complain about treatment because the attending physician is Asian. 

    Dr. Bungiro voiced his thoughts about the recent rise in prejudice: “It is troubling to see some people react with xenophobic tendencies. There was some of this with SARS, and there was some with MERS as well. I think that the thing that we have to keep in mind is that nobody wants to make other people sick, or at least not anyone I interact with. The Chinese population has borne the brunt of this infection, and a lot of people have gotten sick, and over 2,500 people have died, mostly in China. That’s something that we should all be aware of and not use as justification to be hateful or hurtful. On a campus like Brown, I’d like to think that we are usually able to put aside prejudices.”

    As a co-head teaching assistant for Dr. Bungiro’s course BIOL1600: Development of Vaccines, I know that a vaccine for COVID-19 is months away at the earliest. While we wait for a “cure” or the rise of herd immunity (people getting infected, building an immunity, and thus preventing further disease transmission), we have a responsibility to resist xenophobic panic and support those most affected by the outbreak today. When asked how best to do so, Ekim recommended supporting local Chinese businesses who may not be able to sustain months of minimal revenue. She also suggested calling local representatives and advocating against racist travel restrictions. Others have advocated donating medical supplies like surgical masks to medical professionals and sick individuals (who actually need them) or seeking out trustworthy organizations to help support evacuees. 

    On the disease’s social impact, Ekim added, “I want [people] to rationally think about the situation. The xenophobia and mass paranoia have already caused many severe consequences. People are losing their jobs, small businesses are going bankrupt, and this is happening in China and outside because people are scared of Chinese people.” 

    Similarly, Dr. Bungiro advised students to respond to COVID-19 with informed and reasonable precautions, not panic. He said, “I would want them to understand some of the basics of how infectious diseases are typically transferred so they have a realistic understanding of what the risk is. I would want them to get a flu shot, if they’re medically eligible to get one, which almost everyone is. I want them to pay attention to it but not panic and turn to information sources of dubious quality.”

    During periods of global crisis like this, we must make extra efforts to advocate for solidarity, empathy, and knowledge. We must fight against the suspicious stares, unfounded prejudice, and moments of weakness where unreasonable panic wins out. Dr. Bungiro put it best: “Fear feeds on ignorance, and there’s no vaccine for that.”