COVID-19 is one of the most significant challenges to humans since the 21st century. During the pandemic, the stigma associated with COVID-19 has emerged in society, including stigma towards those who have the disease and those who have recovered from the disease. COVID-19 stigma hinders interpersonal communication among those who have been stigmatized and hinders effective prevention and control of the pandemic in society. Therefore, researchers and policymakers urgently need to understand the psychological mechanisms and characteristics of COVID-19-related stigma.
To explore whether there is a difference in the magnitude of emerging pandemic disease-related stigma and existing disease-related stigma, Study 1 found that in the early stage of the COVID-19 pandemic （from February to March 2020）, the public held a more stigma attitude towards the emerging pandemic disease （i.e., COVID-19） than they did towards the existing epidemic（i.e., SARS）. Study 2 also found that the degree of the COVID-19-related public stigma was higher than the SARS-related stigma during the recovery period of COVID-19 （from May to July 2020）. The exploration of COVID-19 stigma from the cognitive, emotional, behavior, and social dimensions found that people's stigma towards COVID-19 （vs. SARS）-related groups was mainly reflected in more avoidance and more negative social evaluations.
To further explore whether COVID-19 stigma has become an internalized stigma, Study 3 conducted an implicit association test（IAT）, which showed that people have an implicit stigma towards people related to COVID-19 through the implicit
association test （IAT）, and there was no significant correlation between implicit and explicit stigma. In addition, the difference between COVID-19 and SARS implicit stigma was not significant.
Study 4 used functional magnetic resonance imaging （fMRI） to explore how this internalized stigma is reflected in brain activity. The results showed that people's activation of the left middle temporal gyrus （MTG） was greater during processing
COVID-19-related people （vs. other disease-related groups）. Inhibition of the right anterior cingulate gyrus （ACC） predicted higher levels of implicit stigma when people engaged in emotional processing （i.e., fear） of COVID-19-related people.
The findings demonstrate that pandemic disease stigma （ compared with preexisting disease stigma） differs in multidimensional explicit processing but not in implicit processing. At the neural processing level, the processing of pandemic stigma has a high level of activation in theory-of-mind brain regions. In emotion processing tasks, inhibition of the right anterior cingulate cortex can predict an individual's implicit stigma. This study is the first to reveal the psychological and neural mechanisms of pandemic infectious disease stigma from the behavioral to neural levels. The research is not only a valuable supplement to the existing stigma theories but also provides information on how to avoid and alleviate the public health crisis in the future.
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