February 19, 2021, by Brigitte Nerlich
Naming without shaming: A virus communication conundrum
We have all heard about the Kent strain of the coronavirus, or the UK or English strain for that matter, or the South African strain, or the Brazilian strain, not to forget the despicable references to the China or Wuhan virus by a former president of the United States. It’s good that we know about viruses and their variants, but it’s bad that we know about these things by these names.
Scientists working on viruses, their mutations and their evolution have recently started to worry about emerging ‘mutants’ or virus variants or new strains of viruses with various mutations. They have also started to worry about the names of such variants, especially about names referencing countries or regions, as that can created barriers in global collaborations focused on detecting, monitoring and dealing with new variants.
An article in the British Medical Journal has, for example, pointed out: “The world now seems obsessed with SARS-CoV-2 variants and designating them with a place of origin. This is an unfortunate stigma that should be avoided at all costs given that where a virus is first detected is not necessarily where it originated. Lest we forget, Spanish Flu (the 1918 Influenza pandemic) had absolutely no connection to Spain.”
Quite a few articles have now been written about the problems related to naming variants, especially after this thorny issue was discussed at a meeting of the World Health Organisation held on 12 January.
One article appeared in Wired entitled “All these mutant virus strains need new code names”; two articles were published in Nature, one entitled “‘A bloody mess’: Confusion reigns over naming of new COVID variants“ and an editorial pointing out that “The world needs a single naming system for coronavirus variants” (with the lede saying: “Geographic associations risk stigma. Researchers must quickly agree on a more meaningful and universal nomenclature”); another article appeared in The Guardian under the title “From Nelly to Doug: nicknames emerge for growing list of Covid variants”, yet another in The Telegraph entitled “WHO calls for new names for Covid variants to avoid country stigma”; and one in CGTN was explicitly entitled “Stop stigma by standardising COVID-strain names – WHO”… and there are more.
In the following I just want to list some of the efforts made to deal with issue of naming and shaming, both by natural scientists and social scientists. So far, no real solution has been found. Would interdisciplinary collaboration help?
Numbers and letters
Viruses and their variants usually have names based, for example, on a characteristic of an amino acid or similar, which itself has a name that’s a number. To that one can add letters… As many of the articles listed above pointed out, and here I am quoting from the editorial in Nature: “For example, the team that identified one variant in South Africa named it 501Y.V2, after a substitution in the 501st amino acid site of the virus’s spike protein. By contrast, Public Health England is calling a variant identified late last year VOC 202012/01 — in which VOC stands for ‘variant of concern’, and the numbers include a reference to the month and year of discovery. Other groups are using the name B.1.1.7 for the same variant; this label comes from a classification system based on the evolutionary relationships of viruses.”
This is confusing not only for scientists but also for members of the public, something the WHO recognises and tries hard to rectify. As Maria Van Kerkhove, Covid-19 Technical Lead for the World Health Organization, is quoted as saying in Politico: “I am on record multiple times to say we need to fix this because it’s too hard to communicate all these numbers.”
Viruses have, for a long time, been named after countries and regions, something that’s easier to remember than numbers and letters, but something that has also bothered the WHO for a long time. As the editorial in Nature points out: “It is only six years since the WHO introduced guidelines to end a previous practice of associating viral diseases with the landscapes, regions, people or cultures where the first outbreaks occurred — a habit that resulted in names such as Middle East respiratory syndrome, or Zika virus, named after a forest in Uganda. These guidelines were intended to protect people from the erroneous suggestion that their region somehow caused a virus, and to reinforce that everyone is at risk from an outbreak, irrespective of where they come from. But these guidelines do not refer to variants — only to the naming of new human infectious diseases.”
One problem rarely mentioned in this context is metaphor. These country-specific names lend themselves very nicely to negative metaphorical framing, framing that ties in well with anti-immigrant and xenophobic sentiments, as was illustrated so horribly by Donald Trump always talking about the China or Chinese virus.
Now we are hitting the same problem with virus variants or strains. In her article for Mother Jones, Isabela Dias, a Brazilian journalist, points out that “language matters. In looking at all the alarming headlines about a ‘Brazilian variant’ arriving in Minnesota or the Bay Area, like some sort of terrifying alien invader, I can’t help but think that we Brazilians don’t pose a danger to others any more than we do to ourselves. And let’s face it, we didn’t ask for some new variant either.” The invader framing adds to the stigmatisation associated with the country naming.
So what to do? Scientists working on the topic and working with each other have developed various methods to find a way out of the naming confusion, such as using bird names or nicknames – but does that work for the public?
As reported in The Guardian, Dr Emma Hodcroft, a molecular epidemiologist from the University of Bern “is part of Nextstrain – a Sars-CoV-2 naming effort that called the variant discovered in Kent 20I/501Y.V1″. She is also “the lead author of a recent study that investigated seven virus variants carrying the same mutation in the US. As part of the research process, she gave each variant an avian moniker: such as Pelican, Quail and Mockingbird.” However: “These nicknames work well in the short term, but are hardly a long-term solution, given the rate at which new variants and mutations are emerging, she cautioned.” What about human nicknames?
The same Guardian article also tells the story of a research group resorting to nicknames: “Áine O’Toole, an evolutionary biologist at the University of Edinburgh who is one of the developers of another system used to name viral lineages, found herself discussing a mutation associated with enhanced transmissibility, D614G, often with colleagues. ‘And you can imagine, it was quite a mouthful. So, we started to call this D to G mutation ‘Doug’, and then any of the other virus sequences that didn’t have this mutation … we called ‘Douglas’, so it was sort of a bit of a private joke within the lab,’ she said. ‘As more mutations came about, we’d come up with a person’s name for them.’” This tweet by Kristian Anderson, including references to Doug, Nelly, Eeek and Pooh, nicely illustrates the confusion that can result from this.
Some epidemiologists have proposed a naming system like that used for naming hurricanes, but I think that doesn’t work, as storms usually disappear after a while to be replaced by others, while variants hang around….
None of these attempts to replace countries with other naming systems and thus to remove associated stigma seems to work.
The issue of stigma and discrimination have been studied for a long time with relation to infectious diseases, from leprosy to cholera to HIV to Covid-19. An article from 2008 points out that “’Stigma’ was originally a classical Greek term for a permanent mark that branded a person as a criminal, traitor, or slave. In recent decades, the word ‘stigma’ has been used to describe the process of negative discrimination against people with certain physical, behavioral, or social attributes. This concept of stigma as discrimination has been central to the medical social sciences […]. The social consequences of stigma can result in adverse health effects in general, as well as in exacerbation of the effects of the epidemiology and pathology of certain diseases.” And you can find many references to the literature there.
Other articles have dealt more directly with the naming issue, especially with relation to the ‘Spanish’ flu, and have explored the rhetorical implications of such naming “for either promoting fear or, alternatively, imparting a sense of safety to the public.
A very recent article published in Social Science and Medicine reports some interesting findings from an experimental framing study with relation to Covid-19. The “findings suggest that specific types of public health messaging related to infectious diseases, especially framing the virus in terms of its country of origin or its likely economic impact, may elicit prejudice and xenophobia. Public health campaigns that emphasize the severity of the virus, however, are not likely to trigger the same negative attitudes.”
More research is needed to study the issue of stigma with relation to the naming of variants and it would be great to see natural and social scientists collaborating on this. They all worry about this issue.
PS NEW NAMING SYSTEM PROPOSED BY THE WORLD HEALTH ORGANISATION BASED ON GREEK LETTERS – SEE THIS STAT ARTICLE – DISCUSS!