Xenophobia in America in the Age of Coronavirus and Beyond.

“China Is the Real Sick Man of Asia” was the headline of an article published in the Wall Street Journal by Walter Russell Mead on February 3, 2020 (1). The title of this article generated a riptide of condemnation from the Chinese government as well as from people of Asian descent. The “sick man of Asia” phrase refers to the fall of the Qing Dynasty in the early 1900s and is a derogatory reference describing the humiliation of a nation besieged by internal strife and external forces. Although most likely generated for sensationalism, this phrase is rooted in xenophobia and reflects the anti-Chinese sentiment whose historical roots have increasingly surfaced with the evolution of the coronavirus pandemic in the United States.

Xenophobia arising from health concerns has its roots as far back as the 1800s when large numbers of Chinese migrant workers were hired as cheap labor. Workers flooded into the United States, causing alarm and spurring early anti-Chinese sentiments with the labeling of immigrants as carriers of “filth and disease” (2). Erika Lee, professor of Asian-American studies at the University of Minnesota, notes that there was a perception “that Chinese people as a race…are disease carriers” (3). Chinese migrant workers were subjected to humiliating medical inspections at Angel Island after arriving in San Francisco—inspections that Europeans at Ellis Island did not experience (4). Anti-Chinese discrimination reached its peak with a series of federal laws, including the Naturalization Act of 1870, the Page Act of 1875, the Chinese Exclusion Act of 1882, and the Geary Act in 1892, which all limited immigration and naturalization of people from China. Despite these laws being repealed in the 1960s, an undercurrent of anti-Chinese sentiment persists even to this day.

Recent survey results from the Pew Research Center show that negative U.S. public views of China are at the highest level seen in the last 15 years, at 60%, up nearly 13% since 2017 (5). Several events in the past decade, such as the SARS coronavirus outbreak in 2012, the arrest of Harvard University’s Dr. Charles Lieber in connection with the Thousand Talents Program, and the deterioration of China–U.S. global trade relations have created an atmosphere of wariness toward China among many people in the United States. Furthermore, there is distrust of the Chinese government throughout the world as the censorship of the now deceased Dr. Li Wenliang came to light, and accusations that the Chinese government has been under-reporting COVID-19 prevalence and death rates. Additionally, in Italy, there are conspiracy theories that Chinese “Big Pharma” and government entities intentionally sent virus carriers into Europe (6). The situation is further complicated by misinformation presented on social media platforms. For example, an early video of a woman eating a bat as the source of the infection was actually shot on the island of Palau near Australia (7). Unfortunately, this type of social media post reflects the recurring racial trope that Chinese people will eat any type of animal and that subsequent disease is deserved. Xenophobic memes and comments are rampant on the internet, with revitalization of terms such as “yellow peril” being reintroduced into the lexicon of the twenty-first century, and derogatory posts have been made by prominent athletes and social influencers.

Uncertainty and lack of full information around COVID-19 have generated additional fears toward people of Chinese origin, bringing latent feelings to the surface. The United States is currently leading the world in known coronavirus cases and related deaths, primarily centered in the Northeast. Chinatowns all over the country are desolate, with many closings of Chinese businesses due to fear of the disease. Asian-Americans have noted that they face increased scrutiny in public regardless of whether they are displaying symptoms of being ill. In addition to the economic pressures, there have been incidents of violence related to coronavirus. High schoolers in the San Fernando Valley accused a 16-year-old Asian-American student of having coronavirus and assaulted him. In Brooklyn, security video captured acid being thrown on an Asian woman taking out the trash. Congresswoman Judy Chu notes that hate crimes against Asian-Americans have risen to approximately 100 occurrences per day (8). The hysteria has unfortunately also infiltrated into the medical community. On its official Instagram account, the University of California-Berkeley health services center initially listed xenophobia toward Asian people as a normal reaction to the coronavirus outbreak (9). The widespread outbreak of coronavirus, coupled with misinformation and the undercurrent of Sinophobia, have led to a challenging situation for those of us of Asian descent who are trying to treat patients. Recently, a PGY-3 anesthesiology resident of Chinese descent at Massachusetts General Hospital was followed and harassed outside the very hospital where she helps COVID-19 patients (10).

As Chinese-American physicians, we have previously experienced the undercurrent of racism firsthand and have lost track of the times patients have asked where we are from, being surprised if we spoke with no accent, and commenting that we must be very good at math and play the piano or violin. One of the authors vividly recalls a conversation with a mentor who explained that the author did not get into a specific medical school because he was an Asian male and the quota had been filled. These encounters make us realize that, despite being raised in the United States since birth, we are still often viewed as being of foreign descent and subjected to preconceived notions of who we are and what model we should reflect in society. This outbreak has intensified the micro-aggressions of racism and brought to full view overt instances of verbal and sometimes physical abuse. Given the growing fear surrounding the novel coronavirus, we have become almost paranoid to cough when others are present, which has compounded the stresses of patient care. Recently, we have witnessed patients requesting that non-Asian healthcare professionals provide them care. Xenophobia has its roots deeply imbedded within American history, but we hope that we can come together as a medical community and put an end to the fearmongering that COVID-19 has generated.

Those in the medical field have an obligation to uncover this undercurrent of racism and challenge xenophobia, while following best practice public health recommendations. We certainly do not want to marginalize the effects of legitimate public health tools such as social distancing, possible quarantine, and flight and travel restrictions. However, we must take a public stance and destroy the public perception that coronavirus is a race-specific disease. Statements like those made by the University of California-Berkeley health services do nothing but breed prejudice, justify xenophobia, and promote ethnic discrimination. Many people have already taken a strong stance to try to assuage the public. Nancy Messonnier, director of the Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases, has stated, “Do not assume that if someone is of Asian descent, they have coronavirus” (3). Jeanne Ayers, Wisconsin health officer, has suggested that travel history and direct contact might be reasons for infection, not ethnicity (11). As healthcare providers, we are among the most knowledgeable and up to date with the science of epidemics, and it our duty to dissuade the current wave of fear-induced xenophobia. The best way for us to approach this fear is to expunge the idea that being Chinese is tantamount to being a disease carrier, be transparent in our dealings with this outbreak, and serve as sources of thoughtful science and knowledge in the battle against discrimination and stigmatization, which are unfortunate byproducts of the current coronavirus epidemic.