Maria Venetis got a breakthrough case of COVID-19 right around New Year’s Eve. When she called friends to cancel plans, she found herself overexplaining how and where she might have caught the virus—until one friend cut her off.
“It doesn’t really matter,” Venetis, an associate professor of communication at Rutgers University, remembers her friend saying. In that moment, Venetis realized “there is no reason for me to point a finger about where I may have possibly gotten this.”
COVID-19, which is a highly contagious, widespread and deadly disease, is so common that it’s difficult to feel guilty about getting it. Although experts have predicted that this virus would soon be endemic in the near future, there is no denying the stigma of being infected. Studies and anecdotal reports show that many people who test positive experience shame and guilt—perhaps because they regret accidentally exposing others, feel like failures for not doing enough to prevent it, or experience stigma online.
Liat Hamama (a Tel Aviv University professor of sociology) recently conducted research on guilt and shame among over 300 individuals in Israel who were positive for COVID-19.. She found that almost 14% of study participants felt strong shame about their diagnosis and about 16% felt a lot of guilt—not the majority, but a sizable minority. These emotions are much more common in America. Johns Hopkins researchers polled approximately 1,500 Americans in late 2020 to find out how many felt ashamed of COVID-19.
These feelings can have serious consequences for your mental health. However, they may also pose a problem from a public-health perspective. The Johns Hopkins researchers linked COVID-19 stigma to a person’s reluctance to seek medical care, test, and tell others who might have been exposed. A second study published in 2021 found that COVID-19 stigma was associated with lower compliance to public health guidelines such as notifying officials or close friends.
Plenty of health conditions, from sexually transmitted infections to mental health disorders, carry damaging stigma—but respiratory diseases typically don’t. “How often do people feel ashamed that they got the flu?” says Joe Gieck, an assistant professor of psychiatry and behavioral medicine at the Virginia Tech Carilion School of Medicine.
COVID-19 could be different, as it has had a profound impact on nearly all aspects our lives in the past 2 years. The disease—along with measures used to prevent it—have also become intensely politicized, leading people to assign moral values to what should be benign public health precautions. Masking and getting vaccinated, for example, can be described as either ethical responsibilities or infringements on personal liberties, depending on a person’s perspective. People are more likely to point out people they see as being bad, particularly on social media, when they feel emotionally high.
“We have this built-in mechanism of trying to be good citizens, but also ostracize those who aren’t,” Venetis says. Research has repeatedly shown that shaming isn’t a good way to prompt behavior change, but people do it anyway.
The perception of the virus has been influenced by risk communication. Guidance issued by public health authorities including the U.S. Centers for Disease Control and Prevention (CDC) has often focused on the actions of individuals, from the “just stay home” days of spring 2020 to more recent advice about wearing protective respirators like N95s.
“There’s been so much emphasis on prevention and mitigation,” Gieck says. When someone follows all the “right” steps and gets sick anyway, “it can result in a sense of having done something wrong.” Many people are also afraid of COVID-19, and fear can exacerbate negative emotions when someone does test positive, Gieck says.
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Shame and guilt are both closely connected, although not necessarily identical. “Guilt is, ‘I feel bad about what I did,’ and shPlease read the following:e is, ‘I am bad because of what I did,’” says Sonya Norman, a professor of clinical psychiatry at the University of California, San Diego. Although guilt may motivate some people to take more conscious decisions, it is not always productive. Shameful internalization can have a negative impact on mental health. It is also linked to low self-esteem, depression, and anxiety. Hamama says that shame can also be associated with interpersonal and poor anger management.
Norman, whose previous experience with U.S. veterans has inspired her to create a therapy intervention for COVID-19 related shame. It guides people to recognize why they feel ashamed; addresses “hindsight bias,” or the tendency to judge past decisions based on present knowledge; and finds strategies for releasing guilt and shame in the future. Norman continues to study the effectiveness of Norman’s program, but she says that patients have given her positive feedback.
Not everyone can or will find a therapist to do that kind of one-on-one work, so it’s also important to address COVID-19 shame at a societal level—particularly as we prepare for a near future in which the virus is treated as an unfortunate but constant part of life. “How we talk about everything makes a difference,” Venetis says.
In personal relationships, Venetis says messages like the one she got from her friend after testing positive—that it’s okay and no one’s fault—can help normalize the diagnosis. However, it is not a good idea to overanalyse the source of COVID-19. This can lead to the conclusion that someone did something wrong.
Similar tactics can be used by public health officials like the CDC. Jennifer Manganello is a University at Albany School of Public Health health communication expert who believes that the terminology used to describe COVID-19 matters. Talking about people “acquiring” or “contracting” COVID-19 is better than saying someone “transmitted” the virus or “infected” someone else, she says, because it takes blame out of the equation.
It’s also important to give people actionable public-health advice while emphasizing that some things are beyond their control, Manganello says. Individuals can take precautions like being vaccinated or boosted. However, the virus is still susceptible to spreading due to social factors such as global vaccine inequalities. “Individual actions are just one piece of the puzzle,” Manganello says.
Scott Ratzan is the founder of Health Communications. He says that health communication may work best when it comes from people who are inherently trustworthy, like pediatricians or community doctors. Health Communication: International Perspectives. Ratzan states that although trust has been eroded in government agencies and health organizations like the CDC as a result of the pandemic, most people trust their own health care and the medical professionals they interact with.
Those experts should use language that comforts people who test positive and emphasizes that there’s nothing shameful about catching a widely circulating, highly contagious virus, Ratzan says. Ratzan says social media has the potential to be used widely for spreading positive messages.
Venetis believes that the perception and way we think about COVID-19 over time will change. The Omicron variant may have helped hasten this process, since it continues to infect even triple-vaccinated people who wear masks—driving home the message that getting sick is not a moral failing, but a practically unavoidable fact of life as we now know it.