COVID-19 through a cultural lens

Abstract

Introduction The COVID-19 pandemic was global in terms of its spread, restrictions, and economic consequences.[1] However, striking differences were observed in different societies and groups in terms of transmission rates, mortality, policies, and psychosocial responses. In the contextualization of COVID-19 experience, culture could shine a beam of light on issues related to knowledge, beliefs, stigma, behavioral responses, and media representations. Science has made it possible for modern societies to predict and thus exercise some control on natural phenomena. The COVID-19 outbreak was disruptive for societies that had settled in a sense of smug serenity.[2] Cultural trauma is triggered when the experience of a crisis threatens the society's collective identity at its core. The traumatic experience of COVID-19 was intense, rapid, and widespread – reflective of the time-space compression of the current global world and hence, it has been termed “compressed cultural trauma.”[3] The disruptions were accompanied by reactive efforts at making sense (meaning) of what was happening that was both reflective of the changing reality as well as a shaper of new reality. The emerging meanings influenced public health policy, political phenomena, and social processes as well as individual lives. Global Scenario Leadership There was a need to create authority during the COVID-19 crisis to ensure collaborative action. Symbolic power does not necessarily follow from legal-rational authority. Political leaders needed to provide a narrative about COVID-19 response (e.g., about how COVID-19 would be contained) and convince people that they could lead the response. Media briefings served both as a medium for providing information, and a stage for ritualistic performances to provide people with a feeling of comfort and stability.[4] Leaders who come across as nonpartisan healing figures, urging reasonable, pragmatic, and responsible actions (like Anthony Fauci in the USA or Randeep Guleria in India) became “iconic.” Others, like President Trump, “ironic.” In the UK, political authorities initially responded to COVID-19 with denials that were rooted in cultural rather than scientific processes. Societal risks (in the absence of data) are evaluated by means of narrative classification – the British government (like the one in Sweden), initially made a “genre guess” that COVID-19 was “not very dangerous”.[5] Hence, it chose to go for “herd immunity.” However, following revised estimates that suggested that herd immunity would develop only after a significant number of deaths, the UK government shifted genres, towards containment of risk through national shutdowns. Swedish authorities, on the other hand, were able to convince the public that the COVID-19 pandemic could be managed with public health measures without recourse to draconian restrictions. In many societies even if leaders have the cultural power and social solidarity for collective action, they may be reluctant to risk it on highly intrusive campaigns. Unhindered by such fears, China introduced tough social policies to contain COVID-19 very early. China's success led some observers to suggest that some governments may have an “authoritarian advantage” in controlling pandemics.[26] However, the Taiwanese example suggested that democratic nations can do as well. The Taiwanese government was able to disseminate the narrative of mutual concern and social cooperation, as a result, rational government measures were widely adopted. This success was rooted in Taiwan's earlier inadequate response to the SARS epidemic, which had led to the questioning of its identity as a “modern nation.” This “cultural trauma” had led to reforms that had “societalized” Taiwan's pandemic response system, which stood it in good stead during the COVID-19 pandemic.[6] Gendered leadership COVID was effectively managed in female-led countries, for example, New Zealand, Taiwan, and Germany.[7] This success conceivably was due to social equalities within these countries, rather than just the gendered leadership. However, the success of these countries in containing COVID-19 highlights the importance of gender equality, and socioeconomic and political equity for public health. Architects of our own pandemics In some ways, human societies are the architects of pandemics. Wet markets that represent a heightened risk for novel pathogen behaviors and host crossovers due to their capacity to link sociocultural and eco-biological networks act as “biocultural hubs” for new epidemics.[8] These markets exist because of their important cultural value (e.g., valued social interaction, beliefs that local products are healthy, cultural value of traditional medicines derived from wild animal products). The timing of the COVID-19 outbreaks also appeared to have many cultural links, as the Spring Festival in Wuhan and the festival season in India acted as super-spreader events.[89] Societal Differences in COVID Response Individualism-collectivism Individualistic cultures prioritize independence, while collectivistic societies prioritize group ties. The promotion of collectivism and the action for the common good has been advocated as a strategy for public health messaging to increase engagement with official recommendations.[10] In a study on data sets from 98 countries, collectivism was associated with lower rates of COVID-19 infection and mortality.[11] It is possible that authorities in individualistic societies might be hesitant about ordering compulsory measures (e.g., lockdown and wearing mask) and citizens might be less compliant with mandatory recommendations. History and culture have played a role in national mask policies during the COVID pandemic. Strict policies were implemented in East Asian countries when COVID-19 cases were in the hundreds, while such policies were implemented in Western countries only after lakhs of cases were reported in those countries. Masks against airborne disease have been worn in China since the Manchurian plague (1910) and in Japan since the Spanish flu pandemic (1918–1920).[12] A survey of passers-by in Tokyo showed that one-third wore masks regularly and about two-thirds had been socialized into this practice during their developing years.[13] Many people in East Asian countries see wearing masks as a collective responsibility for mitigating viral transmission. In the West, wearing masks was stigmatized as an East Asian practice and during the COVID-19 pandemic, it was associated with beliefs around spread of contagion by East Asian minorities.[12] ”Tight-loose” orientation Communities negotiate social norms to seek a balance between freedom and constraint.[14] Tightness–looseness is a measure of the strictness of societal rules. It may be related to the recommendation of, and compliance with, restrictive measures. In a study comparing data from 54 countries, looseness was found to be associated with case and mortality rates due to COVID-19.[15] However, while tight rules regarding social distancing are important for containing COVID-19, looseness within these constraints might help in making people feel connected. Relational mobility is a measure of the degree to which interpersonal relationships are fixed or voluntary within groups. High relational mobility (propensity for making new social connections) might increase the chances of the spread of COVID-19 within sociocultural groups. Further, geographical mobility of relationally mobile groups could spread the virus across regions. Salvador et al. reported that relational mobility was correlated with the rise in the number of COVID-19 cases and deaths in a dataset from 39 countries.[16] Within Society Differences Stereotyping and prejudice Stereotype is an exaggerated generalization, wherein identical features are ascribed to every member of a given category, without considering the real differences between individuals. Prejudice can be conceptualized as an attitude toward a social category based on false or incomplete information.[17] Threatening circumstances like the COVID-19 pandemic increase the probability of triggering stereotypes and prejudices – especially if they are reinforced by political propaganda. Social amplification impacts risk perception within groups and can set a ground for social contagion of beliefs and behaviors during crises. Disease threat is often associated with higher levels of ethnocentrism and greater intolerance and punitive attitudes toward out-groups. As a result, some stigmatized groups face dehumanization (e.g., stereotyped as dirty or carriers of pestilence) based on processes embedded in institutional discrimination.[18] Half of the Chinese American respondents reported being directly targeted by COVID-19 racial discrimination and 90% reported witnessing at least one incident of COVID-19 racial discrimination. In addition, they perceived collective racism, wherein the Chinese are considered a health threat to the American society. They felt that the media played a role in perpetuating Sinophobia.[19] These experiences of racism and racial discrimination were associated with poorer mental health and reduced psychological well-being.[20] Americans who were more fearful of COVID-19, had less accurate knowledge of the virus, had more negative attitudes toward Asians, and had less trust in science and more trust in far-right political leadership, were more likely to engage in discriminatory behavior toward people of Asian descent.[20] As seen in the above example, during crises, the “others” (who can be distinguished based on their traits, for example, gender, age, ethnicity/religion, and sexual pREFERENCES) are often accused of carrying the disease and discriminated against by the majority. Discrimination is a process where five consecutive and overlapping stages are activated.[21] The first stage is characterized by a psychological (empathic) distance between an individual and the others. The second stage is of devaluation of the other, who is dehumanized to varying degrees (e.g., use of pejorative terms like “plague” for individuals/groups). Psychological process is transformed into a social process during the third stage that is characterized by delegitimization – the sanctioning of the deprivation of rights of a given social category (e.g., the virus carriers). It leads to concrete actions towards other people (e.g., labeling of sick people's homes). The fourth stage is characterized by physical segregation (e.g., creation of ghettos or places of isolation) and the fifth by physical extermination. Discrimination can occur at various levels. Individuals may stigmatize others suspected of having COVID or blame people of foreign origin for bringing the disease (scapegoating). Collective actions (e.g., crowd behavior) may occur against individuals/groups (e.g., asking medical personnel to leave tenancy). Enterprises may start discriminating, for example, refusing to serve specific groups due to fear of transmission of infection. Local administration (e.g., labeling houses of people with COVID-19) and government may take measures against certain groups (e.g., the Tablighi Jamaat).[17] Rzymski et al. have suggested some steps for reducing discrimination during epidemic situations.[17] These are: Development and implementation of policies against disease-related fear, prejudice and discrimination, and in support of reduction of health disparities Considering the impact on public perceptions (e.g., panic and stigma) and confidentiality while reporting health data Engagement of social media to block discriminatory communication, and supporting discriminated groups through reassuring posts and infographics Sharing accurate information and raising awareness on the disease with attention to public impact Involvement of nongovernmental organization in monitoring and reporting disease-related discrimination. Intersection of culture and marginalization The COVID-19 pandemic has caused/worsened and exposed discrimination against marginalized communities in several ways including prejudice and aggression; overrepresentation in frontline and essential services; overrepresentation in displaced and incarcerated communities; and structural disadvantage in treatment access and vaccine distribution.[18] This has occurred in combination with preexisting discriminatory health inequities and has led to disproportionate detrimental impacts of COVID-19 in marginalized communities.[22] In India, people from North-Eastern states with more phenotypically East Asian features have been discriminated against and attacked.[23] Rumors blaming Muslims for the spread of coronavirus were propagated.[24] Higher levels of frontline exposure, poverty, homelessness, displacement, overcrowding, food and water insecurity, and lack of access and unaffordability of resources made the already bad situation (preexisting economic/employment disparities and health inequities) of marginalized communities worse.[25] Increased rates of depression, anxiety, trauma, and other mental health issues have been reported in these communities in the wake of COVID-19 pandemic compared to other groups.[24] India was also witness to the long march of migrant workers with precarious employment from cities to their native places during the national lockdowns.[26] The dehumanization (e.g., sprayed with chemical disinfectants; denied minimal support) faced by these migrants on their journeys might have left them with deep scars.[27] In a systematic review of 52 studies on racial and ethnic disparities in COVID-19-related infections, hospitalizations, and deaths, Mackey et al. reported that African American/Black and Hispanic populations experienced disproportionately higher rates of COVID infection, hospitalization, and mortality compared with non-Hispanic White populations. They suggested that health care access and exposure factors may underlie the observed disparities more than susceptibility due to comorbid conditions.[28] Intersection of cultural and sociodemographic categories Intersectionality between cultural and other sociodemographic categories, such as gender, age, and social class affect transmission rates and morbidity. Quarantine measures have posed significant risks for women, children, elderly, and people with disabilities in terms of abusive experiences.[14] Chronological patterns of transmission of the virus (initial spread in richer sections followed by spread in poorer sections) and case fatality due to COVID-19 (often due to comorbidities) were related to social class.[29] Unexpectedly, the levels of stress reported by younger people in several countries were consistently higher than older adults despite higher social isolation implemented on the latter.[30] Globally, more men than women have died of COVID-19 disease. While this may be related to biological differences (e.g., immune responses and smoking patterns), behavioral factors may also play a role, for example, the use of nakabs or burkas by Muslim women might act as a protective factor against contamination. Gender segregation and differing levels of involvement in different societal spheres (e.g., almost 70% of frontline health and social care providers globally are women) might also influence the likelihood of exposure.[31] Disparities in access to healthcare The disparities in access to health care and treatment are reflected in the distribution of the COVID-19 vaccines. Many rich countries negotiated private deals with pharmaceutical companies for early access to several vaccines outside the WHO's COVAX, leading to inequitable distribution of vaccines between and within countries.[32] Symptomatic of this “me-first” behavior was the termination of the United States ties (along with substantial funding) with the WHO in May 2020 in the midst of the pandemic. Common threats can also create opportunities to reduce sectarian prejudices. Coordinated efforts across individuals, communities, and governments to fight the spread of disease can send signals of cooperation and shared values. Since communities may differ in levels of trust in social institutions, there is a need for targeted (culturally sensitive) public health information for marginalized communities delivered in partnerships with trusted individuals and organizations within these communities.[14] Airhihenbuwa et al. have proposed a cultural model of public health messaging comprising three domains: cultural identity, relationships and expectations, and cultural empowerment.[33] Infodemic Global information sharing on COVID was confounded by an infodemic-the spread of false information and fake news. This occurred in the form of sensationalism and misinformation (in mass media) and fake news and conspiracy theories (in social media) and led to a sharp increase in prejudice, discrimination, and xenophobia (e.g., labeling the COVID-19 virus-Chinese virus). The postfactual world and the “performance of truth” Truth versus lies are seen as a binary code in the cultural construction of civil society.[3] Truth, itself, became contentious in the COVID-19 world, particularly on the social media. What were realistic statements of fact to one side, appeared to be ideologically motivated distortions to the other. Some experts stated that we have entered a “post-factual world.”[34] In reaction, the dialectic of accusations and counter-accusations also led to the creation of the new institution of “fact-checking” located in the relatively autonomous civil spheres of journalism.[34] The independent fact-checking of public statements about COVID-19 was critical to maintaining or undermining efforts of political power to establish cultural authority, as exemplified by the demoralization in the UK following the highly publicized failures in public health planning, and a scandal suggesting different quarantine rules for the elite and the rest.[35] Political polarization and conspiracy theories Affective polarization can support partisan beliefs (e.g., self-selection of polarized news sources “echo chambers”) and decreased trust in public health information, so different segments of the population may arrive at different conclusions about threat perception and appropriate actions.[14] In the USA, certain news channels recommended precautionary measures against the transmission of COVID-19, while others downplayed the severity of the pandemic; impacting their viewers risk perception, adoption of preventive behaviors, and infection and fatality rates.[36] Like stories, rumors and conspiracy theories can offer meanings when analyzed in specific contexts; regarding COVID-19 pandemic, some conspiracy theories concerned the origins of the virus (e.g., bioweapon), while others focused on prevention and cure (e.g., alternative remedies should be used).[14] These narratives sometimes linked micro-level phenomena (e.g., rumors) to macro-level structures such as economics and politics (e.g., the pandemic is “bioengineered”).[37] The emergence of COVID-19 added to the preexisting trend of propagation of anti-vaccination fake news due to extensive use of social media.[38] Politicians, the media, and opinion leaders can help reduce political division around various issues by highlighting an overarching identity. Since, misperceptions of the other side underlie polarization, combating misinformation that could generate partisan reasoning and inaccurate beliefs could help. Giving people factual information through trusted voices can combat belief in conspiracy theories and fake news.[14] The Individual in Cultural Context Culture influences individual attitudes and practices that thus can affect the risks of contagion and impact of the disease. The individual trait labeled “collective narcissism” involves a strong sense of identification with one's own perceived group, feelings of collective entitlement, unrealistic beliefs about the ingroup, and outgroup hostility.[39] It is associated with political polarization, dissemination of conspiracy theories related to COVID-19, and negatively correlated with preventive behaviors (e.g., washing hands and staying home).[3940] Cultural context also plays a role in individual adjustment and well-being. Collective optimism (shared optimism about a group) was associated with the adoption of effective coping strategies like positive reappraisal during the COVID-19 crisis.[41] Mourning Death and burial practices had to be altered (e.g., aligning religious leaders with the health system, virtual mourning) to meet COVID-related health protocols (e.g., restrictions on the purification of corpses, number of participants in funerals, time to hold funerals, and availability of the religious leaders).[42] Such ceremonies and practices impact the spiritual struggles and mental health outcomes of the bereaved, highlighting the need for psychological and social support programs for those bereaved due to COVID.[43] Conclusion The impact of every disease is contingent on how individuals, groups, and societies understand it, experience it, and respond to it. It is also evident that the dynamics of privilege and marginalization interact with culturally held beliefs to influence the experience of diseases and their outcomes. Understanding these dynamics can help in better communication and implementation of protective measures. COVID-19 pandemic has been called a “cultural break point” that should signal a major cultural–historical change from the hitherto unreflective social configurations to those with greater collective awareness and responsible participation.[1] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.