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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 21  |  Issue : 2  |  Page : 112-115

Let's fight against the ailment not the ailing


Independent Public Health Researcher, Bhubaneswar, Odisha, India

Date of Submission28-May-2020
Date of Acceptance20-Aug-2020
Date of Web Publication14-Jan-2021

Correspondence Address:
Dr. Janmejaya Samal
C/O – Mr. Bijaya Ketan Samal, At - Pansapalli, PO - Bangarada, Via - Gangapur, Ganjam - 761 123, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AMH.AMH_23_20

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  Abstract 


Coronavirus disease-19 (COVID-19) is a global crisis and has crippled the entire humankind throughout the globe. More than 200 countries in the globe are under the clutch of this pandemic. Apart from creating medical and public health problems, it has created a plethora of social problems in the globe. As a new disease, inadequate and inaccurate information has created havoc in the global community. This in turn has created social stigma and discrimination across the globe irrespective of social strata, geographical distribution, level of education, and economic status. The stigma and discrimination has vehemently affected the efforts to fight against COVID-19 such as containment measures, health-care provision, prevention, and control measures. This disease has peculiarly created stigma and discrimination among both the recipients and providers of health-care services. The stigma and discrimination continue to prevail in societies for both these categories. It is imperative that society should understand the significance of this disease and the role of stigma and discrimination mitigation to win the war against COVID-19.

Keywords: Coronavirus, coronavirus disease-19, discrimination, fear, othering, stigma


How to cite this article:
Samal J. Let's fight against the ailment not the ailing. Arch Ment Health 2020;21:112-5

How to cite this URL:
Samal J. Let's fight against the ailment not the ailing. Arch Ment Health [serial online] 2020 [cited 2021 Feb 25];21:112-5. Available from: https://www.amhonline.org/text.asp?2020/21/2/112/306863




  The Ailment Top


The ailment of concern is the corona-virus disease-19 (COVID-19) and is a global threat now. It is caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-COV-2) which mostly affects the respiratory system.[1],[2],[3] The previous episodes of coronavirus (COV) include the SARS-COV and the Middle East respiratory syndrome-COV and both these viruses have proved great public health challenge to the humankind.[4] The initial cases of COVID-19 date to December 2019 when a cluster of cases of pneumonia with unknown etiology were admitted to a hospital in China. These cases were epidemiologically linked to a seafood and wet animal wholesale market in Wuhan, Hubei Province, China.[5] The transmission of the disease is through person to person contact and through droplets spread through coughing and sneezing from an infected person to healthy individuals.[4] Up to 14 days has been estimated to be the incubation period of the disease at this current stage of epidemic.[6] The clinical manifestations ranged from mild to severe with some cases even resulting in death. The most commonly reported symptoms of the disease include fever, cough, myalgia or fatigue, pneumonia, and complicated dyspnea, whereas less commonly reported symptoms are headache, diarrhea, hemoptysis, runny nose, and productive cough.[7] Real-time reverse transcriptase-polymerase chain reaction from respiratory samples has been suggested as the diagnostic procedures for COVID-19.[8] Current research and evidence suggest that to prevent and control the spread of COVID-19, several public health measures need to be implemented that include isolation, identification and follow-up of contacts, environmental disinfection, and use of personal protective equipment.[9] In addition to these measures, physical/social distancing has emerged as the most significant and hyped mode of prevention of COVID-19 with imbedded merits and demerits.[10] Furthermore, hand hygiene using soap and water and alcohol-based hand rub has also been strongly recommended as a part of COVID-19 prevention.[11]


  The Ailing Top


This refers to the people who are contracted with and are suffering from COVID-19. Albeit the people with COVID-19 are the real sufferers of related social stigma and discrimination, however in the context of COVID-19, the health-care providers have also suffered from stigmatization and discrimination in several communities thus putting both the service receivers and providers under the clutch of social stigma and discrimination. As of May 10, 2020, there were 3,917,366 and 274,361 confirmed cases and deaths, respectively, as per the WHO situation report-111. Similarly, in India, there were 62,939 and 2109 confirmed cases and deaths, respectively.[12]


  The Fight Against the Ailing And the Resultant Stigma and Discrimination Top


At the present juncture of pandemic, the spread of the disease should be prevented and controlled through various public health measures such as isolation, identification and follow-up of contacts, environmental disinfection, and use of personal protective equipment,[9] however inadequate and inaccurate information about the disease has started another parallel war against the ailing through stigma and discrimination. There have been rising incidences of violence against the health-care providers and increased stigmatization of people with COVID-19 or suspected of having COVID-19. This situation impedes the reporting of illnesses.[13] One of the most pertinent events that gathered thousands of missionaries in New Delhi, India, is Tablighi Jamaat. By April 6, 1445 of 4067 tested positive representing 17 Indian states and union territories.[14] Around 22,000 people including Tablighi Jamaat members and their contacts have been quarantined across the country.[15] This event created widespread stigma and discrimination in different parts of the country with blame and shame on the Muslim community on organizing such events during this global crisis where social/physical distancing has been strongly advocated as a measure of prevention. One person in Prayagraj, Uttar Pradesh was shot dead owing to comments against Tablighi Jamaat.[16] A man hanged himself owing to discrimination by fellow villagers for having encountered with Tablighi Jamaat missionaries.[17] Several Muslim drivers were allegedly beaten up in Arunachal Pradesh.[18] Responding to the spate of attacks on Muslim people in the state of Karnataka in relation to Tablighi Jamaat, the Chief Minister had to issue stern warning.[19] In the South Indian city of Vijayawada, reports suggest that, health workers working in COVID-19 care, people linked with Tablighi Jamaat not only faced the discrimination by outsiders but the family members also behaved in the same manner as one of the security guards was not allowed to his house by his wife and son and the police had to intervene and counsel the family.[20]

Moreover, stigma associated with COVID-19 not only affected the affected group of people but also affected the health-care providers who served as the frontline soldiers in mitigating the menace of COVID-19.[21] At the crisis hour under the clutch of the global pandemic, there are reports of doctors, nurses, and paramedics, who are at the forefront of the battle against the deadly COVID-19, of being shunned by the community for the fear of being infected including threats of eviction from apartments and general ostracism.[22] Even though the Prime Minister of the country, Mr. Narendra Modi, has asked the citizens of the country to express gratitude toward the health workers by clapping their hands, clanging the vessels, ringing the bells, the discrimination does not really stop against the health-care workers. Frustrated with this, the Federation of Resident Doctors' Association in West Bengal had to seek help from the Indian health ministry for protection and safety.[23] There are several such reports in different parts of the country where doctors and other health-care workers are facing serious discrimination as they treat and work in COVID-19 hospitals. Two lady doctors in the capital city of India, New Delhi, were accosted by a local resident accusing them of spreading the infection. Albeit the doctors persuaded him of practicing physical/social distancing and other precautionary measures, the man assaulted them and fled and was arrested with charges of sexual assault and criminal intimidation and others. There are many such threats health-care workers received during this crisis period, especially the doctors, received threats of eviction from rented houses and anecdotal evidence also shows threats of rape and death as well.[24],[25],[26]

There are very disturbing news reports that have come to surface during this crisis period because of stigma and discrimination to COVID-19. Activities like spraying of disinfectants-sodium hypochlorite solution on people through sanitation tunnel[27] and stone pelting, mob lynching and not letting the funeral of one of the doctors in Chennai where his close friends had to dig a grave with bare hands to bury the doctor.[28] Stigma and discrimination hinder the fight against the scourge of COVID-19 as stigma at the community level will affect the health-seeking behavior and stigma at the level of health-care providers may hinder in serving the community effectively.


  What Needs to be Done Top


Stigma and discrimination mitigation is of paramount significance to win the war against the COVID-19 pandemic. Stakeholders and concerned agencies have come up with strategies to ward off stigmatization and discrimination associated with COVID-19. A group of more than 400 multidisciplinary Indian scientists voluntarily formed Indian scientists' response to COVID-19 to fight the myths and misconceptions about this disease.[13] Stigma and discrimination has negatively impacted earlier pandemics; such as HIV-AIDS in the past. In case of COVID-19, people are not voluntarily coming forward to seek healthcare owing to stigma and isolation. In addition, they are fearful of being blamed, isolated, and taken away from their family members. At this present juncture, it is imperative that these people receive appropriate psychosocial support and counseling from trained psychologists and other mental health professionals, and they should be persuaded that they have not committed anything wrong deed for which they should be worried about and seeking healthcare and following the protocol can help in mitigating and controlling the pandemic. Their misconceptions should be clarified and should receive psychosocial support, compassion, kindness, and counseling during this period of distress.[29] This calls for public engagement in an effective and efficient manner and the same can be achieved through trust and transparency. This can further be done through communication strategies that carry actionable messages for the public. Furthermore, these messages should bust the myths and misconceptions about the disease and should ensure that stigma and discrimination are strongly rejected.[30] Many information/misinformation regarding diagnosis and treatment has confused the general population and the health-care providers who are at the forefront of fighting this less researched disease. This has further reduced the legitimacy of scientific discovery of new diagnostics, therapeutics, and vaccines. These swindles and rumors have created social stigma among populations thereby resulting in reduced home quarantine and isolation.[31] Thus, it is important to receive accurate and reliable information from appropriate sources because in case of a new pandemic people do have higher appetite to consume whatever information gets available to them from different sources across different social media platforms.[32] People should trust reliable information sources such as the Ministry of Health and Family Welfare Portal-Government of India, State Health and Family Welfare portal, Indian Council of Medical Research portal, and above all the World Health Organization portal.[33] In this context, the MOHFW [Table 1] has issued a guideline to mitigate stigma in the general population.[34]
Table 1: Dos and Don'ts to ward off social stigma in community

Click here to view



  Conclusion Top


Social stigma in COVID-19 is multifaceted which is by default of certain measures that public health and national agencies took to contain the disease (social distancing), and many are due to lack of proper knowledge about the disease. The stigma not only affected the affected group but also the health-care providers who are at the forefront of providing medical care to these affected people. Thus, it becomes imperative, at the level of the society, to raise awareness about the disease and make people understand that the containment strategies such as quarantine, isolation, and social distancing are meant to contain and control the spread of the disease not to reinforce and exacerbate the stigma and discrimination in the community.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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[PUBMED]  [Full text]  
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  The Ailment
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