In February and March, health care workers and public health professionals like me began the tireless work of combatting the COVID-19 pandemic. While we were hailed as heroes, my lived experience was different. When I told people I cared for patients ill with COVID-19, many people took a step back. As I explained that I was an infectious diseases physician working with people experiencing homelessness, they took another step back. This happened with strangers and friends alike.
Since then, I have been called the “problem,” the “vector,” and the “limiting factor,” even though I have not — to my knowledge — been infected. Though I was hailed for my heroism from afar, I felt as though a scarlet “C” would be more befitting than a cape.
I share this story not for sympathy, but as a cautionary tale. There is a significant stigma associated with COVID-19 that could have long-term, devastating effects, especially for children. As a parent, I am terrified about the potential backlash and bullying that my children might face if they become infected. I am worried that they would be blamed or shunned by classmates, educators or parents. It is true that a single infection in a classroom will disrupt lives — close contacts will need to be tested and possibly quarantine and may become infected. But we cannot let stigma creep into our classrooms.
Recognizing the societal factors that make children vulnerable to infection is the first step in reducing stigma ...
School reopening plans have mostly focused on how to prevent infections. They've focused on mask policies, cleaning protocols and how to maintain social distance. Personal safety, however, is broader. As schools continue to develop their plans, officials need to ensure that those who contract the virus are not then ostracized and stigmatized by their communities.
When children do get sick — and they will — educators must ask, “Why was this child at risk?” Recognizing the societal factors that make children vulnerable to infection is the first step in reducing stigma since it will help educators see the infection through a judgment-free lens. Black and Latinx people are more likely to die from or experience severe COVID-19 than their white counterparts. This increased risk is driven entirely by structural racism. Counties with larger proportions of underrepresented minorities carry a disproportionate burden of disease. These counties are less likely to have adequate affordable housing. Low-wage workers who rely on public transportation to get to and from work are at increased risk. Persons living in any congregate setting — domestic violence shelters and homeless shelters — are at increased risk of infection. Let’s not forget that these include children.
Thirty-two million public school children rely on free or reduced lunch, at least 1.5 million students are homeless or unstably housed and nearly 19,000 children may seek refuge in a domestic violence shelter on any given day. Teachers and administrators should receive weekly briefings for updates on the evolving COVID-19 epidemiology and who is most affected. Professional development activities should include training on health disparities. To reduce stigma, educators need to recognize that the infection may be a symptom of an underlying problem.
Imagine a second-grader who has to admit that he “doesn’t feel well,” knowing that he will be quickly removed from the classroom while his classmates may require quarantine. Imagine the backlash he could face. We know about the deleterious effects of stigma from research on other diseases such as HIV and mental illness. People who experience stigma have worse outcomes and are more likely to suffer from depression and suicide. As a result, schools need to actively define themselves as “stigma-free” zones much as they define themselves as “hate-free." Schools should have health care workers speak to classes and parent councils to dispel COVID-19 myths. The lesson is that even though the infection itself may pass, the collateral damage to a child might be long-lasting.
We need to teach children that an infection is nothing to be ashamed of.
While we all have a role to play in preventing infections, even the best-laid plans can be insufficient. COVID-19 is, unfortunately, part of our lives for the foreseeable future. The virus does not care who it infects. We need to teach children that an infection is nothing to be ashamed of. We should encourage teachers to embed COVID-19 into their lessons. There is no shortage of coronavirus coloring books, picture books and early reader books that can be incorporated into early childhood and elementary education. Middle and high school science and math classes can use this as an opportunity to make content applicable. Schools can integrate lessons from COVID-19 into their social-emotional learning curriculum. This will help normalize the virus and people who become infected. In doing so, we could cultivate a more empathic generation.
Ultimately, the stigma and isolation I experienced was thwarted by the support I got from my loving family, my perspective from witnessing unimaginable suffering and the pride I feel in helping my community through a difficult time. We are asking too much of our children to be so resilient. We need to ensure that they are not only protected from the virus, but also from any stigma associated with it. As our schools reopen, let’s remember that safety means more than masks and hand sanitizer. It also means keeping a child safe when those measures fail.