Why Testing and Contact Tracing for Coronavirus Is Unmanageable It is difficult when people can be infected without showing symptoms. by Jimmy Whitworth

Since mid-March, the World Health Organization has urged countries to scale up the testing, isolation and contact tracing of COVID-19 patients in order to combat the pandemic. The reason for this advice is that if you can find infected cases, isolate and treat them, and trace the close contacts who they might have infected, and isolate them too, then you can keep much of the infection out of the general population.

This stops its spread and slows down the speed of the epidemic. It seems a simple and obvious strategy. It has been used extensively in the past, for example to stop epidemics of smallpox and Ebola. So why hasn’t every country done that? Well, it’s not as simple as it appears.

The efficiency of contact tracing in any epidemic depends on the characteristics of the infection and the speed and coverage of the tracing process. So when a new disease such as COVID-19 first emerges it’s not possible to know exactly how useful testing and tracing will be.

Testing and tracing is most feasible as an effective strategy at the start of an outbreak when there are just a few chains of transmission of the disease. But if this does not keep the epidemic under control, and there is widespread community transmission, there will quickly be many cases and contacts. This is especially the case with a disease such as COVID-19, which is easy to catch, is quickly passed on after an infection sets in, and can infect some people without producing symptoms.

Many people will be getting infected from unknown cases and a large proportion of the population would need to be isolated. Testing and tracing soon becomes an unmanageable strategy and a lockdown to reduce physical contact then becomes a more efficient and effective means of controlling the epidemic. This achieves the same thing as testing and tracing, by keeping much of the infection out of the general population, but is a blunter instrument as it targets everybody.

As the current pandemic developed, some countries, including South Korea, were able to use testing and tracing to control the disease and avoid mandatory lockdown measures. But more widely, identifying cases of the disease with testing did not keep pace with the geographical spread of infection around the world. So in other countries, such as the UK, case finding and contact tracing capacity became overwhelmed early on and lockdowns were introduced instead.

In hindsight, those countries which persisted with expanded and rigorous testing and tracing programmes, such as Germany, South Korea, Hong Kong, Singapore, and New Zealand, have fared better with lower deaths rates than those which did not, such as Belgium, France, Italy, Spain, UK and the USA. This is probably because contact tracing and testing can identify asymptomatic infections and isolate them faster than systems relying on the development of symptoms.

Lockdowns aren’t sustainable in the long term because of the social, economic, and physical and mental health effects. The should reduce the spread of the disease so the number of cases starts falling. But if restrictions are relaxed even cautiously then transmission will go up again.

However, with a testing, tracking and tracing strategy in place as well, it will still be possible to keep the epidemic under control. To make this feasible, the numbers of cases needs to come down to a more manageable number, say a few hundred active cases. This is because of the sheer numbers of cases and contacts involved, each of whom would need quarantining until shown to be uninfected. As examples, the average number of tests required per case was 52 in South Korea, and 64 in Australia.

Building testing and tracing capacity is not easy. To start with there are two main types of test you can perform, one that tells you if someone is currently infected (a PCR test) and another that tells you if someone has had the disease in the past (an antibody test). You need the organisational capacity, the labs, equipment and chemical reagents to be able to conduct these on a massive scale.

Contact tracing also requires significant resources. You need thousands of people to interview patients, identify everyone they may have come into contact with since being infected, and track down these contacts. Many countries are also using or planning to introduce contact tracing apps that track your location or identify contacts using Bluetooth in order to automatically gather this data and inform people if they need to self-isolate.

Digital tracing

It is generally agreed in public health circles that these apps are useful as a supplement, but cannot replace manual checking. However, some evidence suggests that COVID-19 spreads too quickly for manual tracing alone, and that an app could help stop the pandemic if 60% of the population downloads it. On the other hand, there are also privacy concerns over how these apps allow governments to track citizens’ movements.

In South Korea the testing was conducted on a base of well-funded and efficient public services and an effective infrastructure, including widespread digital surveillance. For other countries to emulate this success, much still needs to be done in terms of planning, organisation and logistics.

In the UK there are plans to recruit and train 18,000 tracing staff to reintroduce contact tracing. The government aims to conduct 100,000 tests per day, which is about 0.15% of the population.

For the future, it is likely that some form of physical distancing will be required to prevent future waves of infection until an effective vaccine is widely available. These measures, which may need to be periodically tightened and relaxed, should be supported by testing and tracing to keep the number of new infections under control. This is likely to include the testing and quarantining of all new arrivals in a country, to prevent the infection being reintroduced from abroad.

How Genetic Sequences Act as Passports to Track How Coronavirus Travels The steady rate of genetic changes lets researchers recreate how a virus has travelled. by Bert Ely and Taylor Carter

Following the coronavirus’s spread through the population – and anticipating its next move – is an important part of the public health response to the new disease, especially since containment is our only defense so far. 

Just looking at an infected person doesn’t tell you where their version of the coronavirus came from, and SARS-CoV-2 doesn’t have a bar code you can scan to allow you to track its travel history. However, its genetic sequence is almost as good for providing some insight into where the virus has been.

An organism’s genome is its complete genetic instructions. You can think of a genome as a book, containing words made up of letters. Each “letter” in the genome is a molecule called a nucleotide – in shorthand, an A, G, C, T or U.

Mutations can occur every time the virus replicates its genome, so that over time mutations accumulate in the viral genome. For example, in place of the “word” CAT, the new virus has GAT. The virus carries these minor modifications as it moves from one person to the next host.

These mutations behave like a passport stamp. No matter where you go next, previous stamps in your passport still show where you’ve been.

Molecular geneticists like us can use this information to construct family trees for the coronavirus. That allows us to trace the routes the virus has traveled through space and time and start to answer questions like how quickly and easily does it spread from one person to another?

Individual patient data help paint a big picture

Online databases have been collecting SARS-CoV-2 genomic nucleotide sequences since mid-December. Whenever a patient tests positive for SARS-CoV-2, a lab can determine the genome sequence of the infecting virus and upload it. As of late April, more than 1,500 genome sequence samples have been deposited in GenBank, a publicly available database run by the National Institutes of Health, and more than 3,000 are in GISAID, the open-access Global Initiative on Sharing All Influenza Data.

Since each sequence is from a patient who is in a specific place in the world, these viral genome sequences allow scientists to compare them and track where the virus has been. The more similar the sequences from two particular viruses are, the more closely related they are and the more recently they’ve shared a common ancestor. The first SARS-CoV-2 genomic sequence uploaded to the GISAID’s website was collected from a patient in early December 2019.

Of course, the viral mutations themselves do not tell researchers which country they happened in. But since the databases record where particular patterns of mutations have been observed, scientists can determine the route that each viral strain has taken. The global map tracks the movement of the virus around the world.

The data recorded from thousands of patients show that SARS-Cov-2 originated in Wuhan China and spread from there to the rest of the world.

The SARS-CoV-2 phylogenetic tree – the family tree that connects all the sequenced coronavirus samples worldwide. The colors denote regional ‘branches’ of the tree. 

Building maps out of sequences

The genetic data can play a big role in cracking public health mysteries, like how the coronavirus has spread through the United States.

For example, a traveler from Wuhan arrived in Seattle on Jan. 15 and tested positive for the virus on Jan. 20.

On Feb. 28, scientists sequenced a virus sample from an American patient in Seattle and found its mutation signature matched that of the virus from the Wuhan traveler, plus three new mutations. GISAID has estimated the mutation rate at about 0.45 mutations per genome per week – so three mutations between the Jan. 20 case and the Feb. 28 case fits that rate.

Based on the three new mutations, this version of the virus had been multiplying undetected for about five weeks in the Seattle area. Since each infected person can infect several other people without experiencing any symptoms themselves, the virus could have spread to more than 100 people in five weeks.

Using the genome sequences to link the virus from the Jan. 15 traveler from Wuhan with the Washington-based patient from the end of February alerted Washington state officials that the virus was silently spreading through the population. This undetected spreading of the virus in Seattle and elsewhere is one of the primary reasons public health officials are calling for the public to stay home as much as possible.

Another study detailed the path the virus took as it moved from Wuhan to Shanghai to Germany to Italy to Mexico, stowing away in infected travelers. This study tracked infected individuals and compared their viral genomic sequences. Since researchers could compare the viral mutations to those in known locations at specific times, they were able to map out the phylogenetic tree – the family tree that shows how the various virus genome sequences are related.

Using the GISAID estimated mutation rate and the phylogenetic tree, scientists think the first time the coronavirus infected a person likely occurred in Wuhan in November or early December 2019.

If the virus had been around much longer, the viruses of the first known patients would have had a larger variety of mutations than they did.

Still tracking and learning from the sequences

The analysis of viral genomic sequences will continue to be a valuable tool for tracking and containing the spread of SARS-CoV-2.

For instance, sequencing the genome of a virus from a newly infected patient could tell you if it is a virus that has been circulating in the area for a while, or if it is a new introduction from elsewhere.

Someone who’d been in northern Italy before travel restrictions were in place brought the virus to Iceland. That initial outbreak was contained fairly quickly, but then new forms of the virus were introduced from elsewhere in Europe.

A new study pending peer-review indicates that California also had multiple introduction events with distinct viral lineages. For California, knowledge of the frequency of new introductions would be an important factor to consider as officials devise ways to contain the virus.

Viral genome sequences can be informative in other ways as well. Eventually, researchers may find that some forms of the virus are more virulent than others. In that case, the sequence of the viral genome could help physicians decide which treatment would be best for a particular patient.

Bush-Era Actions Have Boosted Coronavirus Response Efforts The 2001 anthrax attacks revealed serious weaknesses in America’s preparedness for withstanding biological or chemical weapons of mass destruction. This sparked several initiatives to provide surge capabilities in the event of a regional or national medical disaster. by Brian Finch and Lora Ries

The coronavirus pandemic is straining most federal and state emergency resources. But the strain—and the government’s response—would have been far worse, if legislation enacted in the previous decade had not laid a solid foundation of expanded homeland security and emergency medical preparedness. 

The Department of Homeland Security (DHS) was created in response to the 9/11 terrorist attacks—but that wasn’t the only impetus. Another significant motivating factor was the 2001 anthrax attacks.

The latter attacks revealed serious weaknesses in America’s preparedness for withstanding biological or chemical weapons of mass destruction (WMD). This sparked several initiatives to provide surge capabilities in the event of a regional or national medical disaster. 

In creating the DHS, the Homeland Security Act of 2002 transferred a number of biodefense capabilities from other cabinet agencies into the new department. For example, it folded a number of biological, chemical, nuclear, and other WMD prevention and response operations, such as the Defense Department’s National Bio-Weapons Defense Analysis Center into the Science & Technology Directorate at DHS.

It also transferred the Federal Emergency Management Agency and the National Pharmaceutical Stockpile (now the Strategic National Stockpile) into the new department. Clearly, responding to major medical events, including biological threats, has always been a core component of the DHS mission.

Once the new department was up and running, Congress gave it legal authorities to supercharge pandemic and WMD preparedness efforts. The first was the Project BioShield Act, signed into law in July 2004, as part of a broader strategy to defend America against the WMD threat.

Project BioShield was created to accelerate the research, development, purchase, and availability of effective medical countermeasures against a variety of threats, initially focusing on WMD agents. Launched with an initial fund of nearly $6 billion, Project BioShield has become the central facility through which critical medical countermeasures, such as vaccines, therapeutics, and diagnostics, are developed and purchased. More than fifty drugs funded through BioShield have been approved by the U.S. Food and Drug Administration.  

The BioShield law also created the Emergency Use Authorization (EUA), giving the Secretary of Health and Human Services (HHS) Secretary expanded authority to deploy resources from the Strategic National Stockpile and to clear countermeasures and other medical resources so that they can be used, even if they have not fully cleared FDA testing protocols.  

One of the first steps taken in response to the current pandemic was to declare a public health emergency, which allows the secretary to utilize the EUA. The administration issued that declaration in late January, well before pandemic concerns dominated the news.

Another key measure, the Public Readiness and Emergency Preparedness Act (PREP Act), was signed into law in 2005. It authorized more than $3 billion for pandemic preparedness and gave the HHS Secretary limited authority to provide immunity from liability for claims arising from the use of pandemic countermeasures. These protections applied not just to the manufacturers of the countermeasures but also to those who distributed and administered them.  

Given the voracious appetite of the plaintiffs’ bar to launch lawsuits based on just those types of claims for any alleged medical injury, the PREP Act was a key step in ensuring the rapid development and use of cutting edge countermeasures in the event of a medical emergency. 

In December 2006, President George Bush signed the Pandemic and All-Hazards Preparedness Act (PAHPA), a law that dramatically reorganized and expanded HHS’s authority with respect to natural and manmade medical catastrophes. Among other things, it established the post of Assistant Secretary for Preparedness and Response to oversee matters related to WMD and pandemic preparedness and response.

PAHPA also brought the Strategic National Stockpile back into HHS, where it was originally launched, as a way to centralize medical disaster response capabilities and better sync the Stockpile’s role as the cache for countermeasures developed through BioShield.

One other highly relevant program initiated by the Bush administration was the National Bio and Agro-Defense Facility. A plant and animal disease research facility, it gives the United States a capability that had been sorely lacking. Previously, this kind of work depended solely on the dated laboratory system located on New York’s Plum Island.

Of course, the federal government can’t fight an epidemic on its own. Most of the in-the-trenches work must be done by the private sector and state and local governments. And once America has the disease under control, it will take an equally concerted effort to get the U.S. economy back on track. Already, some of the nation’s top experts have formed the National Coronavirus Recovery Commission to plot the best way forward to restore economic health as well as public health. 

What can America do to improve the response to the next pandemic? When the United States reaches the other side of this coronavirus curve, it will need to focus on improving its supply chains, remove its dependence on China for critical resources, and increase stockpiles of personal protective equipment and vaccines. In the meantime, its citizens can be thankful for past organizational preparation and new legal authorities that have been invaluable in fighting this pandemic.

If Kim Jong-un Died, It Would Make the U.S.-China Rivalry Worse Neither great power will like the uncertainty of regime transition. by Zhiqun Zhu

This is part of a symposium asking what happens if Kim Jong-un died. 

Though Kim Jong-un reemerged after disappearing from public view for nearly three weeks, speculations about his health and succession persist. Will North Korea have a smooth leadership transition? How will it affect regional security at a critical moment? What will China and the United States do? These will be some of the important questions in every observer’s mind if Kim were to die suddenly.

Undoubtedly, Kim’s demise will inject a new dose of uncertainty to a region already rife with conflicts and will exacerbate U.S.-China strategic rivalry in East Asia.

A joint U.S.-China effort to ensure the stability of the North Korean regime and East Asia, in general, is desirable but unlikely given the current distrust between the two powers. The United States and China will compete for currying favor with the new leadership and shaping the development of North Korea. Both countries will take advantage to enhance their strategic interests in the region. Denuclearization and a strong foothold in East Asia are Washington’s main interests, while stability and gradual reduction of U.S. influence in the region are Beijing’s. 

U.S.-China relations were already in terrible shape in recent years. They are further strained as the two powers are engaged in a diplomatic tussle over the COVID-19 pandemic. Meanwhile, tensions in the Taiwan Strait and the South China Sea remain high. Cross-strait relations continue to deteriorate as Tsai Ing-wen begins her second term. China has become more assertive in the South China Sea, allegedly sinking a Vietnamese fishing trawler and creating two new administrative districts in controversial areas. Differences over their North Korea policies will add fuel to the fire in U.S.-China strategic rivalry.

In the short run, the historical bond between China and North Korea will remain strong when new leadership takes charge in Pyongyang. China has been—and will continue to be—the vital source of economic aid and the most important diplomatic ally for North Korea.

If Kim died suddenly, China will surely secure its borders with North Korea immediately to avert a massive influx of fleeing North Koreans. If power struggle is taking place in Pyongyang and nobody appears to be in control, China is likely to directly intervene, perhaps by sending a group of senior advisors, to help establish a pro-Beijing regime.

Internal uprising remains a low possibility in North Korea due to tight control of information and a lack of mobilization for collective action. Denuclearization will become more challenging since the new leadership will need to demonstrate their mettle to their rivals and the North Korean people.

Among all possible candidates, Kim Yo-jong is most likely to emerge as her brother’s immediate successor. The male-dominated Confucian tradition in Korean political culture seems to be a key obstacle to her assuming the top position. But this is not insurmountable if she has cultivated a strong alliance with party elders and top military brass. After all, Ms. Park Geun-hye served as the President of South Korea not long ago, albeit through elections.

Kim Yo-jong will almost certainly disappoint those who think she will be a softer dictator or will be more accommodating on the nuclear issue. This is clear from her condemnation of South Korea as a “frightened dog barking” after Seoul protested against a live-fire military exercise by the North in early March. 

Yes, We Should Worry if Kim Jong-un Died (But History Demand We Take a Longer View) "The Reagan/Bush-era victory in the Cold War produced prodigious victories. However, it would be wise to acknowledge that the scope of those victories did not extend to North Korea and China." by William Jeynes

 This is part of a symposium asking what happens if Kim Jong-un died.

What would happen if Kim Jong-un died suddenly?

The answer one arrives at depends largely on whether one focuses on the obvious level of analysis, the short-term, or what is actually the longer-term strategy of North Korea.  Given that North Korean leaders have specialized in creating distractions, this long term strategy is largely missed by the West.

When historians of the future one day assess what is generally considered the end of the Cold War, they will determine that the United States and its allies won a historic victory in Europe, but also made a consequential miscalculation regarding the state of that conflict in East Asia. Many people in the United States both hoped and concluded that as West Germany and East Germany reunited, so would South Korea and North Korea. Moreover, they thought that as Russia had retracted its claws and seemed willing to join in more civilized practices than before, so would China act similarly. Future historians will one day regard such conclusions as one of the grandest American miscalculations in history. In reality, the Cold War concluded in Europe, but unbeknownst to most Americans, it continued in China and North Korea. The events of the last nine years or so have finally opened the eyes of many Americans to this reality.

In the short-term, should Kim Jong-un die suddenly two scenarios emerge as the most likely. First, it might be that Kim Jong-un’s thirty-two-year-old sister, Kim Yo-jong, might become the Supreme Leader of North Korea. It was Kim Yo-jong who recently praised a letter that President Trump sent to Kim Jong-un. Nevertheless, given the patriarchal nature of North Korea, it is likely that if the sister were to become North Korea’s leader, she would likely be a figurehead with a set of leading males collectively running the country. Another possible Supreme Leader is Kim Pyong Il, who is Kim Jong-un’s uncle. At age 65 he has the advantage of being male and being the last known surviving son of the founder of North Korea, Kim Il Sung. Were Kim Pyong Il to come to power, because he is largely geographically and personally disconnected from the current leader (he has lived in Eastern Europe for some time), he might resort to the typical temper-filled demonstrations of power normally associated with a new North Korean Supreme Leader. However, if Kim Yo-jong and her co-rulers were to ascend to power her close ties to Kim Jong-un might make some degree of less eventful continuity more likely.

Nevertheless, it would unwise for the observer to merely focus on this immediately evident level of analysis rather than on what is actually the long term strategy of North Korea. Yes, North Korea has a history of acting in a seemingly irrational and volatile way. Because of this proclivity, the relationship must be treated with extreme care. Even so, it is a salient and necessary part of properly interpreting North Korean behavior to understand that the actions of its Supreme Leader, whoever that might be, are designed to reach specific Communist-oriented goals. Many of its most terrorizing actions are meant:  1. as distractions and 2. to frighten adversaries into an attitude of compromise.

North Korea respects President Trump and wants to avoid war, while he is at the helm in the U.S. Instead, North Korea is content with biding its time, while a clear “generation gap” in South Korea clearly works in North Korea’s favor. As the largely pro-American older South Korean generation passes, younger people in South Korea, often affected by a left-wing ideology reminiscent of the 1960s in America, lurch to the left at an unnerving rate. Many older South Koreans suspect North Korean subterfuge in South Korean universities, the media, and the government in order to create young adults in South Korea that embrace China and socialism. If North Korea can produce distractions for the United States to steer America’s eyes from these more important developments, it will make any long-term goals it has much more attainable. It will also put the United States at greater risk. The Reagan/Bush-era victory in the Cold War produced prodigious victories. However, it would be wise to acknowledge that the scope of those victories did not extend to North Korea and China.

Why the Infamous Drug Thalidomide Is Being Considered as a COVID-19 Treatment Thalidomide infamously caused thousands of birth defects to babies who were exposed to the drug after their mothers took it to treat morning sickness between 1958-1962. by Neil Vargesson

In the midst of the coronavirus pandemic, researchers have turned to existing medicines to see whether they can be repurposed to treat COVID-19. 

Antiviral medicines such as remdesivir and favipiravir that prevent the virus from reproducing itself are amongst many medicines being tested. Some cough syrups are even being investigated.

And surprisingly, the drug thalidomide is also being tested as a potential treatment for COVID-19. Thalidomide infamously caused thousands of birth defects to babies who were exposed to the drug after their mothers took it to treat morning sickness between 1958-1962.

Despite its dark past, the drug has been repurposed in recent years, and is an approved treatment for multiple myeloma (a type of blood cell cancer) and complications of leprosy.

Thalidomide was originally used as a sedative, and was later found to also be useful for treating severe morning sickness in the 1950s and 1960s. Tragically its use resulted in severe and rare birth defects in children, particularly to the limbs, but also damaged many other parts of the body.

Yet thalidomide has many different effects within the body – which is why researchers are looking at it as a potential COVID-19 treatment. For example, it can inhibit the immune system’s inflammatory response, making it effective against inflammatory conditions, including leprosy. It can also inhibit new blood vessel formation, making thalidomide potentially effective against cancers. It is currently approved to treat multiple myeloma.

The drug can also protect the lungs, and has been effective in treating idiopathic pulmonary fibrosis. This is a life-threatening condition where the alveoli (which exchange oxygen and carbon dioxide molecules in the bloodstream) of the lungs are damaged, thickened and hardened, preventing them from working correctly. This leaves patients short of breath and with a persistent cough.

Thalidomide has been shown to reduce the persistent cough and reduce the lung damage, improving patient life quality. It appears able to do this by blocking the inflammatory response.

Thalidomide also appears to help relieve lung damage caused by the herbicide Paraquat. High doses of it can be toxic and result in lung inflammation, which causes scarring and reduced function. Animal studies suggest thalidomide can reduce the inflammatory response in lung tissue.

Thalidomide has been found to protect against lung infections caused by the H1N1 virus in mice. H1N1 caused the 2009 flu pandemic. The study found that thalidomide improves the chances of survival for mice infected with H1N1 by reducing the body’s inflammatory response.

Evidence shows thalidomide could protect the lungs by reducing the body’s inflammatory response, preventing damage of lung tissues and controlling the immune system. We know the coronavirus affects the lungs, causing pneumonia-like symptoms that result in inflammation, difficulty breathing and transporting oxygen around the body.

Several research groups wonder if thalidomide’s ability to protect the lungs against other diseases could make it a potential treatment for COVID-19. Repurposing this existing drug to treat a new condition also means the dosage and potential side effects are already known.

Remaining cautious

Preliminary evidence has found that using thalidomide in combination with glucocorticoids (which reduce immune response and inflammation pathways in the body) was able to successfully treat a patient suffering with pneumonia-like symptoms caused by COVID-19. However, this study is yet to be peer-reviewed.

A clinical trial is also underway to investigate if thalidomide could be used to treat moderate and severe COVID-19 induced pneumonia in China. Patients testing positive for COVID-19 will be given thalidomide or a placebo medicine. The placebo should have no effect on COVID-19 progression and will then be compared with the thalidomide-exposed patients. It will still be some time before researchers know whether thalidomide is effective in treating some COVID-19 patients.

However, thalidomide still has the ability to cause serious side effects. Thalidomide exposure during pregnancy can still harm the developing baby, something that happened recently in Brazil.

Clinical use of thalidomide can also cause many other side-effects which include peripheral neuropathy in patients. This causes damage to the nerves in the body’s extremities, causing pain. While such side-effects are usually associated with long-term use, any use of thalidomide needs to be carefully overseen by medical professionals.

Using thalidomide in the treatment of COVID-19 might also give researchers a better understanding of the drug’s effect in the body, and what other clinical conditions it could be useful for. Such work could also result, one day, in making safer forms of the drug that are an effective treatment without harmful side effects. However, it remains too early to determine its effectiveness in treating COVID-19.

Does Language Spark Discrimination During the Coronavirus Pandemic? In the coronavirus pandemic, we have seen discrimination against people who speak a language or dialect associated with an epicenter of infection. by Stanley Dubinsky, Kaitlyn E. Smith and Michael Gavin

As the coronavirus spreads around the globe, it’s being characterized by media and politicians alike as an “invisible enemy.” People are afraid others may carry the virus but not show symptoms of the disease it causes – especially strangers, who may or may not have taken proper precautions against spreading the disease. It is this fear of strangers that causes people to be on heightened alert for anyone who might be somehow different. 

In some cases, the differences are visible, matters of physiological appearance and perhaps dress, leading to the racism and general fear of foreigners that has seen Asians attacked in Australia and the United States, and Africans kicked out of their homes in China.

As researchers of people’s language differences, we find that our preliminary research and anecdotal evidence reveal another sort of discrimination, which happens when people’s differences are audible, not visible. Studies have shown that the language or dialect a person speaks is far and away the most important marker of group and national identity, and is the means by which people can immediately and accurately recognize strangers among them. In the coronavirus pandemic, we have seen discrimination against people who speak a language or dialect associated with an epicenter of infection.

People speaking differently have been denied restaurant service or lodging, lost access to public transportation, and even been physically assaulted. Those targeted have included Chinese people who speak with a Wuhan accent who are in other areas of China; people who speak Mandarin, the official language of the mainland, in Hong Kong, where Cantonese is more common; Italians in other countries; people who speak Italian dialects while traveling outside of their home provinces – and even Americans traveling in their own country.

In work initiated by Kathryn Watson, an undergraduate at the University of South Carolina and a staff researcher in the university’s Language Conflict Project, we have begun a more extensive effort to collect data on linguistic discrimination during the coronavirus pandemic. We do expect language and dialect prejudice will be less prevalent than racism, but we don’t think it should be ignored.

Overhearing New Yorkers

In popular vacation destinations in New England, fear of the virus has made locals hesitant to welcome New Yorkers fleeing the pandemic’s U.S. epicenter, and they have urged wealthy out-of-towners, who are mostly white, to stay away. As a result, New Yorkers seeking refuge face backlash from local residents, who have no trouble picking them out and turning them away.

In some places, police have contacted people driving cars with out-of-state license plates, but when people aren’t in their cars, it can come down to how someone talks. As one Cape Cod store manager pointed out, New Yorkers’ unmistakable accents can be “very different from the New England accent.”

Concern about just this sort of prejudice silenced a University of South Carolina student from Connecticut in March. Southern attitudes toward Northerners aren’t always favorable, and the coronavirus outbreak in New York City hasn’t helped.

The student was in a Myrtle Beach, South Carolina, convenience store when a local man declared to the cashier that state troopers should be stationed at the state line, prepared to shoot anyone trying to enter the state with a “Yankee” license plate. The student told researcher Watson he feared his accent might incite violence, so he remained silent until the man had left.

Not from around here

In Hong Kong, around 90% of the population speaks Cantonese. Many of the city’s natives already viewed Mandarin, China’s official language, as an outsiders’ tongue.

Now the city’s residents have explicitly linked Mandarin with a threat to public health. More than 100 restaurants have begun refusing service to Mandarin speakers. Many Hong Kong residents, already upset with the Chinese Communist Party’s crackdown on the city’s democracy movement and wanting to keep mainland Chinese people out, “have joined together in calling for the border’s closure” entirely.

Even within China itself, The New York Times reports, “people listen for accents distinctive to Hubei Province, the center of the outbreak, and shun residents: avoiding them on public transportation and denying them entry to restaurants and other public spaces.”

In Europe’s biggest virus hot spot, Italy is equally divided. When the government announced new restrictions at the beginning of March, throngs of southern Italians living in the north attempted to flee to their family homes in the country’s rural south, potentially bringing disease with them. Our research has found that some of these people attracted the authorities’ attention by posting on social media – speaking with obvious southern accents – that they had escaped from Milan to be back with “mamma in Sicily.”

At the same time, some Italians from the north who dared to venture abroad risked assault if they spoke their native language. A man from Trieste, Andrea Premier, slipped over the border to Ljubljana, Slovenia, for a weekend back in March. When locals heard him speaking Italian, they shouted “Italiano coronavirus” while beating and robbing him.

As the virus spreads, so will fear of people from hotspots. We expect incidents like these will continue.