Fear of sickness
In light of the current coronavirus scare, I am reflecting on the politicization of infectious disease, particularly the stigmatization of certain diseases. I recently worked in a tuberculosis (TB) clinic and could not help but see some parallels. Tuberculosis is a historically stigmatized disease since treatment necessitates quarantine while infectious. The fear of the unknown is powerful and the new 2019-nCoV is already triggering xenophobia and social quarantine. Both these infectious diseases target the most vulnerable – the elderly, children, those with comorbidities, and people living in overcrowded conditions. Misunderstanding these diseases causes great harm and acts as a barrier to care.
I remember going up North for my first rotation in an Inuit community and having to consider tuberculosis in the differential of all my pneumonia patients. Risk factors for severe tuberculosis are often tied to socio-economic circumstances: crowded housing, poor ventilation, poor nutrition. Tuberculosis spreads where these factors are rampant and is closely linked to poverty. Treatment is complicated by the history of colonialism and the politicization of this disease. In the past, Inuit children with tuberculosis would be shipped south for treatment, sometimes never to be seen again. The stigma of TB remains in many northern communities and historical trauma still impedes care. Many do not want to treat latent disease for fear of further maltreatment.
In the tuberculosis clinic where I worked, I saw predominantly recent migrants who failed the immigration screening and have a history of tuberculosis. Many of them came from endemic regions where they lived in refugee camps and had other risk factors such as poverty and malnutrition putting them at greater risk for the disease. There is often poor health information regarding tuberculosis and many of my patients were very concerned about spreading latent tuberculosis. Some denied symptoms for fear of immigration consequences and others avoided testing because they would not want the stigma of a diagnosis. Fear still lingers due to a misunderstanding of TB.
The World Health Organization (WHO) recently declared the 2019-nCoV coronavirus from Wuhan a health emergency. The fear of a new pandemic is powerful and prompts stigmatization and xenophobia. While celebrating Chinese New Year, I was amazed at the psychological impact of a possible pandemic. The night before Chinese New Year, the grocery stores were empty. The Chinese New year celebrations in Richmond were cancelled. Restaurants were instead working on takeout orders for those who were afraid to leave their houses. I’ve already had patients ask me about their risk of catching the new virus and talk about avoiding those visibly East Asian on the bus. What spreads faster than the disease itself is the fear of the disease. It is unclear how fear will affect the spread of the disease, but looking at tuberculosis, it does not necessarily help. In fact fear and stigmatization studied during the SARS epidemic is thought to prevent patients from seeking timely care1.
In the face of new and old infectious diseases, we need to do better in addressing inequities in healthcare. To fight disease, we need to address fear and work together against stigma and xenophobia in order to treat everyone, both uninfected and infected with respect and dignity. The act of quarantine is a state-forced loss of individual autonomy for the sake of public health and can be a psychologically traumatic experience. For physicians, this means balancing both public safety and careful communication to manage stigma. We need to separate ourselves from fear and racism and ground ourselves with evidence to guide care and management.
Kelly Lau is a family medicine graduate interested in social justice, completing a third year in Enhanced Skills in Global Health at the University of British Columbia.
Reference
1. Fear and Stigma: The Epidemic within the SARS Outbreak https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322940/
