Medicine has been trying to take identity out of diagnosis for a long time. The phrase ‘Chinese virus’ goes against a humanizing trend.
During Wednesday’s coronavirus press conference, President Trump repeatedly referred to the “Chinese virus.” When challenged by the press about the appropriateness of that designation for the cause of COVID-19 infection, he replied, “That’s where it’s from . . . it’s not racist.”
Yes, the first outbreak took place in Hubei Province, China, and even a few years ago many scientists would have innocently called it the Wuhan virus or even the Chinese flu, as was the convention. Early in the news coverage, Time called it the Wuhan Coronavirus.
But over the last few weeks, politicians and the media have taken heat for missteps in terminology, particularly since Trump seemed most strongly to insist upon calling it the “Chinese virus” in the wake of China’s “putting out information, which was false, that our military gave [the virus] to them,” as he put it.
The remedy is easy, critics say: Just call it coronavirus. They’re right. In fact, the profession has been trying to take identity out of diagnosis for a long time. Calling it the Chinese virus goes against a humanizing trend.
In 2015, the World Health Organization (WHO) officially recognized the troubling implications of naming infectious diseases based on their place of origin or ethnic population and advised researchers, scientists, and the media against doing so. Until then, it was common scientific convention to identify bacterial and viral infections by the site of their initial outbreak or discovery.
The Coxsackie virus was named in 1949 for Coxsackie, the Hudson River Valley hometown of two children suspected of having polio. It turned out that they had a new class of paralytic virus. The Norwalk virus, a nonfatal pathogen marked by vomiting and diarrhea, was named for the Ohio city in which the first outbreak occurred in 1968. Lyme disease, a bacterial infection, was diagnosed for the first time in 1975 in Old Lyme, Ct. Ebola was first detected in a village in the Congo that’s near the Ebola River. Researchers working in Uganda’s Zika Forest were the first to identify the Zika virus.
But five years ago, the WHO called on experts, officials, and journalists to avoid names that include geographic locations. “[We’ve] seen certain disease names provoke a backlash against . . . ethnic communities, create unjustified barriers to travel, commerce, and trade, and trigger needless slaughtering of food animals,” said the assistant director-general for health security at WHO.
In the current coronavirus environment, physical and verbal assaults against Asian Americans have occurred in the U.S. and U.K. A sharp increase in gun purchases by those fearing xenophobic confrontation has been noted in Washington State and California.
And while animals may not be the casualties that come to mind, in 2009 Egypt wiped out its entire pig population in a misbegotten attempt to eradicate swine flu. Egyptian health officials tried to halt the extermination and rightly predicted that cities would be overwhelmed with rotting waste on which the pigs normally fed. Elsewhere, people feared eating pork and prices plunged.
Since 2015, the WHO has recommended that new disease names should include descriptive terms, based on symptoms (e.g., respiratory disease, neurologic syndrome, or watery diarrhea). If scientists know how a disease manifests, whom it affects, or its severity or seasonality (e.g., progressive, juvenile, severe, or winter), that can be part of the name as well. If the pathogen that causes the disease is known, it should also be part of the disease name (e.g., coronavirus, influenza virus, or salmonella) — hence today’s “novel coronavirus,” or “SARS-CoV-2.”
The WHO’s actions were part of a quiet but persistent movement within the medical profession to purge clinical classification of stigmatizing language. One of the earliest efforts was to change the name of “Mongolism” or “Mongolian Idiocy” — an inborn intellectual disability. Writing in The Lancet in 1961, an international group of experts urged replacing those labels with “Down’s syndrome” (now also called “Down syndrome”) in recognition of John Langdon Down, a British physician who first fully described the characteristics of the syndrome in 1866, or “trisomy 21,” to reflect the underlying genetic defect. “Expressions which imply a racial aspect of the condition [should] be no longer used,” the scientists implored.
In my own field of psychiatry, a related campaign to change language has been under way for decades. While none of our diagnoses bear the names of places or ethnic groups, the tendency to refer to people by their clinical condition has come under scrutiny. Thus, rather than call a patient “a schizophrenic” — as if that were his or her primary identity — it is better to call a patient “someone with schizophrenia.”
Such “person-first” language has long been promoted by the disability community as well in the spirit of humanizing the afflicted, as in, for example, “a person with epilepsy” rather than “an epileptic.” At times, I think my colleagues go too far. Who really cares if we use the term “drug habit” or call a urine toxicology screen containing heroin metabolite “dirty”? But some addiction experts believe these are unacceptably stigmatizing language.
In light of grave concerns about medical preparedness, death tolls, and economic upheaval, is worry over the term “Chinese virus” trivial? Congressman Ted Lieu (D., Calif.) warned that “Trump is stoking xenophobic panic in a time of crisis.” Washington Post columnist Josh Rogin wrote of larger repercussions: “Let’s stop saying ‘Chinese virus’ — not because everyone who uses it is racist, but because it needlessly plays into the Chinese Communist Party’s attempts to divide us and deflect our attention from their bad actions.”
As someone with who usually has a high threshold for offense at what others deem politically incorrect, I think the criticism of officials who persist in using the term “Chinese virus” is warranted. It aligns with a larger effort mounted by the medical profession to move away from language that is perceived as stigmatizing.