Health

The Psychology Behind Why Some People Hide That They Have COVID-19

It's incredibly important to inform people when you've been infected with the virus.
It’s incredibly important to inform people when you’ve been infected with the virus.

If you test positive for COVID-19, there are guidelines you should follow to protect your health and the health of others. One important step is to notify anyone you may have exposed to the coronavirus about your test results ― either personally or through a contact tracer.

“It is crucial to tell others if you test positive for COVID-19 due to the highly contagious and lethal nature of the virus,” said Becky Stuempfig, a licensed marriage and family therapist in Encinitas, California. Noting that it has been called the “invisible enemy,” she added, “By not informing others, innocent lives are being placed at risk, which can have an enormous ripple effect on entire communities.”

Yet there are many stories of coronavirus-positive individuals waiting hours or days to inform others of their diagnosis or opting not to share the information until after recovering.

Each individual may have their own reasons for not sharing their test results or diagnosis with others, but there are some common explanations for keeping quiet. Below, Stuempfig and other behavioral experts share some of the reasons people may not tell anyone they tested positive for COVID-19 ― and how we can encourage more transparency.

It’s an emotional diagnosis.

“When a person tests positive for COVID-19, they may experience a wave of emotions ranging from shock or disbelief to anger, uncertainty, guilt, shame, confusion, panic, fear, sadness, concern for their future, worry for their family and so on,” said Stuempfig. “Since many people that test positive for COVID-19 are asymptomatic, that only adds to the uncertainty and confusion when receiving positive results.”

This range of feelings may leave people frozen as they struggle to process what’s happened. It can be tempting to avoid reality and simply do nothing, even knowing that giving in to this temptation could be harmful.

“Even someone who has been taking the necessary precautions might feel like they will be judged harshly and blamed for their actions or inactions, and therefore be hesitant to tell others they tested positive.”

– Zainab Delawalla, a clinical psychologist in Atlanta

“No matter what one’s initial reaction may be, the important thing to do is focus on the steps needed to move forward to protect their health and the health of those around them,” said Laura Boxley, a board-certified clinical neuropsychologist at Ohio State Wexner Medical Center.

There’s a fear of judgment.

Another big factor that may lead some to avoid sharing their diagnosis is the fear of judgment, which can add to the stress of having COVID-19.

“In an environment where not everyone takes the spread of the virus seriously and some refuse to comply with mask mandates or social distancing recommendations, there is a sense that some people are contracting the virus due to their own carelessness and therefore have only themselves to blame,” said Zainab Delawalla, a clinical psychologist in Atlanta. “In this atmosphere, even someone who has been taking the necessary precautions might feel like they will be judged harshly and blamed for their actions or inactions, and therefore be hesitant to tell others they tested positive.”

While you may be doing your best to abide by public health guidelines, perfection is an unrealistic standard, and there are still risk factors that are out of your hands. Yet amid the pandemic, it can feel like almost all of our behaviors are subject to scrutiny from others ― whether it’s what type of mask you wear, how well you wash your hands, where you stand on school reopening, if you’re having social visits with friends and family, how closely you stand to others when you talk, if you’ve returned to your physical office, and on and on.

Fear of judgment can explain why someone would be hesitant to share a COVID-19 diagnosis. 
Fear of judgment can explain why someone would be hesitant to share a COVID-19 diagnosis. 

“All of these areas are heavily judged and debated by others all day long, much of it done on public forums such as news channels and social media,” said Stuempfig. “Unless you are willing to go completely ‘off the grid,’ it is quite difficult to escape the judgment factor and can be overwhelming to navigate.”

Stuempfig believes we all need to let go of the “just world” fallacy ― the cognitive bias that a person’s actions result in fair and well-deserved consequences.

“COVID-19 does not follow that rule,” she said. “We can do everything right and still become infected without even knowing it. We need to stop judging others for their behavior because it only serves to further the stigma and fear surrounding this virus. The bottom line is we do not know what is going on in someone’s personal life, and chances are they are doing their best to get through this very difficult time.”

They may feel a sense of shame.

When a person tests positive for the coronavirus, they may unhappily begin to associate the public’s view of the virus with themselves, said Saniyyah Mayo, a licensed marriage and family therapist in Los Angeles. “Seeing themselves as dangerous, harmful and/or deadly is not an idea that a person wants to have about themselves.”

Public scrutiny may also lead people to blame themselves for their positive test results and feel shame about their behavior, even if they followed public health guidelines fairly well.

“This experience has unfortunately created a strong stigma associated with testing positive for COVID-19,” Stuempfig explained. “It is not unusual for stigma to be associated with infectious diseases, but due to the long-term nature of this pandemic, the associated stigma will sadly have a lasting impact on our mental and physical health. It can deepen anxiety, depression and isolation that is already so prominent during this pandemic.”

It’s common to feel embarrassed about having been exposed to the virus and possibly exposing others, Boxley said. But the benefits of sharing diagnostic information to protect people’s health far outweigh those feelings of shame.

“It would be far worse to withhold this information and contribute to the potential spread of disease,” she said. “It would also be far more damaging to one’s relationships if it became known that they had a positive test and withheld that information from others.”

“Many people experience a moral dilemma about needing to return to work or take care of their family members.”

– Becky Stuempfig, a licensed marriage and family therapist in Encinitas, California

We all have the power to break down some of the shame and stigma surrounding a COVID-19 diagnosis. Stuempfig advised showing support for people who receive a positive test result and being mindful that it’s not easy to share this information.

“We can still reach out to neighbors and friends while maintaining physical distance,” she said. “We can send supportive text messages, cards, drop meals off and, most importantly, instill hope for the future by letting them know we look forward to reconnecting when they feel better.”

There are financial implications.

In the U.S., the pandemic has highlighted the lack of adequate sick leave for workers, which can contribute to the spread of illness.

Not everyone has a job that allows them to work from home or take days off when they’re sick, and many people cannot afford to miss paychecks. This has created some very dangerous situations as some workers continue to report for duty even after they’ve been infected.

“Many people experience a moral dilemma about needing to return to work or take care of their family members,” Stuempfig said. “They may be unsure on how to approach that after they test positive. Additionally, they may not have the financial resources to put their life on hold for a week or two while they self-quarantine. This can be particularly true for asymptomatic individuals because they feel fine physically so it can be hard to even believe that they can be a threat to others.”

Some workers face a dilemma as they grapple with the possibility of missing much-needed paychecks while self-isolating.
Some workers face a dilemma as they grapple with the possibility of missing much-needed paychecks while self-isolating.

While a limited paid sick leave measure, passed to deal with the pandemic, have faced bureaucratic challenges, individual employers can do their part to curb the spread of the virus by changing their policies.

“Corporate leaders can help by assuring their employees that they will receive appropriate time off and sick pay if they need to stay home after receiving a positive test result,” Stuempfig suggested. “They can also establish clear methods for employees to confidentially share their test results without fear of losing their job.”

Denial is tempting.

As the saying goes, ignorance is bliss, so it’s tempting to retreat to a state of blissful ignorance when faced with tough information.

“We all have the tendency to want to avoid things that provoke negative thoughts and feelings, so it’s normal that people who test positive would want to simply continue about their daily lives, especially if their positive test doesn’t correspond with active symptoms,” Boxley said. “COVID is a complicated, invisible enemy. However, in these situations, it’s important to be mindful of the long-term benefits associated with knowing your test result and having the ability to make informed decisions about your health.”

Stuempig noted that testing delays can lead to confusion. Many people have reported waiting several days for results or even weeks in extreme cases.

“If you are someone who experienced a long waiting period and then received a positive result, you may be tempted to keep that information private and simply move on with your life because you have already been functioning in the world with a positive diagnosis and the thought process may be: ‘What’s the benefit in changing things now? I’ve already exposed those around me,’” she explained.

It’s not a medically sound response, but it’s human.

They’re misinformed.

There’s a lot of misinformation about the coronavirus, especially on social media. Many people latch onto false narratives, picking and choosing which public health guidelines to follow.

“In our current environment, it can be difficult to differentiate high-quality and low-quality COVID information,” Boxley noted. “COVID is also a complicated disease that we are learning about in real time as physicians, researchers, and government officials work hard to address the pandemic.”

But we should “remember that there are individuals who have spent their entire careers studying and preparing for pandemics and that medical science is not as capricious as politics or media,” she added. “It is in our best interest to look to our scientific institutions such as [the National Institutes of Health] and the [Centers for Disease Control and Prevention] for medical guidance, even as advice can shift as we learn more about COVID.”

Educational, science-backed campaigns from trusted local officials could help cut down on the confusion and stigma associated with the virus, said Stuempfig.

“It can be helpful for leaders in our community to announce publicly when they receive a positive COVID-19 test and discuss the appropriate steps they took afterward. Many famous actors, athletes, musicians and government leaders have gone public with their experience testing positive, which has helped normalize the experience and decrease stigma surrounding the virus,” she said, pointing in particular to Tom Hanks and Rita Wilson’s announcement early in the pandemic that they had tested positive and were self-isolating.

“The more we see and hear well-known people being open about their experience, the more supported and educated we become,” Stuempfig added. “The more we know and understand about the science behind the pandemic, the less misguided judgment will take place.”

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