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| Stigma Hampers Iraqi Efforts to Fight the Coronavirus | Stigma Hampers Iraqi Efforts to Fight the Coronavirus |
| (about 2 months later) | |
| NAJAF, Iraq — The doctor paused before banging on the front gate, gesturing to companions who were wearing full hazmat suits, masks, goggles and gloves to stand back so they would not be the first thing the home’s occupants saw. | NAJAF, Iraq — The doctor paused before banging on the front gate, gesturing to companions who were wearing full hazmat suits, masks, goggles and gloves to stand back so they would not be the first thing the home’s occupants saw. |
| “This is very sensitive, very difficult for our society,” said Dr. Wissam Cona, who works with the provincial Health Department in the city of Najaf in southern Iraq. He now spends his days checking on families recently returned from Iran, which has suffered one of the world’s most severe outbreaks of the coronavirus. | “This is very sensitive, very difficult for our society,” said Dr. Wissam Cona, who works with the provincial Health Department in the city of Najaf in southern Iraq. He now spends his days checking on families recently returned from Iran, which has suffered one of the world’s most severe outbreaks of the coronavirus. |
| He said that the father of the family at this home had begged him not to come with a retinue of health workers, saying, “‘Please don’t park in front of our house. I feel ashamed in front of the neighbors. This is so difficult for my reputation.’” | He said that the father of the family at this home had begged him not to come with a retinue of health workers, saying, “‘Please don’t park in front of our house. I feel ashamed in front of the neighbors. This is so difficult for my reputation.’” |
| For Iraq, one of the biggest obstacles for public health officials fighting the coronavirus is the stigma associated with illness and quarantine. It runs so deep that people avoid being tested, prevent family members who want tests from having them and delay seeking medical help until they are catastrophically ill. | For Iraq, one of the biggest obstacles for public health officials fighting the coronavirus is the stigma associated with illness and quarantine. It runs so deep that people avoid being tested, prevent family members who want tests from having them and delay seeking medical help until they are catastrophically ill. |
| The aversion to quarantine and the reluctance to admit illness may help explain why the number of confirmed cases in Iraq is relatively low, several Iraqi doctors said. A country of more than 38 million people, Iraq had recorded only 1,352 confirmed Covid-19 cases as of Monday. | The aversion to quarantine and the reluctance to admit illness may help explain why the number of confirmed cases in Iraq is relatively low, several Iraqi doctors said. A country of more than 38 million people, Iraq had recorded only 1,352 confirmed Covid-19 cases as of Monday. |
| By contrast, in neighboring Iran, with roughly twice Iraq’s population, the official count exceeds 71,000. Neighboring Saudi Arabia, which has a smaller population than Iraq’s, has more than three times as many confirmed cases. | By contrast, in neighboring Iran, with roughly twice Iraq’s population, the official count exceeds 71,000. Neighboring Saudi Arabia, which has a smaller population than Iraq’s, has more than three times as many confirmed cases. |
| “It is true we have cases that are hidden, and that is because people don’t want to come forward and they are afraid of the quarantine and isolation,” said Dr. Hazim al-Jumaili, a deputy health minister who is guiding the country’s response to the coronavirus. | “It is true we have cases that are hidden, and that is because people don’t want to come forward and they are afraid of the quarantine and isolation,” said Dr. Hazim al-Jumaili, a deputy health minister who is guiding the country’s response to the coronavirus. |
| The stigma attached to illness and quarantine in Iraq and some other Middle Eastern countries largely reflects cultural and religious beliefs. But it also involves an ingrained distrust of the government, historical experience and the fear that given the ragged state of Iraq’s health care system, going to the hospital could be fatal. | The stigma attached to illness and quarantine in Iraq and some other Middle Eastern countries largely reflects cultural and religious beliefs. But it also involves an ingrained distrust of the government, historical experience and the fear that given the ragged state of Iraq’s health care system, going to the hospital could be fatal. |
| A recent video that was widely shared showed female patients in quarantine in a Basra hospital lying near one another without masks, coughing and calling for help as one of them died. | A recent video that was widely shared showed female patients in quarantine in a Basra hospital lying near one another without masks, coughing and calling for help as one of them died. |
| “Some believe the virus means that God is displeased with them, or maybe it is a punishment for a sin, so they don’t want others to see that they are sick,” said Dr. Emad Abdul Razzak, a consultant psychiatrist at Iraq’s Health Ministry. | “Some believe the virus means that God is displeased with them, or maybe it is a punishment for a sin, so they don’t want others to see that they are sick,” said Dr. Emad Abdul Razzak, a consultant psychiatrist at Iraq’s Health Ministry. |
| “For many people it is a shame for a female to say she has this illness or any illness, even cancer or mental illness, and many people have no trust in the health system,” he said. | “For many people it is a shame for a female to say she has this illness or any illness, even cancer or mental illness, and many people have no trust in the health system,” he said. |
| So strong are the stigma and the aura of sinfulness surrounding the virus that families of those who have died of other causes oppose their loved ones’ bodies being in the same morgue or even graveyard as those who have died of the virus. | So strong are the stigma and the aura of sinfulness surrounding the virus that families of those who have died of other causes oppose their loved ones’ bodies being in the same morgue or even graveyard as those who have died of the virus. |
| In contrast to many Western countries, where celebrities have acknowledged having the disease, and even neighboring Iran, where senior political figures announced they were ill with the virus, there is only one instance in Iraq of a politician or prominent figure admitting to being infected. | In contrast to many Western countries, where celebrities have acknowledged having the disease, and even neighboring Iran, where senior political figures announced they were ill with the virus, there is only one instance in Iraq of a politician or prominent figure admitting to being infected. |
| Some of the fear surrounding the disease stems from the Muslim rituals surrounding death, said Sherine Hamdy, a professor of medical anthropology at the University of California at Irvine who has worked extensively in Middle Eastern communities. | Some of the fear surrounding the disease stems from the Muslim rituals surrounding death, said Sherine Hamdy, a professor of medical anthropology at the University of California at Irvine who has worked extensively in Middle Eastern communities. |
| “You don’t want to be forced into quarantine, you don’t want to be forced into the hospital because those social, family bonds are very strong,” she said. “You want to die within the family. | “You don’t want to be forced into quarantine, you don’t want to be forced into the hospital because those social, family bonds are very strong,” she said. “You want to die within the family. |
| “The worst thing in the world isn’t to die, but it’s to die away from your family and your community and to have no control over what happens to your body.” | “The worst thing in the world isn’t to die, but it’s to die away from your family and your community and to have no control over what happens to your body.” |
| The Islamic tradition requires swift burial, preferably within 24 hours of death. The longer the delay, the more people fear for the soul of the deceased. | The Islamic tradition requires swift burial, preferably within 24 hours of death. The longer the delay, the more people fear for the soul of the deceased. |
| Adding to the problems is the tradition of washing the bodies of people who have just died, which the authorities fear could spread the virus. | Adding to the problems is the tradition of washing the bodies of people who have just died, which the authorities fear could spread the virus. |
| “The coronavirus and pandemics overall cause disruptions of social and religious practices, and it’s not easy to tell people that the coronavirus is stronger than God,” said Omar Dewachi, a professor of medical anthropology at Rutgers University, who was born and brought up in Iraq. | “The coronavirus and pandemics overall cause disruptions of social and religious practices, and it’s not easy to tell people that the coronavirus is stronger than God,” said Omar Dewachi, a professor of medical anthropology at Rutgers University, who was born and brought up in Iraq. |
| Quarantining those who are infected imposes a double humiliation in many Iraqi communities. First, it assures that everyone in the neighborhood will learn about the illness. Second, if the victim is a man, it signifies that he is no longer able to protect his wife, his children or in the case of an elder brother, his younger siblings, and so has fallen short of fulfilling his role in the family. | Quarantining those who are infected imposes a double humiliation in many Iraqi communities. First, it assures that everyone in the neighborhood will learn about the illness. Second, if the victim is a man, it signifies that he is no longer able to protect his wife, his children or in the case of an elder brother, his younger siblings, and so has fallen short of fulfilling his role in the family. |
| More traditional families sometimes deny their female relatives a coronavirus test for fear that if she tests positive she will be removed from the fortress of her family and possibly be sexually compromised. | More traditional families sometimes deny their female relatives a coronavirus test for fear that if she tests positive she will be removed from the fortress of her family and possibly be sexually compromised. |
| “In this society, it is not OK for a female to be apart from the family,” said Dr. Mona al-Khafaji, a radiologist in private practice in Baghdad. | “In this society, it is not OK for a female to be apart from the family,” said Dr. Mona al-Khafaji, a radiologist in private practice in Baghdad. |
| She mentioned the case of a 32-year-old female patient with fibrosis, which heightens her vulnerability to the coronavirus, who was having trouble breathing. Dr. al-Khafaji recommended the woman go for a Covid-19 test, but her father and brothers said no, and refused to budge even when her condition worsened. | She mentioned the case of a 32-year-old female patient with fibrosis, which heightens her vulnerability to the coronavirus, who was having trouble breathing. Dr. al-Khafaji recommended the woman go for a Covid-19 test, but her father and brothers said no, and refused to budge even when her condition worsened. |
| Updated June 2, 2020 | |
| Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. | |
| Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. | |
| States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | |
| More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said. | |
| Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. | |
| The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. | |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | |
| If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | |
| Iraq is not the only Middle Eastern country struggling with the stigma surrounding the virus. | Iraq is not the only Middle Eastern country struggling with the stigma surrounding the virus. |
| Egyptians’ aversion to quarantines dates to at least the early 20th century, when cholera and tuberculosis took turns ravaging the country. Some who were quarantined did not survive. | Egyptians’ aversion to quarantines dates to at least the early 20th century, when cholera and tuberculosis took turns ravaging the country. Some who were quarantined did not survive. |
| Similar fears have emerged in Afghanistan, where people have attacked health workers and crawled out of hospital windows to escape quarantines. One day last month, nearly 40 patients attacked health care workers at a hospital in Herat Province and escaped quarantine there. | Similar fears have emerged in Afghanistan, where people have attacked health workers and crawled out of hospital windows to escape quarantines. One day last month, nearly 40 patients attacked health care workers at a hospital in Herat Province and escaped quarantine there. |
| Lately, in an effort to overcome the stigma and put together an accurate picture of the scope of the epidemic, the Iraqi Health Ministry has resorted to random testing. But this program has brought a new set of troubles. | Lately, in an effort to overcome the stigma and put together an accurate picture of the scope of the epidemic, the Iraqi Health Ministry has resorted to random testing. But this program has brought a new set of troubles. |
| For one thing, some healthy people could be falsely stigmatized. And to display its resolve, the government has assigned armed national security personnel to accompany health workers. Given Iraq’s violent past, the presence of security forces is so unnerving it makes some people hide in their homes. | For one thing, some healthy people could be falsely stigmatized. And to display its resolve, the government has assigned armed national security personnel to accompany health workers. Given Iraq’s violent past, the presence of security forces is so unnerving it makes some people hide in their homes. |
| “It is so difficult in this culture because everything we do is a problem,” said Dr. Mohammed Waheeb, a senior pulmonologist at Baghdad Medical City. “If we send an ambulance to pick up the patient, then people are upset because the neighbors will see it.” | “It is so difficult in this culture because everything we do is a problem,” said Dr. Mohammed Waheeb, a senior pulmonologist at Baghdad Medical City. “If we send an ambulance to pick up the patient, then people are upset because the neighbors will see it.” |
| “The same happens or worse if we send the national security,” he added. “Then people feel it is like under Saddam,” he said, referring to Iraq’s former strongman president, Saddam Hussein. | “The same happens or worse if we send the national security,” he added. “Then people feel it is like under Saddam,” he said, referring to Iraq’s former strongman president, Saddam Hussein. |
| The Health Ministry says the use of security personnel is the only way to surmount the difficulties of persuading people to submit to quarantine. Doctors, however, say the security details are needlessly off-putting, at least when health teams are merely out collecting samples. | The Health Ministry says the use of security personnel is the only way to surmount the difficulties of persuading people to submit to quarantine. Doctors, however, say the security details are needlessly off-putting, at least when health teams are merely out collecting samples. |
| The second day of random testing in Sadr City, a sprawling, impoverished neighborhood in eastern Baghdad, illustrated the recurring problems. In this part of the capital, houses are patched heaps of corrugated metal and brick, with garbage strewn on streets that are often unpaved. | The second day of random testing in Sadr City, a sprawling, impoverished neighborhood in eastern Baghdad, illustrated the recurring problems. In this part of the capital, houses are patched heaps of corrugated metal and brick, with garbage strewn on streets that are often unpaved. |
| An old woman, wearing a long black abaya, opened her corrugated metal gate a crack and squinted into the brilliant noonday sun to see who had knocked. Looking down the street she saw more than 40 people — in surgical gowns and masks or full hazmat suits, accompanied by two or three television cameras, community police officers, young militia members from the organization of the nationalist cleric Moqtada al-Sadr and a few local sheikhs. | An old woman, wearing a long black abaya, opened her corrugated metal gate a crack and squinted into the brilliant noonday sun to see who had knocked. Looking down the street she saw more than 40 people — in surgical gowns and masks or full hazmat suits, accompanied by two or three television cameras, community police officers, young militia members from the organization of the nationalist cleric Moqtada al-Sadr and a few local sheikhs. |
| She slammed the gate closed. | She slammed the gate closed. |
| People in Sadr City are skeptical of the Health Ministry, said Dr. Bassim Aboud, who oversees the area for the ministry, as he knocked futilely at the woman’s gate. | People in Sadr City are skeptical of the Health Ministry, said Dr. Bassim Aboud, who oversees the area for the ministry, as he knocked futilely at the woman’s gate. |
| “If people think I am with the government, they will shut the door,” he said. “But if they see me as a doctor, they come to me for help.” | “If people think I am with the government, they will shut the door,” he said. “But if they see me as a doctor, they come to me for help.” |
| Mujib Mashal contributed reporting from Kabul, Afghanistan, and Falih Hassan from Baghdad. | Mujib Mashal contributed reporting from Kabul, Afghanistan, and Falih Hassan from Baghdad. |