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Does It Matter What We Call a Disease?

The very names of such diseases are felt to have a magic power. — Susan Sontag, Illness as Metaphor (1978)

It took six weeks for the World Health Organization to bestow a name on the new viral respiratory disease that emerged in December 2019 in Wuhan, China: COVID-19, an acronym for COronaVIrus Disease 2019. The naming process was slow and deliberate because of WHO disease-naming guidelines released in 2015, which rule out eponyms (diseases named for people, such as Down syndrome or Alzheimer's disease), place names (such as Lyme disease or West Nile virus), and occupational associations (such as Legionnaire's disease). The goal in naming the new virus, said WHO director general Tedros Adhanom Ghebreyesus in his February 11 announcement, was "to prevent the use of other names that can be inaccurate or stigmatizing."

It was a fair and worthy objective, honored by many in the public sphere. But not by all. Lou Dobbs, the Fox Business Network anchor known for his strident anti-immigration views, has repeatedly insisted on calling COVID-19 "the Wuhan virus."

House of Representatives Minority Leader Kevin McCarthy calls it the "Chinese coronavirus." "It's a China-born disease," he tweeted on March 10. "Which is why Dems & media called it 'Chinese coronavirus' for weeks."

And in his televised March 11 address from the Oval Office, President Trump called the disease — which the WHO had earlier in the day declared a pandemic affecting eight countries, including the US — "a foreign virus."

These choices aren't accidental. They send a signal that this novel virus — for which there is no vaccine, to which no one yet has immunity, and which has a mortality rate as much as 30 times greater than that of the seasonal flu — is not merely a pathogen: it's an alien invasion.

Not coincidentally, this is the same language that the current US president has used to describe immigration from Mexico and Central America. "It's like an invasion," President Trump said in a November 2018 address. "They have violently overrun the Mexican border." Sometimes the language includes the disease-related word infestation: In a June 2018 tweet, Trump complained that Democrats "don't care about crime and want illegal immigrants, no matter how bad they may be, to pour into and infest our Country." (Capitalization sic.)

As linguist and former Visual Thesaurus executive producer Ben Zimmer wrote in The Atlantic in August 2019, this trope has often been associated with non-Europeans, especially those from Asia: "In California in the late 19th century, immigrant Chinese laborers bore the brunt of the "invasion" discourse. While the term historically had been used to refer to the incursion of armed forces, Chinese immigrants were seen as 'invaders' of a more insidious kind."

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It's true that in the first weeks of the disease's outbreak, references in the media to "Chinese coronavirus" were not uncommon. After the WHO&'s February 11 announcement of the COVID-19 name, however, most reputable news sources switched to the official name. The director of the Centers for Disease Control and Prevention, Robert Redfield, told a House of Representatives hearing that it was "absolutely wrong and inappropriate" to use labels like "Wuhan" and "Chinese" in referring to the disease.

The way we name diseases, scientifically or informally, can affect our perception of, and response to, those diseases. In the early 1980s, before the human-immunodeficiency virus, or HIV, was identified, the disease it causes was called GRID, an acronym for gay-related immune deficiency. That name not only stigmatized homosexuals but also encouraged a false sense of complacency. As it turned out, of course, the disease that was ultimately called AIDS does not discriminate on the basis of sexual preference.

Geographic names like Zika virus (named in the late 1940s after the Zika forest in Uganda) and Ebola (named in mid-1976 after the Ebola River in the Democratic Republic of Congo) were likely chosen in good faith, to pinpoint the origins of an emerging disease. But the names are problematic: They sound "exotic" to Western ears, suggesting that the diseases are peculiar to remote places — "shithole countries," to borrow another Trumpian phrase — populated by people who "aren't like us." In reality, thanks to international travel both Zika and Ebola eventually spread outside Africa, including to Europe and the Americas.

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Before the discovery of the germ theory of disease, in the late 19th century, diseases were often given fanciful or mystical names. Cholera — caused by a bacterium that flourishes in untreated drinking water — comes the Greek word for "bile," an imbalance of which was surmised to be the source of the malaise. Typhus, which was eventually discovered to be spread by fleas and ticks, is a Greek word meaning "smoke" or "haze," as a way to describe the "hazy" state of mind sufferers have.

Over the centuries, the sexually transmitted disease we now know as syphilis was called by myriad names that pointed accusatory fingers at outlanders. The French called it "the Neapolitan disease," the Italians called it "the French disease"; Russians called it "the Polish disease," Poles called it "the German disease." Its "scientific" name is in fact a literary invention. In 1530, an Italian doctor and poet, Girolamo Fracastoro, published a story poem whose main character, a shepherd named Syphilus, had the disease. The meaning and origin of "Syphilus" are unclear; it may be Latinized Greek for "pig-lover."

Influenza, from which we derived flu, is an Italian word meaning "influence"; it was thought this infectious disease characterized by high fever was caused by astrological or atmospheric influences. The flu pandemic of 1918–1920 is popularly known as "Spanish flu" — a perfect example of naming by misdirection. The actual origin of the disease is unknown. (It may have started in Kansas.) When it first appeared, during World War I, wartime censors "minimized early reports of illness and mortality in Germany, the United Kingdom, France, and the United States," according to a Wikipedia entry. "Papers were free to report the epidemic's effects in neutral Spain (such as the grave illness of King Alfonso XIII).These stories created a false impression of Spain as especially hard hit, giving rise to the pandemic's nickname, 'Spanish flu.'" Understandably, the name was not embraced by Spaniards. They came up with their own nickname, Naples Soldier, the title of a song in a popular operetta of the era that was said to be "as catchy as the flu." Unsurprisingly, the name pointed to a foreign origin: it was another "Neapolitan disease."

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The "magic power" of disease names, as the critic Susan Sontag put it more than 40 years ago, has not diminished with modern insights into epidemiology. "Every plague must have its point," writes Adam Gopnik in a March 11 essay for the New Yorker. "Again and again, in the history of illness, we find the same desire to attach a moral to a microbe." During the current crisis, "this desire to find a moral agent to blame has produced an urge to, as they say in the academy, 'other' the bug." Calling COVID-19 "the Chinese coronavirus" or "the Wuhan virus," Gopnik writes, is "an apparent effort to other it right out of American responsibility and back to the Mysterious East."

There is nothing to be gained from this name-calling other than the sad and fleeting thrill of xenophobia (literally "fear of foreignness"). Microbes are amoral border-flouters, immune to superstition and tribalism. We're all in this together; let's choose names and language that keep us clear-eyed, empathetic, and scrupulously pragmatic.


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Nancy Friedman is the chief wordworker at verbal-branding consultancy Wordworking, and the author of a fine blog on naming, branding and more called Fritinancy. Nancy has named a venture-capital firm, a laser hair-removal device, a mobile-money service, and many other companies and products. A former journalist, she still writes or ghostwrites articles, speeches, white papers, and books. Click here to read more articles by Nancy Friedman.

Join the conversation

Comments from our users:

Monday March 23rd, 10:16 AM
Comment by: Ted G. (Fairfax, VA)
Well researched and flawlessly presented; you define excellence in communication. I would like to nominate you to lead the effort to draft a Constitutional Amendment (Twenty-Second-Reconfirmed Amendment?) to encourage Trump to run for a third term.
Monday March 23rd, 11:08 AM
Comment by: Nancy FriedmanVisual Thesaurus Contributor
Ted G.: Thanks for the kind words. As for the nomination, I decline.
Monday March 23rd, 10:59 PM
Comment by: David S. (Evanston, IL)
Um ... a nice article about disease names ends by calling someone xenophobic. And that's "clear eyed, empathetic and scrupulously pragmatic." It seems a little more like a dagger.
Monday March 23rd, 11:01 PM
Comment by: Nancy FriedmanVisual Thesaurus Contributor
David S.: Whom did I call xenophobic?
Tuesday March 24th, 8:56 AM
Comment by: David S. (Evanston, IL)
Who? Someone who uses a toponym or demonym to descibe a virus: "There is nothing to be gained from this name-calling other than the sad and fleeting thrill of xenophobia (literally 'fear of foreignness')." You didn't name the thrill seekers here, nor did I suggest you did. But earlier you did mention some who made such references and they are of one political persuasion. I'm not being critical, as it's your perogative to speak your mind, but merely making an observation. There is an internal incnsistency: it's okay to call out people who behave as xenophobes but we ought not attach certain adjectives to a virus.
Tuesday March 24th, 12:50 PM
Comment by: Nancy FriedmanVisual Thesaurus Contributor
David S.: Thanks for taking the time to comment. I stand by my language (which was "the fleeting thrill of xenophobia" and not an ad hominem attack).
Friday March 27th, 10:28 AM
Comment by: JoAnn Z.
There is much to be gained by calling it Wuhu or Chinese Virus. It gives us a starting point to learn about wet markets, eating wild animals, farming wild animals without regulation, unregulated food markets of diseased animals, interspecies transmission, etc. What is it about these food markets that is not seen elsewhere in the world? Why is it that EVERY year the new strains of influenza start in China? How about we use the most scientifically accurate term? not some p.c. term?

Let's not call it "Wuhu Flu" because it is a "cold"(coronavirus) virus, not another influenza virus. That's inaccurate.
Friday March 27th, 3:26 PM
Comment by: Nancy FriedmanVisual Thesaurus Contributor
JoAnn Z.: Thanks for taking the time to read and comment.

The most scientifically accurate term is the one chosen by the World Health Organization on February 11: COVID-19. This isn't "political correctness"; it's scientific terminology.

It is of course appropriate to discuss epidemiology and vectors--no one is denying that. But objective scientific terms are the best way to have a common framework for that discourse.
Friday March 27th, 3:30 PM
Comment by: Nancy FriedmanVisual Thesaurus Contributor
P.S. to JoAnn Z.: The region is Wuhan, not Wuhu.
Saturday March 28th, 10:20 AM
Comment by: David C. (Marietta, GA)
Speaking of voting on the names of diseases, Nancy, agoraphobia is now pandemic. So as not to stigmatize the sick, however, we call it "social distancing."

Indeed, "antisocial" has been redefined as "caring for the frail." Howard Hughs, were he still with us, could have served as the poster child for the new wellness program.

As long as the world refuses to hold still, neither will the language.

In the meantime, join the phobic and stay well.
Saturday March 28th, 10:00 PM
Comment by: Joann Z. (Rockford, IL)
PSS. I prefer WuHu. I like the sound of it.
Thursday April 2nd, 7:16 PM
Comment by: Ellen M.
It is interesting that the only three countries (Singapore, South Korea and Taiwan) that were prepared and responded quickly enough to launch successful containment strategies against this new strain of SARS are ethnic Chinese.

Yet the People’s Republic of China's Communist leadership did everything wrong. Wuhan authorities hid the outbreak in November. Under CCP orders, they destroyed samples, sequences and data in December and silenced whistle-blowing doctors. Meanwhile, travel for the Spring Festival in January sent millions of innocent Chinese all over China and the world carrying the virus. President-for-Life Xi refused early offers of help from the WHO and the USA. After weeks of delay, the CCP cracked down with hard lockdowns of Wuhan and Hubei. The CCP continues to produce implausible data claiming they have succeeded in quelling the epidemic in the PRC.

It is also interesting that the mainstream media, including CNN, NYT, WaPo and the US broadcast networks, all used variations on “Chinese virus,” “Wuhan pandemic,” etc. through January and most of February. As Nancy reports, on February 24 the WHO provided “official” designations for the disease and the virus with language guidelines to “avoid stigmatization.” This is the same WHO that wouldn’t work with Taiwan (who had a handle on the outbreak early), in order to stay in good odor with the PRC.

It’s not that the media style guides changed quickly to use the WHO designations, which seems reasonably professional (I use them myself). But from where did the coordinated language policing and handwringing come from that the previous terminology, perfectly acceptable a week before, was now creating ethnic hatred? We’re certainly not seeing the real bigotry that caused the City of San Francisco to quarantine all of Chinatown during the plague pandemic of 1900-04!

CCP propaganda in early March pushed the meme that it’s racist to refer to this as a Chinese disease (at the same time suggesting it originated as US biowarfare). It is, of course, merely coincidence that at the same time a sudden surge of journolists Tweeted this meme and asked such questions at Trump’s Beat the Pressers.

Therefore, I propose calling this the CCP Pandemic. Or maybe CommieSARS, which has a nice vintage Soviet ring to it.
Thursday April 16th, 5:18 PM
Comment by: Ellen M.
JoAnn Z,

I agree with you heartily about disease about names pointing to origins.

The presence in Wuhan of the only Level-4 virus containment research facility in the PRC was perhaps not a coincidence. It looks increasingly likely that an accidental virus release or infection of a graduate student (who may be the index case, but he's been disappeared) could be the original source.

Enough non-CCP controlled virologists have analyzed the SARS-CoV-2 virus genomics to convince me it was not weaponized. However, there was research conducted using horseshoe bats collected from South China (not native to the Hubei region). This would match the viral phylogeny and explain why this strain doesn't look like those in bats usually found in Wuhan or its wet market.

Of course, this hypothesis does not eliminate the possibility that a lab bat was sold to the market by an underpaid graduate student, either. Given the specimens, sequences and data destroyed in December under CCP orders, we may never know for sure.
Tuesday April 21st, 9:23 AM
Comment by: Wesley A.
Congratulations Mrs. Nancy Friedman. As I published on Linkedin, your article sounds like fresh air in such xenophobic times.
Thank you, for sharing.

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