During the coronavirus pandemic, there have been signs of appreciation for health workers, while there have also been manifestations of rejection, isolation, and even death threats to workers and their families, alleging fear of infecting neighbours and patients. Stigmatization of health workers has been studied infrequently. Most scientific literature focuses on stigma towards people who suffer from some type of disorder, such as HIV or mental illness.

As in many infectious contagious diseases, coronavirus is associated with actions of stigma, discrimination and rejection. Epidemics with a high number of cases and related deaths and uncertainty raise fears in the population. Messages of social distancing, isolation, quarantine, risk zones, etc. used by governments to try to control new infections, increase the perception of risk and favour the exclusion, not only of the person who has become ill, but also of their family and those who have been in contact, such as healthcare workers.

Stigma and discrimination are associated with ignorance, negative views of those at risk and perceived probability of contagion, as documented in epidemics of influenza, cholera, SARS, Ebola, or yellow fever, among others. Knowledge of the history of medicine helps us gain a better understanding and manage the current stigma situation for health workers.

Associating healthcare workers with contagion can promote delay in seeking care, concealment of symptoms, and delay control of the pandemic. On the other hand, mitigating discrimination and stigma can help control transmission. The stigma undermines social cohesion, fundamental in the control of the pandemic, isolating groups, such as health workers, avoiding contact with them and delaying necessary health care.

COVID-19 has awakened stigma due to several factors. It is a disease where knowledge is emerging, the evidence changes day by day. Some uncertainties increase fears, the contagion is related to ‘others’, perceived as dangerous, like those who have been in contact with the virus, such as the sick and health workers. Fears, misinformation, ignorance are associated with stereotypes, discrimination and stigma.

The management of fears raised by the COVID-19 pandemic at the public health level can be addressed with behavioural strategies that respond to the needs of a segment of the population at risk of being stigmatized through health education and adequate communication, not only at the level of data reporting, also by messages on television, press conferences, mass media and Internet sites.

So what can I do to combat stigma against health workers? Here are some actions recommended by leading health including the World Health Organisation.

• Disclose evidence-based information, for example, about transmission media, protection measures, providing statistical data. Stigma is fuelled by ignorance.
• Promote consultation of reliable data sources (WHO, Ministry of Health, Universities).
• Fight disinformation, hoaxes and rumours that contribute to stigma, correcting information errors, while acknowledging people’s feelings; promote the importance of prevention, detection, reporting and treatment.
• Be careful with language, avoiding names that promote stereotypes and stigma (‘Chinese virus’,’ super infector ‘,’ contagious person ‘) Avoid identifying the person with the condition and dehumanizing them as a’ suspected case ‘, or’ number of deaths ‘ Use terms that account for the human situation, such as’ person with coronavirus’,’ deceased as a result of the disease ‘
• Help redefine health workers as heroes as well as victims.
• Share stories that promote empathy, humanize the experience and difficulties that health workers face in the pandemic, and hopeful accounts of people who have recovered.
• When possible, involve ‘influencers’, religious leaders, politicians, celebrities and journalists, interactions with health workers must be made visible. Spread news, songs, etc. that give a positive image of the institutions and staff that work there.

Ricardo de la Espriella. Psychiatrist, a clinical epidemiologist. Care Director of the Province of Latin America, Sisters Hospitallers.