Evidence Based Health Policy,

Today, Covid -19 has become a global problem and affects almost all important economic, political, social and cultural aspects of the world (1). Over time, the issue of the psychological effects of this viral disease on the mental health of people at different levels of society has become very important. While it is medically considered a more contagious disease than other respiratory diseases such as influenza or SARS, it has a lower mortality rate (2). But it seems that this contagious disease not only causes concerns about public physical health, but also causes a number of psychological diseases and social problems. One of the social consequences of coronavirus disease is the patient's fear of social reactions, disease stigma, and being a carrier, which is called stigma; anxiety that increases the prevalence
and is a serious obstacle to stopping the disease. Stigma expresses the negative behavior and attitude we show towards a person or special situation. In another definition, stigma is introduced as a concept consisting of the consequences of ignorance, prejudice and discrimination against an issue (3). It is believed that the corona is becoming a stigma that attacks the dignity of those affected. This means that a person with coronavirus, in addition to enduring the burden of pain and stress caused by illness and fear of death, has to endure the negative views and feelings of others such as rejection, humiliation and all kinds of discrimination by society; the consequences and problems of coronavirus related stigma seem to be more painful than the disease itself. Following the global outbreak of the coronavirus, a joint report by UNICEF and the World Health Organization emphasizes that Covid-19, due to unknown circumstances, causes stigma and socially discriminatory behavior against people of certain ethnicities, as well as anyone thought to be associated with the virus (4). It is an emerging disease and there are many unknowns about this virus and people are often afraid of the unknown and easily relate this fear to others. Therefore, it is understandable that there is a sense of confusion, anxiety and fear among people, and these factors reinforce the harmful stereotypes (5).
People's misconceptions, the use of words with negative connotations, the dissemination of misinformation and misinterpretation are among the causes and factors that cause stigma and fear of notoriety in these patients and those associated with them; it seems that in many countries, including Iran, the consequences and problems caused by stigma are associated with this very painful disease, therefore, these factors lead to the fact that infected or even suspicious people refuse to take some measures such as referring to health centers or screening and do not pay attention to the observance of health principles and quarantine. In some cases, the hospitalized patient even escapes from the hospital due to his illness and insistence on not being ill.
Evidence clearly shows that notoriety and fear of infectious diseases have prevented responding to these diseases (6). The social anonymity associated with Covid-19 can mask the disease and spread the disease. It is believed that stigma is mainly caused by fear and anxiety and increases the prevalence and is a serious obstacle to stopping the disease. What is useful in this situation is trust in reliable health care and counseling centers, empathy with patients, accurate knowledge of the disease and the use of effective and practical measures so that people can take care of themselves and their loved ones. Changing this social problem requires reforming social attitudes and behaviors with sick people, and requires health care professionals, cultural policymakers, university professors, the media, and influential people in this field to provide the necessary information to the community and to special to do relatives of the patient. The way we talk to people about the disease is very important in helping them to take effective action and fight the disease and to prevent the spread of fear and notoriety. Another important measure to deal with this social problem is to provide a suitable environment in which the disease and its impact can be discussed in a transparent, honest and effective manner (7). The role of health care personnel and especially the front line staff of the health system such as health workers and caregivers is also very important and vital in this regard. Support, acceptance, and reassurance should be the main focus of all caregiver activities. Health care workers must accept and support the patient and, like other patients, provide them with care and health care services. Patients' families should cooperate with the affected or improved people in the post-treatment period as well as during the quarantine period and treat them like other family members and normal people; because a negative and pessimistic view of these people can lead to other people in the community, if the symptoms of the disease occur, hide it and carry the disease in the community by not going to medical centers. The media can also play a very important and vital role in this regard. News and words used in the media are very important; because these words shape the language of society about this disease. Using inappropriate words and statistics or exaggerating can negatively affect people's attitudes and behaviors towards people suspected of having the disease, sufferers and their families. Other people in the community are also expected not to spread rumors and not to address the victims as criminals.
Key words
Social stigma, Covid-19, Health system.