Picture of Kyle LeeKyle Lee is a family physician at St. Michael’s Hospital in Toronto and Lecturer in the Department of Family and Community Medicine at the University of Toronto.

Every disease, ever, has come from China, homie. Everything comes from China because they’re f****** disgusting

They’re a “Backward population” with “gross eating practices”.

These are just some paraphrased online comments and tweets regarding COVID-19 in recent months. These types of comments are often seen on news websites, blogs or social media, and they represent the attitudes of many the public towards those of Asian background.

I was 16 years old when SARS hit Hong Kong. At the time, the virus was far from my mind despite my being a high school student in a predominantly immigrant, East-Asian populated neighbourhood in Vancouver. My days were mostly pre-occupied by assignments and the worrying chatter amongst friends about university applications. Though I never had direct contact with SARS, it was a constant reminder on the 6 o’clock news while we ate dinner, before my mother’s shift as a neonatal intensive care nurse at the nearby Children’s Hospital. My family had roots in Hong Kong and Macau, so we had plenty of relatives living in Asia who were evidently directly impacted by the epidemic. Face masks and hand sanitizers had become normal accessories for them.

Flash forward six years to medical school. I become used to curious patients and supervisors asking me where I am from. I answer these questions in a professional way, subconsciously choosing to ignore the ‘othering’ of these remarks. It’s been called the hidden curriculum, and unfortunately it seems it still challenges medical students to this day.

One weekend in medical school stood out particularly from the rest. A group of intoxicated young lads belligerently hollered at me from amongst the crowds spilling out of the pubs in the early hours of the morning:

“Bruce Lee! Hey! Let’s fight!”

They continued to make martial arts fighting sounds. I turned away, scurrying a few steps faster with my friends while they continued shouting.

“Ch-nk!” They shouted loudly as we parted ways.

I shook my head and chuckled out loud, finding it comical as well as disconcerting, in an effort to diffuse tensions within my friends.  Inside, I had a sense of shock and bewilderment, that my appearance should elicit such epithets from total strangers.

Such experiences have coloured the lens through which I view the world now as a family doctor in Toronto. What’s new in 2020, compared to the time of SARS in 2003, however, is China’s rise as an emerging superpower and its clear global economic influence. Yet still I grow frustrated when my immigrant patients struggle to navigate the healthcare system without strong English skills; my heart sinks to think of the racism they may face. Chinese international students donning masks continue to arrive at my clinic requesting various medications to prevent COVID-19, perhaps hoping a familiar face would empathize and take them seriously.

It saddens me to think so many cities, and Toronto in particular, should see such an anti-Chinese backlash during infectious disease outbreaks. Since the early days of the Yellow Peril, to the 1885 Chinese head tax and internment camps of Japanese-Canadians, to customers avoiding Chinese-owned small businesses during SARS, the Chinese diaspora around the world continue to battle xenophobia, physical attacks, and racism. Even the child of a well known Ontario physician reported encountering racist remarks at school, while thousands of parents in York Region asked schools to ban students from certain parts of Asia in light of the global spread of SARS-CoV-2.

Online misinformation is rampant and sifting through the barrage of messy headlines on COVID-19 is a daunting task. Public health departments and influential medical personnel are barely keeping up with the reach of social media and its prominent influencers.

I find only a small degree of comfort with the symbolic gestures from prominent authority figures, like Prime Minister Justin Trudeau eating at a Chinese restaurant over Lunar New Year or Toronto mayor John Tory publicly denouncing the shunning of Chinese Canadians as immoral and harmful. The World Health Organization (WHO) and the U.S. Centers for Disease Control Prevention (CDC) tweeted about fighting prejudice against people of Asian descent. However, despite some positive messaging to combat the negative remarks, Dr. Theresa Tam, of Chinese descent herself, still found backlash on Twitter when addressing COVID-19 in her role as chief public health officer of Canada.

Now as a teacher, I am acutely aware of my responsibility to those I instruct. While taking first year medical students to the wards, I grow protective and careful around how patients may react to them. I am also forced to reflect on how the patients are reacting to me. We’re constantly reminded, no, told: Patients come first. But, are they fearful because I am not wearing a mask? Do they know it has been a year since I last visited Asia, or that I haven’t been in contact with family members or friends who have recently travelled there? Is my presence causing them distress?

As physicians we hold a unique position where we have the knowledge, duty, and role of guiding our patients and community in times of crisis. I find it confusing, then, when I am at the same time susceptible to the stigma and misconceptions of society. As the virus spreads around the world to more countries, it remains to be seen how racial tensions change.

COVID-19, like many viruses and pandemics, is unpredictable. But is racism unpredictable? Or does it follow the same course each time? Keil and Ali found that the generated stigma during the SARS outbreak was primarily influenced by: 1) images of the public with respiratory masks, 2) employment status (i.e. healthcare workers), and 3) Asian-Canadian and Chinese-Canadian ethnicity. I fear this pattern seems to be repeating from SARS to COVID-19.

I try to laugh and think: Maybe I really should adopt the spirit of Bruce Lee and fight. But rather than fighting each other, I suggest we fight racism, stigma and xenophobia instead.