COVID-19: A Close Look at Grief and Stigmatization

COVID-19: A Close Look at Grief and Stigmatization

COVID-19: A Close Look at Grief and Stigmatization
Ananna Bhadra Arna, Kazma Faheem, and Dr. Austin Mardon 
Antarctic Institute of Canada

According to the World Health Organization (WHO), the novel Coronavirus is an acute respiratory disease caused by SARS-CoV-2, which can have mild to severe effects on infected individuals. The disease first originated in Wuhan, China, in 2019 and subsequently spread globally. COVID-19 symptoms include shortness of breath, loss of taste, fatigue, fever, cough, confusion, and chest pain, among many symptoms (WHO).


Since there were no vaccines to treat COVID-19 at the pandemic's start, the virus spread globally at an alarmingly high speed. It forced countries to shut down their borders and impose mandatory quarantine, social distancing, and restrictions on family gathering sizes (New York Times). As governments restricted people's movement and hampered their social lives, this exacerbated a problem that, in pre-pandemic times, was prevalent but well-hidden: mental health crisis. Countries began to observe increased suicidal rates and deaths due to loneliness, isolation, and lack of interactions across all age groups. As the death number surged, grief became an all-too-familiar topic; however, this did not mean we were knowledgeable about handling such a difficult concept. Furthermore, misinformation and distrust circulated due to this pandemic's uncertain nature. As many did not fully comprehend the modes of transmission or the means of prevention, they resorted to persecuting each other through labeling, blame-shifting, and out casting.

The COVID-19 death toll skyrocketed and thus resulted in an inability for individuals to gather around to share feelings of loss. As social interactions and support groups are vital to grief management and healing, losing this opportunity disturbs the mental health of many affected. This article investigates whether COVID-19 causes any grief-related disorder among the loved ones left behind. Furthermore, the article investigates the social stigma attached to contracting COVID-19.

COVID-19 and Grief
The COVID-19 pandemic not only caused the deaths of nearly 6 million people worldwide, according to WHO, but the virus has caused Prolonged Grief Disorder (PGD) and higher rates of depression among the loved ones left behind. The International Classification of Diseases (ICD) defines PGD as a 'persistent' grief response by the loved ones left behind by the deceased from COVID-19, which leads to their inability to cope with loss and takes them down the spiral of denial, anger, and depression. Depression, as Mayo Clinic defines it, is a persistent feeling of sadness that causes individuals to lose interest in their daily lives. One does not need to look at the scientific data to confirm that the deceased's family deals with grief for the departed member at some point in their lives; the state of grief need not be immediate nor short-lived. Elisabeth Kübler-Ross and David Kessler, in their article On Grief and Grieving, describe the five stages of grief: denial, anger, bargaining, depression, and acceptance. The article states that individuals are bound to experience "natural" anxiety and depression as they move along these stages. They mention a critical point we often overlook; overcoming depression and anxiety does not happen in a vacuum. As humans are social beings, the interactions with other humans become an asset in overcoming these complex emotions; they need one another to share the loss and support each other through the suffering. However, as the countries began to impose mandatory social distancing, temporary lockdowns, and local family gatherings, the "natural" depression and anxiety went off the rails and as a result became a PGD epidemic, according to Naomi M. Simon, a professor of psychiatry at New York University. Recent research indicates that depression negatively impacts one's immune system (Marshall); thus, a depressed individual is more susceptible to falling ill due to a relatively weaker immunity. The significance of this finding is that there is a chance that deceased loved ones may contract Covid and possibly pass away; in doing so, the cycle of PGD and depression begins again.
Although countries have managed to introduce vaccines to help curb the virus, have they done the same to the mental pandemic specifically; have the countries introduced anything to help fight the PGD and depression caused by COVID-19? The answer remains unclear. Countries should invest money into combating this crisis by improving their existing mental health systems. According to Lancet Global Health, countries worldwide spend less than 2% of their national budget on health, making it difficult for hospitals to allocate appropriate resources to combat disorders like PGD and depression. Society can develop the most effective tools to combat psychological disorders, but if governments are unwilling to fund them, those tools never get used to save lives. Countries should collectively decide the amount each country is willing to spend on Mental Health and design a bill that will enable individuals to access Mental health treatment without any cost. In addition, governments should introduce bills that would equip healthcare workers with resources to help educate the deceased loved ones on how to deal with grief and depression and do a follow-up on the individuals to ensure that they do not develop PGD or depression.

How does COVID-19 initiate stigma?
As COVID-19 ravages across the globe, the mortality rate is not the only thing affected here. Many social issues that were often overlooked have skyrocketed with the pandemic, as we spent all our efforts on mitigating the spread of the virus. Stigmatization is one of such issues that has become even more evident in this chaotic time. When our priority should be on creating a united front to combat this unknown force, we have done the exact opposite by creating divisions amongst ourselves through prejudice, labeling, and stigmatization.
We have been accompanied by stigma, distrust, and blame-shifting during any epidemics known to history. It is our inherent trait that when we encounter something unknown, we become more intolerant and apprehensive about where we are heading and whom we should rely on for relevant information. As COVID-19 is an unmarked territory where knowledge keeps constantly growing and evolving, it becomes even more confusing and overwhelming for the standard population; often, they are unable to translate and access the scientific knowledge available correctly. This results in mistrust and gives rise to misinformation that is usually more relatable and accessible to the public and encourages irrational behaviors. When we become unable to feed our curious minds with answers to questions like why we are making confident choices, it leads to counterproductive effects where we label and alienate others and ourselves under the protection of what we think we know. The answer to this very question of "why" determines our opinion, emotion, and action. For example, if an individual is tested positive for COVID-19, their initial thoughts would be to reflect on what they did that has led to this - the "why" behind their condition. If we cannot find this answer, we become less receptive to accepting new info and analyze them with a certain level of mistrust. The contingent nature of this situation makes us feel disempowered and threatens our autonomy.
This practice of blame-shifting and stigmatization has already been a part of the Western culture; however, COVID-19 has made it even worse. Since the wake of civilization, we off-load our responsibility to others or become fatalistic, saying things like "it was my destiny." In either scenario, we lose our accountability as we show reluctance to admit to our mistakes and take responsibility for the consequences. We try to protect our threatened self-image by blame-shifting, as we do not like to acknowledge or portray ourselves as a failure and incompetent individuals and hurt our credibility. We, thus, encourage a culture of blame that now infiltrates various social organizations, contributing to a toxic environment that is detrimental to creativity and collaboration. During the pandemic, with little expectation of what knowledge is accessible and should be widely known, people are more prone to make irrational accusations and pass off the blame to others. It simply becomes a race of who blamed whom for what action. For example, if tested positive, people might blame themselves ("I did this to myself") or others ("you passed on the virus to me").
The scope of social stigma during a pandemic can be narrowed down to circumstances where a person with specific characteristics or an illness is negatively viewed since their unique trait or illness is perceived as a disadvantage to the general population. The stigma and discrimination not only included individuals who contracted the virus but also the countries which got associated with the virus. For example, China has been designated as the country of origin since the wake of the COVID-19 pandemic. As we work hard to keep everyone safe and ponder upon the unknown, many could not stop themselves from associating their fear with China. Thus, we saw the leaders of powerful nations blame China and their government to be single-handedly responsible for this global-scale crisis. The president of the United States called SARS-CoV-2 the Chinese virus, thus successfully shifting the blame for spreading the virus and diverting public anger and attention towards China and the Chinese government. The racism and backlash against the Chinese population did not stop there. They were further humiliated when some Italian politicians accused them of having unhygienic customs like "eating live mice." The effect of such defamation and accusation was very detrimental and widespread. People of Chinese descent were discriminated against and verbally and physically assaulted. This hate was extended to others of Asian descent wherein one week of March, 650 such cases of racism against people of Asian heritage were reported in the United States alone. Many countries and their residents refused to be served by Asian businesses and accepted Asian customers, especially those "coming from China." Chronophobia amongst people was so intense that once a country went under the COVID-19 waves, we closed not only just our borders to them but also our hearts; we redirected our anger, hate, and frustration toward the community through intolerance, exclusion, and discriminatory acts. 
As stigma interferes with vaccine drives and preventive measures for the spread of the virus, stigma reduction becomes an essential prerequisite to ensure the complete success of these measures. Since the pandemic, misinformation has been one of the primary drivers of stigma; misinformation was used to downplay the consequences of COVID-19, to misinterpret and mistranslate scientific knowledge to the public. Platforms like social media and newspapers made it easier to spread misinformation to a broader audience. For example, we saw many Italian newspapers attributing Coronavirus as the "Chinese virus," Many social media platforms, such as Facebook and Twitter, served as a medium to recruit participants and spread misinformation and propaganda theories for the anti-mask anti-vaccine movements. All this undermines awareness against COVID-19, pushing people against the deadly virus, despite the local and international efforts. In a survey conducted in parts of Africa, even though the general population showed awareness against the pandemic, misconceptions and misinformation still circulated and undermined the best outcome. Nearly 50% of the respondents dismissed COVID-19 as a government campaign and disregarded its life-threatening consequences. Still, in April 2022, as many of us stand in the middle of the sixth wave, more than 30% of the global population remains unvaccinated. We need to dig deeper and see why these people are discouraged from the protection against the virus. Whether it is the stigma against coming out as a COVID-19 infected, or the misinformation circulating against the pandemic, we have to find the problem and work towards a mutual solution. The humanitarian organization UNICEF points out that "COVID-19 does not discriminate, " so we should not either. We have come this far, and only through mutual understanding and social cohesion can we go further. 

References
Banerjee, D., Kosagisharaf, J. R., & Sathyanarayana Rao, T. (2020). “The Dual Pandemic” of Suicide and COVID-19: A Biopsychosocial Narrative of Risks and Prevention. Psychiatry Research, 295, 113577. https://doi.org/10.1016/j.psychres.2020.113577
Braithwaite, I., Callender, T., Bullock, M., & Aldridge, R. W. (2020). Automated and partly automated contact tracing: a systematic review to inform the control of COVID-19. The Lancet Digital Health, 2(11). https://doi.org/10.1016/s2589-7500(20)30184-9
CDC. (2021, August 6). Coping with Stress. Www.cdc.gov. https://www.cdc.gov/mentalhealth/stress-coping/cope-with-stress/index.html
COVID-19 and Stigma | Johns Hopkins Bloomberg School of Public Health. (n.d.). Publichealth.jhu.edu. https://publichealth.jhu.edu/2021/covid-19-and-stigma
Elias, A., Ben, J., Mansouri, F., & Paradies, Y. (2021). Racism and nationalism during and beyond the COVID-19 pandemic. Ethnic and Racial Studies, 44(5), 1–11. https://doi.org/10.1080/01419870.2020.1851382
Henry, T. (2011, September 7). Toxic: Dealing With A Culture Of Blame. Accidental Creative. https://accidentalcreative.com/articles/collaboration/toxic-dealing-with-a-culture-of-blame/
Holder, J. (2021). Tracking Coronavirus Vaccinations Around the World. The New York Times. https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html
ICD-11 - Mortality and Morbidity Statistics. (n.d.). Icd.who.int. https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1183832314
Kübler-Ross, E., & Kessler, D. (2009). Five Stages of Grief condensed version. https://grief.com/images/pdf/5%20Stages%20of%20Grief.pdf
Marshall, G. D. (2011). The Adverse Effects of Psychological Stress on Immunoregulatory Balance: Applications to Human Inflammatory Diseases. Immunology and Allergy Clinics of North America, 31(1), 133–140. https://doi.org/10.1016/j.iac.2010.09.013
Mayo Clinic. (2018, February 3). Depression (major depressive disorder). Mayo Clinic; Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007
Mental Health and the COVID-19 Pandemic. (2018). CAMH. https://www.camh.ca/en/health-info/mental-health-and-covid-19
Misinformation leads to increasing COVID-19 stigma in sub-Saharan Africa - Mali. (n.d.). ReliefWeb. Retrieved April 2, 2022, from https://reliefweb.int/report/mali/misinformation-leads-increasing-covid-19-stigma-sub-saharan-africa
Moynihan, D., & Porumbescu, G. (2020, September 16). Analysis | Trump’s “Chinese virus” slur makes some people blame Chinese Americans. But others blame Trump.. Washington Post. https://www.washingtonpost.com/politics/2020/09/16/trumps-chinese-virus-slur-makes-some-people-blame-chinese-americans-others-blame-trump/
Simon, N. M., Saxe, G. N., & Marmar, C. R. (2020). Mental Health Disorders Related to COVID-19–Related Deaths. JAMA, 324(15). https://doi.org/10.1001/jama.2020.19632
Taylor, D. B. (2021, March 17). A Timeline of the Coronavirus. The New York Times. https://www.nytimes.com/article/coronavirus-timeline.html
Villa, S., Jaramillo, E., Mangioni, D., Bandera, A., Gori, A., & Raviglione, M. (n.d.-a). Retrieved April 1, 2022, from https://www.clinicalmicrobiologyandinfection.com/action/showPdf?pii=S1198-743X%2820%2930477-8
Villa, S., Jaramillo, E., Mangioni, D., Bandera, A., Gori, A., & Raviglione, M. (n.d.-b). https://www.clinicalmicrobiologyandinfection.com/action/showPdf?pii=S1198-743X%2820%2930477-8
Vindegaard, N., & Eriksen Benros, M. (2020). COVID-19 pandemic and mental health consequences: Systematic review of the current evidence. Brain, Behavior, and Immunity, 89. https://doi.org/10.1016/j.bbi.2020.05.048
WHO. (2022). Coronavirus disease (COVID-19). World Health Organization; World Health Organization. https://www.who.int/health-topics/coronavirus#tab=tab_1
World Health Organization. (2020). Social Stigma associated with COVID-19. https://www.who.int/docs/default-source/coronaviruse/covid19-stigma-guide.pdf
Yuki, K., Fujiogi, M., & Koutsogiannaki, S. (2020). COVID-19 pathophysiology: A review. Clinical Immunology, 215(1), 108427. https://doi.org/10.1016/j.clim.2020.108427
Zimonjic, P. (2022, March 25). Trudeau faced harsh critics in the EU Parliament this week. Here’s who launched the attacks. CBC. https://www.cbc.ca/news/politics/european-members-parliament-attact-trudeau-1.6397579 
Ananna Bhadra Arna, BSc (Hons) (University of Saskatchewan) is an MSc. candidate at the Department of Biochemistry, Microbiology, and Immunology. 
Kazma Faheem, a fourth-year undergraduate student at the University of Saskatchewan. She is currently majoring in Biomedical Sciences with a specialization in Biochemistry, Immunology, and Microbiology. In her spare time, she likes to learn programming languages such as  Python, HTML, and CSS. 
Austin Albert Mardon, CM, FRSC (University of Alberta) is an adjunct professor in the Faculty of Medicine and Dentistry, an Order of Canada member, and Fellow of the Royal Society of  Canada.
 

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