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  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">IJGH</journal-id>
      <journal-title-group>
        <journal-title>International Journal of Global Health</journal-title>
      </journal-title-group>
      <issn pub-type="epub">2693-1176</issn>
      <publisher>
        <publisher-name>Open Access Pub</publisher-name>
        <publisher-loc>United States</publisher-loc>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="doi">10.14302/issn.2693-1176.ijgh-21-3838</article-id>
      <article-id pub-id-type="publisher-id">IJGH-21-3838</article-id>
      <article-categories>
        <subj-group>
          <subject>short-communication</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Covid-19, Stigma &amp; Law of the Leper </article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Theophilus</surname>
            <given-names>Kofi Gokah</given-names>
          </name>
          <xref ref-type="aff" rid="idm1842086588">1</xref>
          <xref ref-type="aff" rid="idm1842087020">*</xref>
        </contrib>
      </contrib-group>
      <aff id="idm1842086588">
        <label>1</label>
        <addr-line>Cardiff University School of Social Science.</addr-line>
      </aff>
      <aff id="idm1842087020">
        <label>*</label>
        <addr-line>Corresponding author</addr-line>
      </aff>
      <contrib-group>
        <contrib contrib-type="editor">
          <name>
            <surname>Lucio</surname>
            <given-names>Mango</given-names>
          </name>
          <xref ref-type="aff" rid="idm1841952772">1</xref>
        </contrib>
      </contrib-group>
      <aff id="idm1841952772">
        <label>1</label>
        <addr-line>Italy</addr-line>
      </aff>
      <author-notes>
        <corresp>
  Theophilus Kofi Gokah, <addr-line>Cardiff University School of Social Science</addr-line>. <email>tgokah@yahoo.co.uk</email></corresp>
        <fn fn-type="conflict" id="idm1843112532">
          <p>The authors have declared that no competing interests exist.</p>
        </fn>
      </author-notes>
      <pub-date pub-type="epub" iso-8601-date="2021-09-20">
        <day>20</day>
        <month>09</month>
        <year>2021</year>
      </pub-date>
      <volume>1</volume>
      <issue>3</issue>
      <fpage>7</fpage>
      <lpage>12</lpage>
      <history>
        <date date-type="received">
          <day>13</day>
          <month>05</month>
          <year>2021</year>
        </date>
        <date date-type="accepted">
          <day>19</day>
          <month>07</month>
          <year>2021</year>
        </date>
        <date date-type="online">
          <day>20</day>
          <month>09</month>
          <year>2021</year>
        </date>
      </history>
      <permissions>
        <copyright-statement>© </copyright-statement>
        <copyright-year>2021</copyright-year>
        <copyright-holder>Theophilus Kofi Gokah</copyright-holder>
        <license xlink:href="http://creativecommons.org/licenses/by/4.0/" xlink:type="simple">
          <license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p>
        </license>
      </permissions>
      <self-uri xlink:href="http://openaccesspub.org/ijgh/article/1877">This article is available from http://openaccesspub.org/ijgh/article/1877</self-uri>
      <abstract>
        <p>COVID-19 also known as Corona Virus is a new strain of Chronic Obstructive Pulmonary disease. While its virology is yet to be properly understood, its impact by way of human deaths is well registered. Stigma of infected persons is least mentioned as a ‘sub-strain’ that can push people into social isolation and exclusion (like in the book of Leviticus 13) leading to COVID-19 Related Depression (C-19RD). Using inter-disciplinary approach, this paper seeks to understand how this can happen in a COVID-stricken world. </p>
      </abstract>
      <kwd-group>
        <kwd>Public Health &amp; Covid-19</kwd>
        <kwd>Stigma</kwd>
        <kwd>Social Media</kwd>
        <kwd>Behaviour &amp; Labelling theory Functionalism</kwd>
        <kwd>Leviticus</kwd>
        <kwd>Interactionism</kwd>
      </kwd-group>
      <counts>
        <fig-count count="0"/>
        <table-count count="0"/>
        <page-count count="6"/>
      </counts>
    </article-meta>
  </front>
  <body>
    <sec id="idm1841949748" sec-type="intro">
      <title>Introduction</title>
      <p>The origins and background of COVID-19 has been intellectually discussed <xref ref-type="bibr" rid="ridm1842562180">6</xref>. On social                      media platforms there are short videos and                       communication exchanges focusing on social (in terms of death), economic and political impact of the disease. What has not yet been discussed is its                 <italic>melodrama</italic> and hegemonic discourse <xref ref-type="bibr" rid="ridm1842457796">23</xref>. The                  disease and its spread offers insights into social            responses to deadly viral infections in different    social contexts. In fact, this paper focuses on one such context – Ghana. This is important because of varied public responses portrayed mainly via social media.<xref ref-type="bibr" rid="ridm1842430916">31</xref> The discussions here lead to qualitative understanding of the <italic>how</italic> and <italic>why</italic> of public reaction to the disease, and protest behaviour to express opinions about matters concerning them. This can also be understood from the ‘Law of the Leper’. </p>
      <p>Law of the Leper is a socio-religious                     injunction in biblical times (Leviticus 13; 14: 10 – 20) where people with infectious diseases were     isolated from the community or quarantined to                prevent cross-contamination or infecting others as is the case of COVID-19. They were only allowed into the community if given the all-clear; in spite of that, social interaction and acceptance is not guaranteed on return.</p>
      <sec id="idm1841948452">
        <title>De-contextualisation </title>
        <p>Since COVID-19 took the world by storm, the World Health Organisation declared the disease a global pandemic. it has affected almost the entire world with the exception of Antarctic regions where no official cases have been reported. As of April 2020, the global officially reported cases suggest that infections had reached 1, 696, 588 with 105, 952 deaths <xref ref-type="bibr" rid="ridm1842397844">34</xref>. Within the same period Africa is reported to have 9,728 confirmed cases and 444 deaths. If the trend continues much longer it will render moderate gains made by most countries insignificant thus making already stressed economies worse <xref ref-type="bibr" rid="ridm1842434660">30</xref> . Strains of COVID-19 such as Lambada strain, UK strain, Delta Plus strain, South    Africa strain, B.1.1.7 (Alpha) strain found in North America; B.1.351 (Beta) initially found in South Africa; P.1 (Gamma) detected in Brazil and B.1.617.2 (Delta) in India suggest we are in a long haul with COVID<xref ref-type="bibr" rid="ridm1842525492">14</xref>.</p>
        <p>Regardless of its origins, as Kantarcioglu and others (ibid) have explained, <italic>there is something taking place on our blindside.</italic> That something remains unknown and can be harmful for public health and well-being.               Indeed, global economies have been hit by the pandemic but weaker ones such as African economies which have already been described as fragile and vulnerable may be more weakened and will require increased investment and long-term initiatives to repair and promote their  development programmes <xref ref-type="bibr" rid="ridm1842463412">26</xref>. </p>
        <p>From theoretical social functionalism and             psychological functionalist perspective<xref ref-type="bibr" rid="ridm1842399716">33</xref>  COVID-19 has taught the world critical lessons ranging from                     economic, political, social (in terms of kinship,               religion and education) to functional needs for                                  adaptation, goal attainment, latency and integration.     These are seen in measures offered by authorities as part solution to curb the spread of COVID-19. They argue that to contain the virus, social distancing should be                   maintained. Within functional parameters social                         distancing has the ability to exclude and isolate people who may be suspected of being infected by an alien                disease like COVID-19. <xref ref-type="bibr" rid="ridm1842517356">15</xref></p>
        <p>Although Katz <italic>et al </italic><xref ref-type="bibr" rid="ridm1842517356">15</xref>  are critical about social           distancing measures, particularly quarantine and                  isolation, because it is not always supported by good              evidence, and the fact that there may be barriers to their use, because lessons learned from its practice can be seen in both developing and developed contexts; I am not              particularly sure about the thinking held                             <xref ref-type="bibr" rid="ridm1842517356">15</xref>regarding ‘guidance for social distancing lacking    sufficient details about its implementation in   every               social context nor the factors considered by public health officials when making those decisions (p. 150). What I do agree with is that, social distancing is such a <italic>complex                  concept</italic> in terms of its application because of its political, ethical, moral and social challenges underpinned by               experience and resources. <xref ref-type="bibr" rid="ridm1842712460">3</xref><xref ref-type="bibr" rid="ridm1842566572">5</xref>  Within  these spaces, COVID-19 has demonstrated how narrow the gap                  between developed and developing countries are in terms of their innovativeness and readiness to fight global emergencies. </p>
      </sec>
    </sec>
    <sec id="idm1841945644" sec-type="methods">
      <title>Method &amp; Discussion</title>
      <p>A review of how COVID-19 is portrayed on social media reveal interesting trends. In all 15 short video clips (between 2 – 3 minutes), textual content and reader’s comments were observed. These postings were either humorous or informational. The humour and textual    messages were stigmatizing COVID-19 and suspected persons who might have the disease and not behaving in line with guidelines given by local and international health institutions i.e. guidance on: public sneezing,<xref ref-type="bibr" rid="ridm1842544916">8</xref>  hand hygiene <xref ref-type="bibr" rid="ridm1842436964">29</xref> and social distancing <xref ref-type="bibr" rid="ridm1842550172">9</xref>.</p>
      <p>Two models helped to understand stigmatisation of people infected with COVID-19; these are behaviour model and Labelling theory which conceptualises stigma as a social construction <xref ref-type="bibr" rid="ridm1842499044">17</xref><xref ref-type="bibr" rid="ridm1842496524">18</xref><xref ref-type="bibr" rid="ridm1842491772">19</xref> The way society or people construct their worldview of reality can be         misleading or go against sociology of knowledge <xref ref-type="bibr" rid="ridm1842438404">28</xref>. This expression manifests in micro-interactions with   stigmatised people who become <italic>social victims</italic> in                 everyday interaction and unintentionally or intentionally elevating the <italic>self </italic>which becomes a ubiquitous concern in social interactionism.<xref ref-type="bibr" rid="ridm1842402812">32</xref></p>
      <p>The point being made by Vlasceanu and others reflects Di Maggio and Powell’s<xref ref-type="bibr" rid="ridm1842560740">7</xref> view which implies that sociological interactionism helps to provide an                  alternative view of self-regulation, formal codes of                  conduct or ethical codes in response to pressures that may be brought upon an environment to improve                 accountability or shape behaviour. How this plays out in sociological institutionalism where in some cases, social codes for example, are not intellectually defined, because of their flexible boundaries, resulting from culture,                    tradition, religion and one’s world-view is not properly understood. This has led to fluidity in interpretations which in itself shape people’s response to victims of             Corona Virus or COVID-19. </p>
    </sec>
    <sec id="idm1841920372">
      <title>Findings &amp; Discussion</title>
      <p>A number of illnesses and disabilities have been associated with stigma, including diabetes epilepsy <xref ref-type="bibr" rid="ridm1842453332">24</xref>, and mental ill-ness <xref ref-type="bibr" rid="ridm1842496524">18</xref><xref ref-type="bibr" rid="ridm1842491772">19</xref>  with descriptive accounts. In this paper an example of stigma is reported on a relative of a patient who tested positive for coronavirus                  (COVID-19) leading to stigmatisation from his society. An example is this man:</p>
      <p>The stigmatisation started after my father’s    diagnosis and subsequent quarantining. No one wants to come close to him and his family anymore. Even the               provision shop, which used to be very busy, has seen very few customers since his father tested positive for             COVID-19...No one comes to our shop to buy anything anymore, and as a result of that, my father asked my grandmother to close the shop; if people see that anybody from this house has gone out, they will run away and sometimes they will be mocking you.</p>
      <p>               (<italic>Anonymous</italic>, Ghanaweb Friday 10 April 2020)</p>
      <p>Whilst we can understand the context of the            narrative, stigmatisation does not distinguish between demonising the ‘disease’ and the ‘infected person’. These melodramas are often shown in clips from videos                      depicting people jumping out of public transport when someone advertently or inadvertently sneezes; instant reactions by mere mention of travel history to China             including offering gifts from China. These were                  sarcastically rejected with scorn. </p>
      <p>Social network sites and video-sharing sites,  create opportunities to exchange opinions on corona  virus (Covid-19) with other people<xref ref-type="bibr" rid="ridm1842708204">2</xref>. Studies that have taken individual-level approach tend to find positive              relationship between frequency of social media use and protest behaviour <xref ref-type="bibr" rid="ridm1842501996">21</xref>. Apart from that, its sources have become information hub <xref ref-type="bibr" rid="ridm1842538540">10</xref>  to monitor what is                 happening in both national and international spaces. <xref ref-type="bibr" rid="ridm1842396908">35</xref> does not think this is a bad idea because by so doing                people are able to mobilize instant information to engage in particular activities or ways to protect themselves and others. These sorts of actions can, unfortunately, lead to stigmatisation contrary to typical norms of support and care given to an afflicted person.  </p>
      <p><xref ref-type="bibr" rid="ridm1842464996">25</xref> defines disease-related stigma as ‘when       individuals with an illness are deemed undeserving of help and support’. This type of stigmatising is disturbing if applied to COVID-19. Conceptually, it implies that                infected persons are characterised as unworthy of full social status. It is not surprising that sociologists have been studying how certain illnesses are associated with reduced social status <xref ref-type="bibr" rid="ridm1842537532">11</xref><xref ref-type="bibr" rid="ridm1842453332">24</xref> and how negative reactions may impede coping and recovery <xref ref-type="bibr" rid="ridm1842706476">1</xref><xref ref-type="bibr" rid="ridm1842496524">18</xref><xref ref-type="bibr" rid="ridm1842491772">19</xref>. </p>
      <p>In Goffman’s <xref ref-type="bibr" rid="ridm1842537532">11</xref>epistemology, stigmas arise from personal attributes that others perceive as deeply discrediting. Whilst we directly do not know what might be going through the mind of the above informant, we can see through his minds-eye a certain level of distress               resulting from social pressure which is uncomfortable. </p>
      <p>People affected by COVID-19, in its extreme form may suffer chronic obstructive pulmonary (COP) disease and pneumonia. People with this condition are marked by their coughs, flu or cold, dyspnoea and need                  supplemental oxygen. These characterisations draw      attention to others that <italic>the person is sick</italic> and, in a way, produces anxiety.</p>
      <p>Stigmatising infected people could lead to social withdrawal as a way of escape from social backlash. Friends, and in some cases, relatives may become                  reluctant to socialise with an infected person <xref ref-type="bibr" rid="ridm1842443516">27</xref>                      leading to exclusion and isolation <xref ref-type="bibr" rid="ridm1842516276">16</xref>. In some extreme cases persons infected with the Corona virus (COVID-19) coupled with their exclusion can suffer emotionally from isolation, low esteem and uselessness. With time,                  depression may set in, causing the infected person to give up social roles and community responsibilities <xref ref-type="bibr" rid="ridm1842504084">20</xref>. </p>
    </sec>
    <sec id="idm1841917348" sec-type="conclusions">
      <title>Conclusion &amp; Recommendations</title>
      <p>The foregone discussion primarily concerned itself with contextualising stigmatisation of persons          infected with COVID-19, otherwise known as Corona Virus, a deadly disease, which has claimed several lives indiscriminately. The World Health Organization                declared the disease a global pandemic. Both labelling theory and behaviour model helped in understanding stigmatisation of people affected by the corona virus within a certain social context. It is possible that the ethos of what has been discussed could apply beyond the context of this paper. Imageries and ‘melodramas’ provided on social media were the reference points for this discussion. Its actors (like in biblical times as found in Leviticus 13 and 14) reinforce Goffman’s <xref ref-type="bibr" rid="ridm1842537532">11</xref> thinking about people purposefully distancing themselves from perceived infected persons during an outbreak of an infectious disease, thus, subjecting such persons to social rejection. </p>
      <p>Since stigma depends on cultural institutions to provide support, enforce norms, behavioural cues and social codes, it depends on government,                                      non-government, religious, educational, and medical institutions to reinforce ‘normal’ cultural behaviours and identities which has the tendency to limit or result in              de-stigmatising conformity to those who are infected with COVID-19 <xref ref-type="bibr" rid="ridm1842809508">4</xref>. For this to happen the following              recommendations are offered: </p>
      <p>(a) Social codes must be enforced through public             recognition, rewards and punishment at all strata of    society. This approach will promulgate specific (corporate) social responsibility directed at empowering people and organisations to promote social cohesion, addressing exclusion (especially, people infected with corona virus).</p>
      <p>Having said that, I do not negate on the fact that stigmatisation may be relevant in one context or another depending on what it is purposed to achieve; for                instance in the case of suppressing social                                       misdemeanour.</p>
      <p>(b) Since non-compliance is attributed to lack of                   enforcement <xref ref-type="bibr" rid="ridm1842535300">12</xref> there must be checks and balances in existing systems which focus on those responsible for enforcement and penalties for non-compliance. This principle of deterrence will serve as barrier against                unwarranted or ‘justified’  stigmatisation. This is                   supported in social psychology literature which suggest that compliance is encouraged by situations which arouse a sense of social obligation <xref ref-type="bibr" rid="ridm1842458948">22</xref></p>
      <p>(c) Community-based strategies are needed to help                    enforcement of anti-stigmatisation codes. This could be achieved by drawing on available local resources and structures to eradicate problems associated with stigma.</p>
      <p>(d) Public education must be intensified to avoid                     push-back and social resistance against stigmatisation and exclusion of people who do not deserve to be                 treated as such. </p>
    </sec>
    <sec id="idm1841916772">
      <title>Acknowledgment</title>
      <p>This paper is dedicated to Johanna M. Gokah and Caroline Auma-Gokah</p>
    </sec>
  </body>
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