Fighting two enemies: COVID-19 and stigmatization

It has been eight months since the first reported case of a strange, viral infection emanated from Wuhan, China.

A child born eight months ago would be crawling and standing by now. At around the eighth month of life, that child’s babble should be able to make sounds like Da-da, Ba-Ba and other mono syllabic words. There is a particular word that child would be all too familiar with. It is a tri-syllabic word made up of just six letters; C-O-R-O-N-A. If the child is not able to make out the three syllables in corona, s/he can make sounds with the first two syllables; C-O-R-O.

Nine months ago, airplanes at major airports were crisscrossing across the globe, garment factories in China, Vietnam and Indonesia where making clothes for large stores on the West of the Atlantic, entertainment houses were fully booked for shows and football tournaments were being organized on a large scale for live audiences. In today’s COVID-19 world, there are more planes in hangars than in the air, garment factories are being closed, entertainment houses if open at all are opening at a fraction of total capacity and our footballers are playing to virtual audiences. Weddings and funerals are taking place virtually.

It is normal to find people wearing masks and to see heads of states talking from the podium shared with a giant bottle of sanitizer. The corona virus has precipitated these dystopian-like events in our present world. There is still a silver lining for the Tech Giants; Google, Amazon, Apple and Facebook. These four titans have been smiling all the way to the bank. An African child would probably be named on the seventh day of life and the names given would probably be centered on events that occurred in the lives of the parents or other relatives. Some Ghanaian names are selected on the basis of the day of the week the child was born. Children can also be named after a much loved relative or just the order of birth like in Taiwo and Kehinde where Taiwo is the older twin. Some names are faith-based like Favour, Goodness and Happiness and some are centered on celebrities like Rihana and Britney. The belief surrounding names is that they carryan aura which could give a resultant negative or positive effect. These names are believed to have a self-fulfilling prophecy. If a child was of Yoruba lineage and born while one or both of the parents was abroad, Tokunbo would be an appropriate name.

If the child was born in an eventful circumstance that might have defied all odds, the parents might name the child Esupofo. In Yoruba, Esupofo means the devil is a loser. Esu means the devil and Pofo means loser. As is common in Nigeria and other nations, once a woman has a child, her appellation becomes attached to the name of her offspring. Therefore, the mother of Esupofo can be called Iya Esu or Iya Pofo. Translated Iya Esu is mother of the devil and Iya Pofo is mother of a loser. Now, as an emboldened, palpable Nigerian, any person called Iya Esu or Iya Pofo will quickly reject the anecdotal nouns because of the stigmatization attached to them. The stigmatization attached to Iya Esu or Iya Pofo is not attached to the full name Esupofo. However, the social construction attached to the separate nouns make the owners of such names to be stigmatized.

Some people with surnames perceived as connoting negativity have gone as far as changing their surnames. On the contrary, two children surnamed Bush became the 41st and 43rdpresidents of USA. It would be unusual and considered negative in our culture to be named or surnamed Bush. In the Nigerian social context, it is believed that the name you give a child, a place or a disease has a self-fulfilling prophecy to it. A cynical name could be a harbinger of bad luck or omen while a name considered good is socially acceptable and thought to bring good fortune to the family. Closer home, we have had a man whose name brought him so much luck, he became the president of Nigeria. Nonetheless, whether the name connotes a good or bad omen, both sides of the coin have been found as armed robbers, kidnappers and as prison inmates. Men and women named Blessing or Tragedy have been caught in armed robbery, cybercrime and every imaginable crime. There is a lot of stigma attached to the name of a person if it is antithetical to acceptable societal and cultural norms. The name of a place can also be stigmatized especially if it is attached to an infectious disease. The town of Lassa, in Borno State is not a stranger to stigmatization. Ever since a virus, Lassa Fever virus was named after the town of Lassa, Borno State, the residents have unsuccessfully tried to change the name of the virus to remove the sting of stigmatization from their town. The first case occurred in 1969 when an American nurse travelled through another West African country before arriving in Lassa. Nigeria has taken the case to the World Health Assembly but the name has been difficult to change.

Other places named after infectious diseases have been stigmatized. The Ebola virus disease was named after the Ebola River in Democratic Republic of the Congo. Several infectious diseases named after places include the Zika virus named after the Zika forest in Uganda, Marburg virus disease from Marburg, Germany, Guinea worm named after the Guinea region of West Africa and Middle East Respiratory Syndrome (MERS) named after Saudi Arabia’s Middle East.

Given the finger pointing attached to towns or rivers attached to names of diseases, it is little wonder that the Chinese Government got riled up whenever the novel coronavirus was labeled as the Chinese or Wuhan virus. What are the causes of stigma? Why do we stigmatize? In human history, many diseases have been stigmatized. Leprosy, HIV, certain cancers, tuberculosis, SARS, H1N1 and the Influenza virus used to be severely stigmatized but the levels of stigmatization reduced as soon as an effective treatment management became established. The stigmatization did not go away entirely but it was markedly reduced.

In contrast, with the novel coronavirus, there is still no standard, effective treatment regimen. There is still so much unknown about the spread of the virus. It is still uncertain if a survivor can achieve life-long immunity. The road to recovery from COVID-19 is a long one because months after patients have recovered, they still complain of chest pain, difficulty in breathing and tiredness. Globally, the management of the disease varies. Many African countries including Nigeria are still using chloroquine in their treatment regimen. Pakistan, India and Indonesia are also using it. There have been success stories with chloroquine when used in the early onset of the disease usually before the virus multiplication gives a moderate to severe case of the disease. Sadly, the use of chloroquine has become so politicized that when a Nigerian media personality admitted to the use of chloroquine in our treatment centers, he faced a backlash. His case is not the only one, with the American elections less than 100 days away, the battle to use or not to use chloroquine has become even more intense that doctors who do so use it stealthily for fear of repercussions from the authorities. Chloroquine will not work in the moderate to severe cases of COVID-19 when the cytokine storm has occurred. The cytokine storm is an overreaction of the host’s immune system to the virus causing multi systemic damage which can cause permanent damage or become fatal. Chloroquine in conjunction with zinc, Azithromycin, Vitamins C and D works best when the case is caught early before the person starts presenting with symptoms requiring hospitalization. The patients must not have contraindications to chloroquine.

When it comes to the novel coronavirus, anyone with the disease is stigmatized. Not only those with the disease but healthcare workers and caregivers of those infected with the ubiquitous virus are stigmatized.

Long after they recover, they are shunned, further driving those with the disease underground and increasing the clandestine spread of the disease.

Stigma is a social construction that disenfranchises the stigmatized person or group of persons. The stigmatized persons are socially excluded. They are discriminated against. Their personhood is devalued. Stigmatization of those with disease or that have had the disease and recovered is a wrongful adaptation of the society to avoid the disease pathogen. The stigmatizers often feel that their actions are justifiable. This narrative is quite contrasting when those with the disease pathogen are from the elitist ruling class. In Nigeria, not less than six governors have successfully battled with the coronavirus. The Prime Minister of United Kingdom had a severe form of coronavirus infection but survived. None of these leaders were stigmatized after recovery. They were able to bounce back and continue their daily lives. However, the trajectory for the ordinary citizens who have also sparred victoriously with the unseen enemy has not proven the same. It appears that there is a selected stigmatization.

To be continued tomorrow

Obilade, (PhD) a physician, Associate Professor of public health, wrote from Abuja.