The COVID-19 pandemic has been stressful for communities across the globe. It has perpetrated a level of anxiety in all populations, which has led to stigma towards certain people – especially Asian Americans in the US. The current outbreak has provoked stigma in Nepal as well. Health care workers, COVID-19 patients or suspects and people who have returned home from abroad are having to face these stigmas.

A few days back, an adult male presented himself in our fever clinic at the Charikot Primary Health Care Centre with a history of sore throat and cough. He had returned from South Korea a month back and had lived in self-quarantine for 21 days. None of his family members showed any symptoms. He and his family members were, however, facing persistent discrimination from neighbours.

He came to us after someone posted his name and address in the social media, accusing him of possibly spreading the disease in his village. Thus, he demanded a test for COVID-19 to prove he did not have the virus.

The very next day, a young female who had returned from Dubai 11 days back came to us demanding a test. She had absolutely no symptoms. But she came to our hospital after walking more than four hours because her community had pressured her to get the test.

Social stigma in the context of health is the negative association between a person or group of people who share certain characteristics and a specific disease. Mental disorders, AIDS, venereal diseases, leprosy and the like are diseases that are stigmatised in our community – by limiting social participation. Stigma is not limited to the person suffering from the disease but extends to one’s family members, too.

Stigma is associated with the COVID- 19 outbreak because of its highly contagious nature and relatively high mortality. Stigmatisation has huge impact on a patient as well as the quality of care he or she receives from the health institutions. The patient might keep away from seeking help for the illness for fear of discrimination. In Dolakha, there are lots of migrant workers from India, and yet they are not seeking care at the nearby health centres because of this fear. Also, there are cases where after a recent foreign country visit, people hide themselves from the community so that their family member need not go through the negative consequences.

Stories of people with fever being denied health care in private hospitals all across the country are rampant in the media. The COVID-19 stigma is unique because of the discrimination that health care workers and medical students face along with the patients. While there are many people motivating health care workers in this fight against the disease, there are also those who see us as potential COVID-19 carriers. Stories of forced evictions of health care workers are published every day.  The entire staff of Sindhuli hospital, who lived on rent, were evicted by their landlords last week.

A final year BDS student who returned to Nepal from Bangladesh faced similar discrimination. He had returned two weeks back and was in isolation for those two weeks. He did not show any symptoms nor did his family members. But he faced extreme pressure from the community to go and get tested for COVI-19. Neighbours went as far as to complain to the police. Then ward chairperson requested the family to get checked in our hospital.

They came to us, but there was nothing to check. They were not the ones with the problem. The real problem was the stigma towards possible COVID-19 patients that was slowly rooting in our society. There are stories of hate crimes in the USA against Asian Americans following the outbreak. We haven’t reached that stage. But if there is an outbreak, people with a travel history, health care workers and family members of COVI-19 patient or suspects could face stigma in the form of social rejection, physical violence and denial of health care.

There is a need to intervene against this stigma now before it spreads its roots. We need urgent advocacy in the community through policy makers and community leaders. The Mayor of Bhimeshwor Municipality has been actively engaged in limiting the stigma of this disease through community engagement.

There is a lot we need to do. But we have done it before, for diseases like leprosy and HIV/AIDS. We need a national plan to combat the stigma against COVID-19 with strong monitoring. We need to engage social influencers as well as religious leaders and celebrities to talk about such stigma in the community and ways to prevent it.

Journalists should focus their stories on the positive things to minimise the stigma rather than speculating on the facts about COVID-19. Researchers and programme evaluators should intervene in time to reduce its harmful effects in the future.

According to the CDC (Centres for Disease Control and Prevention), communicators and public health officials can be key persons to help counter stigma during the COVID-19 pandemic. There are a number of ways to do this:

• Maintain privacy and confidentiality of those seeking health care
• Quickly communicate the risk or lack of risk from associations with products, people and places.
• Raise awareness about COVID-19 without increasing fear.
• Share accurate information about how the virus spreads.
• Speak out against negative behaviours, including negative statements on social media about groups of people, or exclusion of people, who pose no risk from regular activities.
• Be cautious about the images that are shared. Make sure they do not reinforce stereotypes.
• Engage with stigmatised groups in person and through media channels, including news media and social media.
• Thank health care workers and responders. People who have travelled to areas where the COVID-19 outbreak is happening to help have performed a valuable service to everyone by helping make sure this disease does not spread further.
• Share the need for social support for people who have returned from China or are worried about friends or relatives in the affected region.

Dr Gupta is Associate Medical Director, Nyaya Health Nepal, Charikot