Epidemiological placism in public health emergencies: Ebola in two Dallas neighborhoods

C. TB, Mandal RK, Pokharel S, Gupta R, G. C. KB. Internalized stigma related to COVID-19 and its psychosocial and mental health correlates: a multicentric health facility based observational study from Nepal

Introduction

The COVID-19 pandemic has led to physical and psychological complications and social consequences in the form of illness-related stigma. This study aimed (1) to assess the sociodemographic and clinical variable, as well as COVID-19 related knowledge and perception of persons admitted for COVID-19/Suspected COVID-19 in Nepal, (2) to determine their levels of COVID-19- related internalized stigma, depression, and anxiety symptoms, and (3) to evaluate the correlates of COVID-19- related internalized stigma.

Materials and methods

It was a cross-sectional exploratory study with a convenience sample of 395 participants (306 confirmed cases, 89 suspected cases) conducted between July-October 2020 in four health facilities in Madhesh and Lumbini provinces of Nepal. We used a semi-structured questionnaire to assess sociodemographic details, clinical information, COVID-19-related knowledge, perception, COVID-19-related internalized stigma, and the Hamilton Anxiety Depression Scale (HADS) in Nepali language. Descriptive statistics, correlation analyses, and linear regression analyses were performed. The level of statistical significance was considered at p < 0.05.

Results

Around 23.3% of the patients had anxiety symptoms, 32.9% had depressive symptoms, and 20.3% had high COVID-19-related internalized stigma (mean ISMI score: 2.51-4.00). Linear regression analyses showed a significant positive association of COVID-19-related internalized stigma total score, with the following eight factors, i.e., no income in the past one month (p = 0.013), below average socioeconomic status (p = 0.004), anxiety symptoms (p = <0.001), depressive symptoms (p = <0.001), recent testing positive for COVID-19 (p = <0.001), involuntary admission (p = <0.001), prior experience of being in isolation and quarantine (p = 0.045), and those who blame others for COVID-19 (p = 0.025).

Conclusion

COVID-19 survivors and suspects are vulnerable to symptoms of depression, anxiety, and COVID-19-related internalized stigma. For the first time from Nepal, our data suggests that COVID-19-related internalized stigma is associated with anxiety and depression symptoms, perceived below-average socioeconomic status, involuntary admission, prior experience of being in isolation and quarantine, recent COVID-19 positive report, self-blame, below-average socioeconomic status and no income in the past one month. Mitigating and preventing internalized stigma associated with a public health crisis such as COVID-19 is imperative by diagnosing and treating such mental health issues early and designing interventions and policies especially targeting vulnerable populations focusing on their economic background and socio-cultural beliefs.

A systematic review of fear, stigma, and mental health outcomes of pandemics

BACKGROUND

The COVID-19 pandemic has negatively affected the mental health of people globally. Despite substantial research on the short-term psychological impact of COVID-19, its long-term consequences on mental health remain relatively unexplored.

AIMS

We aimed to examine mental health literature on prior outbreaks to provide recommendations for developing effective strategies to mitigate the short- and long-term psychological impact of the current pandemic.

METHODS

We conducted a narrative review of 41 studies to analyze the adverse impact of the following epidemics and pandemics on the mental health of individuals, groups, and communities: Middle East Respiratory Syndrome, Severe Acute Respiratory Syndrome, Influenza A/H1N1, and Ebola Virus Disease.

RESULTS

We noted that these past epidemics and pandemics escalated stress, distress, anxiety, fear, and stigma that persisted in countries and communities. We also identified the role of misinformation in propagating discrimination and prejudice towards certain groups.

CONCLUSIONS

We discuss how the mental health outcomes of previous pandemics differed from the COVID-19 outbreak. We believe that strategies that reduce misinformation, educational initiatives, and mental health programs when introduced at the individual and community level have the potential to effectively diminish the negative psychological impact of COVID-19.

PRISMA

This study followed the PRISMA guidance and was not registered in PROSPERO. This is a narrative review that used qualitative thematic analysis. Publishing a protocol on a protocol repository for such reviews is not the standard of practice.

Wastewater Monitoring for Infectious Disease: Intentional Relationships between Academia, the Private Sector, and Local Health Departments for Public Health Preparedness

The public health emergency caused by the COVID-19 pandemic stimulated stakeholders from diverse disciplines and institutions to establish new collaborations to produce informed public health responses to the disease. Wastewater-based epidemiology for COVID-19 grew quickly during the pandemic and required the rapid implementation of such collaborations. The objective of this article is to describe the challenges and results of new relationships developed in Detroit, MI, USA among a medical school and an engineering college at an academic institution (Wayne State University), the local health department (Detroit Health Department), and an environmental services company (LimnoTech) to utilize markers of the COVID-19 virus, SARS-CoV-2, in wastewater for the goal of managing COVID-19 outbreaks. Our collaborative team resolved questions related to sewershed selection, communication of results, and public health responses and addressed technical challenges that included ground-truthing the sewer maps, overcoming supply chain issues, improving the speed and sensitivity of measurements, and training new personnel to deal with a new disease under pandemic conditions. Recognition of our complementary roles and clear communication among the partners enabled city-wide wastewater data to inform public health responses within a few months of the availability of funding in 2020, and to make improvements in sensitivity and understanding to be made as the pandemic progressed and evolved. As a result, the outbreaks of COVID-19 in Detroit in fall and winter 2021-2022 (corresponding to Delta and Omicron variant outbreaks) were tracked in 20 sewersheds. Data comparing community- and hospital-associated sewersheds indicate a one- to two-week advance warning in the community of subsequent peaks in viral markers in hospital sewersheds. The new institutional relationships impelled by the pandemic provide a good basis for continuing collaborations to utilize wastewater-based human and pathogen data for improving the public health in the future.

Indigenous sovereignty, data sourcing, and knowledge sharing for health

In this article, we consider the impacts of the COVID-19 pandemic on Indigenous Peoples (IPs) by reporting on information-gathering work across two non-governmental and Indigenous organisations to compensate where federal systems failed. Strategies IPs have employed to understand and respond to the pandemic, and described here, include: collaborative efforts across communities intra- and inter-nationally; open-source data platforms; and small-scale epidemiological research. Our review exposes the informational politics faced by Indigenous organisations and communities, and their struggle to pursue needed resources or protections while avoiding the critiques of 'post-neoliberal' and 'science denialism'. We conclude by suggesting ways that Indigenous communities improve our understanding of their needs during public health crises, and maintain both informational and medical self-governance.

Can Debunked Conspiracy Theories Change Radicalized Views? Evidence from Racial Prejudice and Anti-China Sentiment Amid the COVID-19 Pandemic

With the advent of the 'age of conspiracism', the harmfulness of conspiratorial narratives and mindsets on individuals' mentalities, on social relations, and on democracy, has been widely researched by political scientists and psychologists. One known negative effect of conspiracy theories is the escalation toward political radicalism. This study goes beyond the exploration of mechanisms underpinning the relationship between conspiracy theory and radicalization to focus on possible approaches to mitigating them. This study sheds light on the role of counter-conspiracy approaches in the process of deradicalization, adopting the case study of anti-China sentiment and racial prejudice amid the Covid-19 pandemic, through conducting an experiment (N = 300). The results suggest that, during critical events such as the Covid-19 pandemic, exposure to countermeasures to conspiracist information can reduce individual acceptance of radicalism. We investigated two methods of countering conspiracy theory, and found that: (1) a content-targeted 'inoculation' approach to countering conspiracy theory can prevent the intensification of radicalization, but does not produce a significant deradicalization effect; and (2) an audience-focused 'disenchantment' method can enable cognitive deradicalization, effectively reducing the perception of competitive victimhood, and of real and symbolic threats. This study is one of the first attempts to address causality between deradicalization and countermeasures to conspiracy theories in the US-China relations.

Stigma toward people with COVID-19 among the Lebanese population: a cross-sectional study of correlates and mediating effects

INTRODUCTION

Stigma develops during outbreaks such as the COVID-19 pandemic due to the human fear that arises from the anxiety about a disease of an unknown etiology, with the associated detrimental consequences on both the individual and society. This study was conducted to assess if knowledge about COVID-19, attitude, practice and behavior regarding preventive measures against COVID-19, fear, and anxiety towards COVID-19 will affect the level of stigma and evaluate the mediating effect of fear, anxiety, and diagnosis of COVID-19 on stigma.

METHODS

A cross-sectional online survey conducted between December 20, 2020, and January 05, 2021, enrolled 405 participants recruited from the Lebanese population. Two scales were created and adapted to the Lebanese context to measure the current stigma (stigma discrimination scale, self-stigma scale) toward COVID-19.

RESULTS

More than half of the sample had moderate to severe stigma discrimination (62%) and self-stigma (65.9%). The multivariable analysis showed that higher fear of COVID-19 scale (Beta = .143) was significantly associated with a higher stigma discrimination scale. Whereas, higher knowledge score (Beta =  -.153) was significantly associated with a lower stigma discrimination scale. Fear of COVID-19, anxiety from COVID-19, being diagnosed with COVID-19, and having a family member with COVID-19 partially mediated the association between knowledge and stigma discrimination scale. No mediation effect of fear and anxiety scale was found between the knowledge and self-stigma score.

CONCLUSION

Our main findings indicate that a considerable proportion of the Lebanese population has stigma discrimination behaviors toward COVID-19 patients and that those who were infected with the virus experienced COVID-19-related stigmatization.

Pandemic-related racial discrimination and its health impact among non-Indigenous racially minoritized peoples in high-income contexts: a systematic review

This study aims to review articles reporting the perspectives and experiences of pandemic-related discrimination among racially minoritized peoples in high-income contexts. We searched online databases (Medline, EMBASE, PsycINFO, Web of Science, and ProQuest) for peer-reviewed articles published between January 2002 and October 2020. Eligible studies reported either quantitative or qualitative accounts of pandemic-related discrimination from the perspectives of racially minoritized peoples in high-income contexts. Two authors screened 30% of titles/abstracts, and all full-text articles. Each article included for extraction underwent a quality assessment by two reviewers. Data were extracted and categorized thematically using NVivo 12, followed by a secondary analysis informed by critical race theory. Of the 1289 articles screened, 16 articles from five countries met the inclusion criteria. Racial discrimination is heightened during pandemic periods, due to the social association of specific racial groups with pandemic diseases including COVID-19, SARS (Asian), H1N1 (Hispanic) and Ebola (African). Fear based responses to racially minoritized peoples during pandemic periods included verbal/physical abuse, hypersurveillance, and avoidance, often occurring in public spaces. Pandemic-related racism had subsequent impacts on mental health and health care accessibility. Various coping strategies, including community support, avoidance, and problem solving, were documented in response to racial discrimination. Racialized discrimination and violence is a serious threat to the health and wellbeing of racially minoritized peoples, particularly due to its increase during pandemic periods. Racism must be recognized as a public health issue, and efforts to address its increased impact in pandemic contexts should be made, including ensuring that adequate representation of racially minoritized groups is present in policy, planning, and implementation.

A spectrum of (Dis)Belief: Coronavirus frames in a rural midwestern town in the United States

Community responses to the SARS-CoV-2, or “coronavirus” outbreaks of 2020 reveal a great deal about society. In the absence of government mandates, debates over issues such as mask mandates and social distancing activated conflicting moral beliefs, dividing communities. Policy scholars argue that such controversies represent fundamental frame conflicts, which arise from incommensurable worldviews, such as contested notions of “liberty” versus “equity”. This article investigates frames people constructed to make sense of coronavirus and how this affected social behavior in 2020. We conducted an interpretive framing analysis using ethnographic data from a predominately white, conservative, and rural midwestern tourist town in the United States from June to August 2020. We collected semi-structured interviews with 87 community members, observed meetings, events, and daily life. We identified four frames that individuals constructed to make sense of coronavirus: Concern, Crisis, Constraint, and Conspiracy. Concern frames illustrated how some individuals are uniquely affected and thus protect themselves. Crisis frames recognized coronavirus as a pervasive and profound threat requiring unprecedented action. Constraint frames emphasized the coronavirus response as a threat to financial stability and personal growth that should be resisted. Conspiracy frames denied its biological basis and did not compel action. These four conflicting frames demonstrate how social fragmentation, based on conflicting values, led to an incomplete pandemic response in the absence of government mandates at the national, state, and local levels in rural America. These findings provide a social rationale for public health mandates, such as masking, school/business closures, and social distancing, when contested beliefs impede collective action.

The Mediating Role of Internalized Stigma and Shame on the Relationship between COVID-19 Related Discrimination and Mental Health Outcomes among Back-to-School Students in Wuhan

Outbreaks of an epidemic, such as coronavirus disease 2019 (COVID-19), always brings about far-ranging discrimination and stigmatization to the epicenter. This was a cross-sectional survey conducted to assess experienced discrimination, internalized stigma, shame, and mental health (anxiety, depression, distress, insomnia) among college students who merely had a perceived linkage with COVID-19, and explore the linkage between discrimination and negative mental health outcomes through the mediating effects of shame and internalized stigma. A total of 995 participants (53% female) were involved in this study, in which 40.9% of college students were reported to be discriminated against because of their experience in Wuhan. The experience of COVID-19-related discrimination is indirectly associated with anxiety, depression, and insomnia, in which shame and internalized stigma play a complete mediating effect. Meanwhile, it is both directly and indirectly associated with distress through shame and internalized stigma. The findings of this study suggest that COVID-19-related discrimination is associated with shame and internalized stigma, which in turn predict psychological symptoms over time.

COVID-19-related stigma profiles and risk factors among people who are at high risk of contagion

Rationale

COVID-19 is likely to be stigmatized. The people of Hubei province perceived courtesy and affiliate stigma due to the geographic linkage to COVID-19. Perceived courtesy stigma refers to the perception of stigma of people who are associated with COVID-19 (e.g., the geographic linkage). Affiliate stigma is the internalization and psychological responses of perceived courtesy stigma among the associates.

Objective

The current study aims to reveal different patterns of perceived courtesy and affiliate stigma among people who are at high risk of contagion of COVID-19, and to examine the possible risk factors.

Method

A sample including 2813 adults who located in Hubei Province, China (female: n = 2,184, 77.64%; male: n = 629, 22.36%; mean age = 37.85 years, SD = 6.61 years, range = 18–63 years) were employed in the current study, using latent profile analysis for searching stigma profiles.

Results

Three profiles of stigma were found: the “Denier” (35.98%), “Confused moderate” (48.13%) and “Perceiver” (15.89%) displaying the low, moderate and high level of perceived courtesy and affiliate stigma, respectively. Multinomial logistic regression analyses revealed that generally people with a high level of education, perceived threats, anxiety symptoms, and familiarity with quarantined cases have a high likelihood to be distributed into the “Perceiver”.

Discussion and Conclusions

Our findings highlight the issues of COVID-19-related stigma and provide evidence for launching effective health actions to promote a cohesive society and culture of health. The media can transmit scientific knowledge, promote positive interactions and social cohesion between the stigmatized group and the dominant group, and create spaces for stories that nurture group identification among the implicated people. Future studies should use more representative sample and improve the measures.

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People at high risk of contagion of COVID-19 may experience stigma.

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Stigma may concern perceived courtesy and/or affiliate stigma.

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Three distinct profiles of stigma were identified.

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Risk factors were measured at the interface of individuals and the community.

A Narrative Review of Stigma Related to Infectious Disease Outbreaks: What Can Be Learned in the Face of the Covid-19 Pandemic?

Infectious disease pandemics are associated with social consequences and stigma that are noticeably similar in various health conditions, health systems, and cultures. Stigma impacts health-related outcomes, not only as a barrier to receiving the timely diagnosis and appropriate treatment but also as an important variable that increases mental health issues such as anxiety and depression. The COVID-19 outbreak has been associated with stigma too. Studying similarities as well as differences in the features of stigma observed in each outbreak can provide us with the knowledge and deeper understanding of the situation, which is necessary for approaching the issue comprehensively. The stigma needs to be addressed rigorously by professionals and health care providers as well as authorities. Here, we narratively review stigma due to some well-known infectious diseases and how it parallels to the current COVID-19 situation. After discussing its effects on both individuals and societies, we provide solutions to manage this important issue.

Racialized Risk in Clinical Care: Clinician Vigilance and Patient Responsibility

Racial/ethnic identity is contingent and arbitrary, yet it is commonly used to evaluate disease risk and treatment response. Drawing on open-ended interviews with patients and clinicians in two US clinics, we explore how racialized risk is conceptualized and how it impacts patient care and experience. We found that racial/ethnic risk was a common but poorly defined construct for both patients and clinicians, who intermingled concepts of genetics, biology, behavior, and culture, while disregarding historical or structural context. We argue that racializing risk embodies social power in marked and unmarked bodies, reinforcing inequality along racial lines and undermining equitable health care.

Surveillance in the field: Over-identification of Ebola suspect cases and its contributing factors in West African at-risk contexts

During an Ebola outbreak, the WHO recommends that health professionals consider people as suspect cases (SCs) when they show key signs such as the sudden onset of high fever or specific symptoms after having had contact with a suspect or confirmed Ebola case. SCs should then get care, be isolated and be reported to health authorities until the Ebola virus disease is confirmed through a lab test. This exploratory study aims to understand this identification process in the field based on a qualitative analysis of the diagnosis and therapeutic itineraries of 19 SCs in Cote d'Ivoire and Senegal (2014-2015). Results indicate that the main criteria for SC identification at the field level were fever (understood broadly) and provenance from a highly affected country (applied indiscriminately). WHO criteria were not followed in at least 9 of the 19 cases. Several medical, social and cultural factors favour over-identification of people as SCs, including relativism in defining 'high fever', placism, humanitarian or securitarian bias, issues in categorising SC's contact cases, and the context of fear. To avoid undue categorisation and its possible harmful social effects, the WHO definition should be implemented more carefully in various contexts and with greater consideration for ethical issues, while prioritising diagnosis strategies with higher specificity.