key: cord-0773560-c6yrtwq9 authors: Rzymski, Piotr; Nowicki, Michał title: COVID-19-related prejudice towards Asian medical students: A consequence of SARS-CoV-2 fears in Poland date: 2020-05-03 journal: Journal of infection and public health DOI: 10.1016/j.jiph.2020.04.013 sha: 777ad2e71bda9333c674044a2b59c1371f8377e4 doc_id: 773560 cord_uid: c6yrtwq9 Abstract The coronavirus disease 2019 (COVID-19) outbreak caused by SARS-CoV-2 has triggered global panic. We have conducted an anonymous online survey of Asian medical students in Poland to assess whether they experience any form of prejudice related to the ongoing pandemic. As demonstrated, the COVID-19 outbreak had triggered xenophobic reactions towards students of Asian-origin (n=85) before the first SARS-CoV-2 case was confirmed in Poland. Facing prejudice, including discrimination related to COVID-19, may add to feelings of isolation of students of Asian origin who study abroad, and affect career development, especially for students. We recommend that universities should proactively develop policies that support students, faculty, and staff affected by discriminatory behavior both during the current outbreak and in the future. However, preventing such behaviors should also be enforced by national authorities The outbreak caused by betacoronavirus SARS-CoV-2 that emerged in December 2019 in China and later spread to other countries has forced the World Health Organization to first declare a Public Health Emergency of International Concern at the end of January and then to announce a pandemic of COVID-19 (coronavirus disease 2019) on March 11, 2020 [1] [2] [3] . The first cases in North America, Oceania, and Europe were reported in January 2020, while the spread of COVID-19 to Africa and South America was confirmed in February 2020 [4] . With epidemiological updates reported by different authorities daily, the outbreak has received enormous attention from the worldwide mass media [2] . However unavoidable, this has triggered an unintended backlash of public fear and panic, which in selected countries has preceded the emergence of the first confirmed COVID-19 cases [5, 6] . Considering that the majority of affected individuals, including those with fatal outcomes, are of Asian origin, one could, sadly, expect an increase in Asia-phobic reactions [7] . In the past, the epidemic of infectious diseases has also been associated with the backlash of discrimination and xenophobia, and this was also seen during the SARS outbreak in 2003 [8] [9] [10] . There is no doubt that the surgical masks, which have recently been in short supply in China, have become one of the symbols of the current outbreak. Wearing them has become very common in Asia, particularly following the SARS outbreak in 2002, and this practice has also crossed over into immigrant Asian populations [11] . Apart from preventing the spread of disease, they are worn for unrelated reasons such as to guard against air pollution and allergens, or as a social firewall [11] . However, the association between SARS-CoV-2 and the use of face masks may also be a potential source of public misassumption that any Asian individual wearing them constitutes a threat of COVID-19. To identify whether individuals of Asian origin may experience any prejudice related to SARS-CoV-2, we have conducted an anonymous online survey of Asian medicine students at Poznan University of Medical Sciences in Poland. The study, conducted before the first COVID-19 case was identified in Poland, explored the place and nature of such prejudice/xenophobic events, and determined the level at which they have affected the surveyed subjects. According to the Central Statistical Office in Poland, approximately 13,000 individuals of Asian origin study in Poland [12] , and therefore, the experiences of prejudice reported here may represent a part of the much wider problem on the national level. The study was conducted in February 2020 before the first case of COVID-19 was confirmed in Poland on March 4, 2020. To explore whether Asian medical students in Poland may face any prejudice/xenophobia related to an outbreak of COVID-19, an anonymous, online survey based on a self-designed, structured questionnaire was conducted ( Table 1) . As previously indicated, research that is based on an online questionnaire creates the opportunity to swiftly reach specific groups of individuals and ensures the safety of surveyed individuals under pandemic conditions, which is a recommended approach [13] [14] [15] . The anonymity of the study assured the elimination of embarrassment often seen in subjects experiencing discrimination and stigma [16] . The selected group included Asian students at Poznan University of Medical Sciences in Poland who were directly invited to complete the survey via an e-mail message. All surveyed students were living in the city of Poznań (Greater Poland Voivodeship). Table 1 . The structure of the questionnaire used in this study to measure COVID-19 related prejudice in the group of Asian students in Poland The survey was completed by eighty-five medical students from Asia (mean±SD age Wearing the face mask was relatively common within the studied group, with 43.5% of students declaring that they wear them regularly, particularly in December, January and February ( Figure 1 ). The primary reason behind their use was self-protection from catching infections from other people but also to prevent others from infection when the wearers themselves experienced symptoms; protection from air pollutants was also a frequently indicated motivation (Figure 1 ). In Poland, seasonal influenza and the lowest air quality peak A lower percentage of Asian students also reported prejudice at restaurants (12.9%) and during shopping (21.2%). This was mostly manifested by people staring at them, pointing with a finger and asking them if they carry coronavirus. Some were also asked to leave restaurants due to other customers' complaints or felt some public pressure in the form of discouragement from touching products available in the market. The most frequently selected score on a Likert scale for situations at restaurants and shops was respectively 5 (median; IQR: 5; 4-5) and 2 (median; IQR: 3; 2-4). Prejudice was also experienced in health service units in which medical students have classes or which they visit as patients. Approximately one-fifth of those surveyed (21.2%) reported the terrified reactions of other patients after encountering them, and being asked whether they carry coronavirus. Some patients also questioned the supervising medical doctors for allowing Asian students to do clinical rounds and some students were also told to remove a face masks when they visit patients to avoid unnecessary tension. Moreover, 6 medical staff, namely one nurse, expressed her fear over catching a virus when withdrawing a student's blood for lab tests. These reactions had an obvious negative effect on Asian students, since 5 was the most frequently selected score when evaluating them on the Likert scale (median; IQR: 3; 2-5). Last but not least, nearly one quarter (24.7%) of Asian students have faced preconceptions related to COVID-19 at the university where they study. The observed reactions included other students stepping away, starring continuously, making xenophobic comments, assuming that wearing a face mask is equal to being positive for SARS-CoV-2 and opening the doors with a tissue after an Asian student has touched the handle. Moreover, some lecturers have made some jokes about coronavirus which were not considered funny or have asked students to remove the face masks despite explanations that the mask was due to flu symptoms and for the protection of classmates. Again, these situations had a negative effect on most of the surveyed students -a score of 5 was most frequently selected (median; IQR: 4; 3-5). In conclusion, the reactions presented here clearly show that Asian students in regions yet unaffected by SARS-CoV-2 could have already experienced an uncomfortable level of prejudice in the public spaces encompassing transport, gastronomy, shopping, health services and university. Such behaviors can particularly affect those individuals of Asian origin who are tending to wear face masks. Overall, these findings underscore the responsibility of different parties in overcoming and preventing discrimination during outbreaks of infectious diseases. Firstly, universities that host Asian students and staff from abroad should support their students during the outbreak (and any other future epidemic emerging from Asian region) and protect them from harmful misconceptions. This may be achieved by providing reinforcing statements as well as educational campaigns related both to the outbreak and the true reasons behind the use of face masks [17] . The preventive measures, as well as policy development and implementation, should also be undertaken by those involved in the management of international student exchange programs, and by national and international authorities for higher education. To maximally increase output, mass and social media should be employed in undertaken actions [18] . The successful implementation of anti-discriminatory practices requires to follow advice on intercultural communication, also when reporting and visualizing public health risks [19, 20] . A novel coronavirus (2019-nCoV) causing pneumoniaassociated respiratory syndrome Outbreak of coronavirus disease 2019. 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