Andrew G Ryder Ph.D.

Mental Health in Context

Reflections on Pandemic Prejudice

Part 2: How disease outbreaks contribute to the spread of ethnic prejudices.

Posted Jun 30, 2020

E. A. Unuabona/Unsplash
Racism is a pandemic. So is COVID-19. Navigating all this is the challenge for our time.
Source: E. A. Unuabona/Unsplash

Years ago, I was working at a large urban hospital when I was asked to assess an inpatient, a marginalized person who had been living on the streets for a long time. As the patient showed signs of tuberculosis, I was given a special mask to wear for my interview. The mask was awkward, on many levels. It felt like too much and also too little. Too much as the wide gap between us would only suffer from further barriers. Too little as I needed this thin layer to protect me from a potentially fatal disease. This image lingers in my thoughts as I read about pandemic prejudices.

A brief reminder

In my previous post, I started with a recent survey documenting prejudice against Chinese-origin people in Canada. Although much of this prejudice was "inspired," so to speak, by COVID-19 it had nothing to do with reasonable concerns about infection. Rather, this kind of prejudice draws on common and longstanding beliefs linking ethnocultural "others" to uncleanliness and risk of disease. There is a long history of using these kinds of assumptions to justify overtly racist policies.

Then, I reviewed two studies from the 2003 SARS epidemic. In the first, people avoided New York City’s Chinatown out of misplaced fears of disease. Even locals had concerns, especially about recent immigrants. In the second, people stigmatized residents of the Amoy Gardens residential complex in Hong Kong, which really did experience a SARS outbreak. Residents in turn avoided people living in Block E, which had the majority of the cases. With each study, I drew closer to understandable fears of infection.

The behavioral immune system

So as I read these studies, I had some nagging questions. Are at least some of these prejudices somehow different, in that they’re linked to understandable fears? Or is there some point where they become more justifiable? After all, SARS and COVID-19 do seem to have origins in China. Certain streets in Chinatown might have had active cases, although they turned out not to. Amoy Gardens really did have a serious outbreak, especially in Block E.

Priscilla du Preez/Unsplash
Behavioral Immune System: The urge to stay away
Source: Priscilla du Preez/Unsplash

Is this simply a case of ‘better safe than sorry’? After all, in my previous post, I described how certain cultural contexts developed tendencies towards lower mobility. Greater concern about outgroup members is part of this package. The behavioral immune system has been proposed as a set of psychological mechanisms that help protect us from disease exposure. Perhaps our tendency towards these prejudices helps keep us safe, even if the system is sometimes overactive.

The behavioral immune system may well be operating in these examples and it may well be "natural." That means we should be aware of how the system sometimes functions. It does not mean we simply go along with it. After all, the psychological literature is full of examples of things we are tempted to do that we make ethical commitments to not doing. Far from justifying prejudice, a better understanding can help us keep these commitments.

Four reflections on pandemic-related prejudice

With this in mind, I offer four reflections on the tension between understanding prejudice while not justifying it, in light of the studies I reviewed on COVID-19 and SARS.

1. Some people simply hold prejudices under a wide range of circumstances. Fears of disease provide a cover. The insults, threats, and intimidation reported by Chinese-origin Canadians in relation to COVID-19 are not protecting anyone from disease. Even if these prejudices are understood as an overactive behavioral immune system, acting on them is inconsistent with ethical commitments to resist ethnocultural prejudices.

Michael Mrozek/Unsplash
A wet market ... half-a-world away from China
Source: Michael Mrozek/Unsplash

2. There are legitimate concerns about cultural practices clearly linked to health problems, such as open-air wet markets or eating certain animals. But it is much harder to discuss these concerns in good faith against a backdrop of prejudice. As Eichenberger pointed out in her study of Chinatown, we tend to be much less concerned when some of “our” practices also have health consequences. Consider, for example, the over-prescription of antibiotics in American hospitals.

3. Like diseases, prejudices generate suffering and its attendant symptoms. Moreover, these prejudices can contribute to the spread of disease. Some of the stigmatized people in Amoy Gardens were refused medical treatment. Other people may have been tempted to conceal symptoms. Or consider the recent immigrants in Chinatown. Would they have been so willing to seek treatment for possible SARS symptoms? Mistrust of authorities, who may be seen as representing the prejudiced majority, worsens all these trends.

You'd prefer not to have one of these pinned to your front door
Source: CDC/Unsplash

4. Sometimes public health authorities need recourse to serious measures, such as localized quarantines or targeted travel bans. It is much harder to get widespread buy-in for these measures if there is reason to believe that prejudice is motivating them. This includes support from affected communities and also from majority-group members who might contest such measures so as not to appear prejudiced themselves.


Right before I went into the isolation ward to conduct my interview, a senior psychologist reminded me to remember that I looked frightening and would need to find other ways to connect. This timely comment pulled me out of my fears and reminded me that I was about to interact with a human being. I would not ever want to work in a facility that demanded I always wear a mask ‘just in case’, or that handed me one whenever I had to interact with someone socially marginalized.

But given the reasonable risk of infection, I was glad to have the mask in this case. I also would not ever want to work in a facility that refused to provide a mask even when risk is high, out of misplaced fear of marginalizing someone further. Thanks to my senior colleague, I was able to have a good human connection despite the mask. And when I learned that the patient’s tuberculosis test was positive, I was relieved that I wore that mask.

It is good to be appropriately concerned about infectious disease. The challenge is gauging these concerns and making sure we see the other person’s humanity even when concerned. Disease-related prejudices share much in common with diseases themselves. They are ‘naturally occurring’ (and also culturally shaped). As such, they are worth studying carefully to understand them better. At the same time, they are detrimental to our individual and collective health. As such, they are worth fighting.

E. A. Unuabona/Unsplash
Racism is a pandemic. So is COVID-19. Navigating all this is the challenge for our time.
Source: E. A. Unuabona/Unsplash