==== Front Int J Health Policy Manag Int J Health Policy Manag ijhpm Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 Kerman University of Medical Sciences 10.34172/ijhpm.2020.87 Letter to Editor Stigmatization, Discrimination, Racism, Injustice, and Inequalities in the COVID-19 Era Teixeira da Silva Jaime A. * Independent Researcher. * Correspondence to: Jaime A. Teixeira da Silva, Email: jaimetex@yahoo.com 11 2020 03 6 2020 9 11 484 485 20 5 2020 31 5 2020 © 2020 The Author(s); Published by Kerman University of Medical Sciences2020 This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://ijhpm.com Citation: Teixeira da Silva JA. Stigmatization, discrimination, racism, injustice, and inequalities in the COVID-19 era. Int J Health Policy Manag. 2020;9(11):484–485. doi:10.34172/ijhpm.2020.87 ==== Body Dear Editor, The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which induces the respiratory coronavirus disease 2019 (COVID-19) and has transformed society, medicine, and values in so many ways, has already claimed (May 31, 2020) 369 627 lives and infected 6 087 902 people globally.1 During this highly transformative period, human interactions have been forcefully altered, either through implemented social distancing or lockdowns, to limit the spread of the virus. Reducing people’s movement, and the duration and frequency of contact between them, imposes artificial barriers of contact that can lead to friction and discord. Healthcare systems, often under pressure, were unprepared and faced life-and-death decisions, reigniting or amplifying sensitive social issues, including stigmatization, discrimination, racism, injustice, and inequalities, as a result of health disparities.2 In this time of isolation, affected individuals have largely stayed in contact through social media and online apps, but the use of social media has also seen a rise in misinformation3 and fake news,4 which may negatively impact the health and lives of individuals, especially those seeking advice regarding sanitary conditions or treatments to halt or prevent COVID-19. Compounding the immediacy of the pandemic, patients infected by this virus may be receiving prioritized treatment at the expense of patients with other critical illnesses.5 The strain on human resources, particularly healthcare workers, is acute when essential care and equipment becomes scarce, leading to competition between critical care and emergency cases, or even negligence of the elderly, those with special disabilities, as well as indigenous, homeless, migrant and imprisoned populations.6 Border closure, limiting the international or transnational movement of individuals, or imposed travel restrictions, worsened the plight of asylum seekers and undocumented migrants.7 These travel restrictions might be a violation of International Health Regulations if the restriction infringes upon rights of movement to seek a better or viable health solution.8 There was a rise in anti-Chinese sentiment, or racism, causing shame and stress to Chinese nationals or even to other Asians, and thus stigmatization.9 Such prejudice often arises with the need for self-protection, and the fear underlying this need for a racialized response to the COVID-19 threat led to some panic and hysteria, microaggressions and mass generalizations, even spates of violence and protests, causing the disproportional victimization of ethnic minorities and socio-economic discrimination of marginalized groups, made worse by erroneous misinformation.10 Curtailed movement and choices, or intrusive and forcefully imposed policies, restrictions or regulations, the use of state surveillance, drones, forced implementation of mobile apps to track citizens and the spread of COVID-19, color coding for citizens based on their travel and health status, as well as profiling, even under the premise of protecting society’s health, may be used to fortify state control and surveillance, possibly restricting civil liberties, or freedoms and rights, thereby raising privacy concerns by suspending democratic deliberation or fortifying authoritarianism.11,12 COVID-19 might fortify other psychosocial and structural burdens, including misogyny, homophobia, homelessness and mental health.13 In this pandemic, and in post-COVID-19 societies, the challenges that humanity faces as a result of limitations need to be addressed now, prior to the arrival of the next pandemic, or the resurgence of this one. If the healthy versus sick dividing line can be better appreciated through solid science- and evidence-based medicine, and if proper public health governance and policies can be effectively implemented through resolute political leadership, then more compassion towards those infected by COVID-19, or respect towards others that are mistreated as a result of this pandemic, including those who recovered from COVID-19 and are living a post-infection life, may emerge and prevail.14,15 Ethical issues Not applicable. Competing interests Author declares that he has no competing interests. Author’s contribution JATdS is the single author of the paper. ==== Refs References 1 John Hopkins University. Coronavirus Resource Center. https://coronavirus.jhu.edu/map.html. Accessed May 31, 2020. 2 van Dorn A Cooney RE Sabin ML COVID-19 exacerbating inequalities in the US Lancet 2020 395 10232 1243 1244 10.1016/S0140-6736(20)30893-X 32305087 3 Ren SY Gao RD Chen YL Fear can be more harmful than the severe acute respiratory syndrome coronavirus 2 in controlling the corona virus disease 2019 epidemic World J Clin Cases 2020 8 4 652 657 10.12998/wjcc.v8.i4.652 32149049 4 Shimizu K 2019-nCoV, fake news, and racism Lancet 2020 395 10225 685 686 10.1016/S0140-6736(20)30357-3 5 Baker T Schell CO Petersen DB Essential care of critical illness must not be forgotten in the COVID-19 pandemic Lancet 2020 395 10232 1253 1254 10.1016/S0140-6736(20)30793-5 32246914 6 Vieira CM Franco OH Restrepo CG Abel T COVID-19: The forgotten priorities of the pandemic Maturitas 2020 136 38 41 10.1016/j.maturitas.2020.04.004 32386664 7 Orcutt M Patel P Burns R Global call to action for inclusion of migrants and refugees in the COVID-19 response Lancet 2020 10.1016/S0140-6736(20)30971-5 In Press. 8 Habibi R Burci GL de Campos TC Do not violate the International Health Regulations during the COVID-19 outbreak Lancet 2020 395 10225 664 666 10.1016/S0140-6736(20)30373-1 32061311 9 Chung RY Li MM Anti-Chinese sentiment during the 2019-nCoV outbreak Lancet 2020 395 10225 686 687 10.1016/S0140-6736(20)30358-5 32122469 10 Devakumar D Shannon G Bhopal SS Abubakar I Racism and discrimination in COVID-19 responses Lancet 2020 395 10231 1194 10.1016/S0140-6736(20)30792-3 11 Studdert DM Hall MA Disease control, civil liberties, and mass testing – calibrating restrictions during the Covid-19 pandemic New England J Med 2020 10.1056/NEJMp2007637 In Press. 12 Ang YY When COVID-19 meets centralized, personalized power Nature Human Beh 2020 4 5 445 447 10.1038/s41562-020-0872-3 13 Shiau S Krause KD Valera P The burden of COVID-19 in people living with HIV: a syndemic perspective AIDS Behav 2020 10.1007/s10461-020-02871-9 In Press. 14 Logie CH Turan JM How do we balance tensions between COVID-19 public health responses and stigma mitigation? Learning from HIV research AIDS Behav 2020 10.1007/s10461-020-02856-8 In Press. 15 Smith GD Ng F Li WHC COVID-19: Emerging compassion, courage and resilience in the face of misinformation and adversity J Clin Nursing 2020 29 9-10 1425 1428 10.1111/jocn.15231