**7. Risk factors for stigma and xenophobia associated with COVID-19**

There are several risk factors for stigma and xenophobia. One of them is isolation and quarantine practices. Social distancing in the COVID-19 pandemic is an effective way to reduce morbidity and mortality. However, it should be noted that social distancing can increase stigma for affected populations [5]. It has been reported that quarantine, hopelessness, financial losses are associated with social stigma during the COVID-19 process. Quarantined individuals are more likely to be stigmatized and socially rejected. Stigma is a very important issue, especially for involving people who are quarantined. Media reporting is a powerful tool for influencing public opinion and contributed to stigma in previous outbreaks [53]. It is reported in the literature that there may be people who carry the virus asymptomatically in the COVID-19 pandemic. This is another risk factor for stigma and xenophobia. People can see and stigmatize other people as a constant carrier [54]. Those with COVID-19 may be accused of not following stay-at-home directives or not taking appropriate precautions when going out. People can be stigmatized even when they do not have the virus. For example, someone with allergies, congestion, and sneezing may be stigmatized for leaving their home while sick [55]. Another risk factor for stigma is social media. When the COVID-19 outbreak broke out, hate speech about China and Chinese people on social media provoked social stigma. In a study, a search for "china and coronavirus" on Twitter found 3,457,402 tweets about China-related to COVID-19. Hate speech was detected in 25,467 tweets [56]. Another risk factor for stigma is the language used. Researchers are careful when naming the COVID-19 virus to avoid any stigma. Tedros Adhanom Ghebreyesus, the director of the World Health Organization, said he needed to come up with a name that does not refer to a

geographical place, an animal, a person, or a group of people, but is also pronounced and related to the disease [57]. This sensitivity suggests that pointing to a certain group will increase stigma even when naming the virus. For example, being able to say a patient with a diagnosis of COVID-19 instead of a patient with COVID can reduce stigma. Words can create a stigma against geographic regions and certain populations and cause prejudice and panic [5]. Pandemics can cause intense stigma in certain populations. For example, during the 2003 SARS epidemic, discrimination against people of Asian descent was widely reported worldwide, affecting the care-seeking behavior and mental health of many people of Asian descent [4]. The African-Americans Policy Forum (AAPF), an advocacy group for Asian Americans in the United States, reported 1500 incidents of discrimination in 45 states between March 19, 2020, and April 24, 2020. These complaints ranged from verbal abuse to physical attacks in public. Most of the complaints were reported as verbal abuse, including children and the elderly [18]. A Chinese group also living in the UK received intense stigmatizing and accusatory Facebook posts [58]. It is necessary to be very careful when giving news about health workers who are at risk of intense stigma. Exposure to dramatic news images of sick and deceased healthcare professionals can cause the viewing public to exaggerate the risk of personal infection and stigmatize healthcare professionals [59]. In the pandemic process, the influence of the media and politicians comes to the fore as two important factors that trigger xenophobic tendencies towards immigrants. Discourses in the media and the way politicians plan and conduct the pandemic process and the expressions they use in this process shape attitudes and perceptions towards immigrants in society [42].
