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 is such a contagious and widespread disease that feeling guilty for contracting it is, at this point, illogical. But even with experts predicting that the virus will soon become endemic, the shame of getting it persists. 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 professor of social work at Tel Aviv University, recently researched guilt and shame among more than 300 people in Israel who tested 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. Those feelings appear to be more common in the U.S. In late 2020, when Johns Hopkins researchers surveyed approximately 1,500 Americans, about 25% said they would feel ashamed if they caught COVID-19.
Those feelings have clear consequences for mental health, but they could also be problematic from a public-health standpoint. 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. Another study, published in 2021, also found that COVID-19 shame was linked to lower compliance with public health guidelines, such as notifying health officials and close contacts.
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 may be different because it has shaped nearly every aspect of our lives for the past two 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. In that emotionally heightened state, people are quick to call out those they perceive as behaving badly, especially on social media.
“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.
Risk communication has likely also contributed to perceptions of the virus. 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.
Guilt and shame are closely related, but not identical. “Guilt is, ‘I feel bad about what I did,’ and shame is, ‘I am bad because of what I did,’” says Sonya Norman, a professor of clinical psychiatry at the University of California, San Diego. While guilt can at least motivate people to make more conscientious decisions moving forward, shame is rarely productive, she says. Internalizing shame can be damaging to mental health and is linked to depression and low self-esteem. Shame is also associated with poor anger regulation and interpersonal problems, Hamama adds.
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Norman is working on a therapeutic intervention for people who have struggled with COVID-19-related shame based on her previous work treating U.S. veterans. 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 is still studying the program and its efficacy but says she has gotten promising feedback from patients.
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. Conversely, overanalyzing where someone got COVID-19 is rarely helpful and can imply that the sick person did something wrong.
Public health authorities like the CDC can use similar tactics. Jennifer Manganello, a health communications expert at the University at Albany School of Public Health, says the language used to describe COVID-19 is important. 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. While individuals can and should take certain precautions, like getting vaccinated and boosted, the virus continues to mutate and spread due to societal factors like global vaccine inequality. “Individual actions are just one piece of the puzzle,” Manganello says.
Health communications may be most effective coming from sources whom people inherently trust, such as pediatricians and community doctors, says Dr. Scott Ratzan, founding editor of the journal Health Communication: International Perspectives. The pandemic has caused an erosion of trust in the government and public health groups like the CDC, but most people still trust the health and medical experts they engage with personally, Ratzan says.
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. Social media is a useful tool for widely distributing constructive messages, he adds.
Over time, Venetis says, the way we talk about and perceive COVID-19 will likely shift on its own. 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.
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