JMIR Publications

ABSTRACT

Background:

Stigma is the deleterious, structural force that devalues members of groups that hold undesirable characteristics. Since, stigma is created and reinforced by society -- through in-person and online social interactions -- referencing the novel coronavirus as the “Chinese virus” has the potential to create, perpetuate, and reinforce stigma.

Objective:

Our objective was to assess if there was an increase in the frequency of the phrase “Chinese virus” on Twitter, post- the March 16, 2020 presidential reference of this term.

Methods:

We extracted tweets from all fifty United States using a list of keywords that were derivatives of “Chinese virus.” Only non-commercial tweets with original content were included in our analysis. We compared tweets posted between March 9th and March 15th (pre-period) with those posted between March 19th and March 25th (post-period). We used Stata 16 for quantitative analysis and Python to plot a state-level heat map.

Results:

A total of 16,535 “Chinese virus” or “China virus” tweets were identified in the pre-period and 177,327 of these tweets in the post-period, illustrating an increase of nearly ten times (10X) at the national level. All fifty states witnessed an increase in the number of tweets exclusively mentioning “Chinese virus” or “China virus” instead of COVID-19 or coronavirus. At the state level, on average, 271 of these “Chinese virus” tweets were found in the pre-period and 2,910 were identified in the post-period, also indicating a ten times (10X) average increase. The five states with the highest number of post-period tweets were: Pennsylvania (5,249), New York (11,754), Florida (13,070), Texas (14,861) and California (19,442). The five states with the highest percent increase in pre- to post-period “Chinese virus” or “China virus” referencing tweets were: Kansas, South Dakota, Mississippi, New Hampshire, and Idaho.

Conclusions:

Regardless of the intent behind using the phrase “Chinese virus” or “China virus,” the rise in tweets referencing these terms along with the content of these tweets, indicate that COVID-19 stigma may be created and perpetuated online. If so, this could be detrimental to public health efforts. There is evidence to show that stigma can be internalized, and internalized stigma can lead to distrust of health professionals, skepticism of public health systems, and an unwillingness to disclose behaviors related to transmission. Because COVID-19 is infectious, contact tracing is critically important to assessing community spread; thus, it is imperative that all Americans, regardless of race and ethnicity, trust their public health and health care systems, so they are willing to accept testing, and if diagnosed with COVD-19, report their whereabouts and activities. Stigmatizing COVID-19 by calling it the “Chinese virus” may exacerbate distrust and fear among targeted populations and hurt containment efforts.