Healthcare workers reflect on COVID-19 stigma

A qualitative study exploring the perceptions and experiences of frontline healthcare workers during the COVID-19 pandemic found that stigma surrounding this infectious disease affected both patients and clinicians. Feelings of blame or inadequacy changed as the pandemic evolved and may have affected how care was delivered. 

Health-related stigma occurs when an illness or condition is deemed socially undesirable. This attitude affects health outcomes and prompts discriminatory behavior. Studies have found that healthcare workers who experience such stigma have increased burnout, depression, insomnia, anxiety and post-traumatic stress disorder.

“Stigmatization of illness has been around forever, all the way back to biblical times. Think of leprosy: People with leprosy were set apart, put in colonies,” said Janice Sabin, research professor emeritus of biomedical informatics and medical education at the University of Washington School of Medicine. “After COVID came roaring into society, we assumed that there would be some stigma involved and decided to study it.” 

Sabin is the lead author of the study, which was published in the journal BMC Public Health. She is part of a research team within the UW’s Center for Health Workforce Studies.

The findings are based on interviews held in 2021 with 19 frontline clinicians, including doctors, nurses and rehabilitation professionals from Washington, Illinois, New York and Florida. The selected states had relatively high rates of COVID-19 and varying state-imposed public health crisis mandates in place. Questions explored clinicians’ observations of how related stigma developed, what drove it, and what strategies could help prevent its emergence in the future.

Respondents described patterns of stigma that evolved over time, first directed toward patients with COVID-19 and healthcare workers who contracted the virus, and later, toward people who chose not to be vaccinated. 

The interviewees said fear of infection early in the pandemic led some healthcare workers to avoid entering patients’ rooms or to delay care. They believed these behaviors interfered with prompt treatment or slowed the recognition of medical conditions unrelated to COVID-19. Some interviewees said they thought that patients were judged for becoming infected, under the assumption that they had failed to take appropriate precautions.

Healthcare workers also reported stigma in their own ranks. Clinicians who tested positive sometimes felt embarrassed to disclose their diagnosis because they feared negative reactions. Some also described being avoided by coworkers or feeling socially isolated from friends and family outside the workplace because they were caring for COVID-19 patients.

Study respondents observed that COVID-19 stigma shifted over time. Early in the pandemic, clinicians reported that people of Asian descent were sometimes unfairly associated with the emergence of this coronavirus. As vaccines became widely available, respondents said, people who were unvaccinated were sometimes treated poorly. Several clinicians said appropriate medical treatment was always provided, but that vaccination status influenced empathy toward patients.

The study identified several factors that clinicians believed contributed to stigma, including fear of infection, assigning blame to individuals who became ill, existing social and racial biases, provider burnout and public messaging. Respondents suggested that infection-control measures, while necessary, may have unintentionally reinforced feelings of isolation because infected patients had to be confined away from others.

To reduce stigma in future public health emergencies, respondents recommended treating patients with dignity regardless of their health decisions, encouraging respectful conversations across differing viewpoints, strengthening community connections before crises occur, and having healthcare leaders and the news media provide clear, accessible information.

“We heard a lot of sensitivity from our respondents, understanding that these are all people trying to stay healthy, trying to do the best they can in a very terrible situation,” Sabin said. 

The findings suggest that health-related stigma is not static and can change as scientific knowledge, public health policies and social attitudes evolve, the authors wrote. They expressed that strategies to reduce stigma should be considered alongside disease-control measures during future outbreaks.

“Our participants told us how important it is to facilitate community cohesion and give people information that can help allay unwarranted fears,” Sabin said. “When people get comfortable with one another and are a cohesive group, they help each other.

“The pandemic was a scary time and people were dying. Fear is often warranted and precautions are always advised. But being afraid of a group of people who don’t have the illness is not a humanizing way to look at things,” she said.

The research was funded by the Health Resources and Services Administration (U81HP32114-05-03), U.S. Department of Health and Human Services.

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