The death toll from the COVID-19 pandemic in Israel will very soon include 8,000 men, women and children of all ages. But the catastrophe has not hit all sectors equally, according to a new study by Jerusalem’s Taub Center for Social Policy Studies in Israel.
The independent, non-partisan socioeconomic research institute – which provides decisionmakers and the public with research on critical issues facing Israel in education, health, welfare, labor markets and economic policy to advance the well-being of all Israelis – asked its research director Dr. Alex Weinreb to investigate this issue. His newly issued report found that by late September 2021, 14% of Israel’s population – or 1.3 million people –had been infected with the potentially fatal virus.
He mapped out its cumulative over the first 18 months of the pandemic, focusing on variations in rates of Covid testing, infection and hospitalization across and within key subpopulations. The study showed that the highest cumulative rates of testing were found in Jewish cities, towns and settlements where few ultra-Orthodox Jews (haredim) live. The highest infection rates were in haredi areas, and the highest hospitalization rates were in Druse and non-Beduin Arab towns and settlements.
Controlling for rates of poverty, population density and the percent of residents over age 65 explained only some of these differences.
Weinreb used data from the government’s COVID portal, which includes daily cumulative testing, infection and hospitalization rates by locality from the beginning of the pandemic until September 29th of this year. He merged these data with three main characteristics – the socioeconomic status of the place of residence, the density of the population living there and the percent of those in the locality over the age of 65.
The data include 205 places in Israel where eight of the country’s nine million people live. The places were grouped into one of seven streams based on the dominant affiliation of its resident population: Jewish non-haredi, haredi, Arab, Beduin, Druse, mixed Jewish-Arab and mixed haredi/non-haredi.
The highest Covid testing rates among Jews who are not ultra-Orthodox and the lowest among the Beduin.
By the end of September, the cumulative rate of Covid tests since the beginning of the epidemic reached 2.7 tests per person, but there were significant differences between and within sectors. The testing rate in Beduin areas was the lowest – an average of 115,000 tests per 100,000 residents – while the highest rate was in the Jewish non-haredi sector – over 324,000 tests per 100,000 residents. The testing rate in the haredi areas was around the national average. In the Arab and Druse towns and settlements the average testing rates were relatively low – 210,000 and 217,000 per 100,000 persons, respectively, although within the Druse sector, the testing rate in the locations in the Galilee were 60% higher than in those in the Golan.
A slightly different picture emerged from the data on confirmed infections. The percent of cumulative infections was lowest in the Beduin sector (8.4%) and highest in the haredi sector (31.0%), while the national average was 13.7%. The haredi sector was exceptional, with high rates of confirmed infections relative to the rest of the towns of Rechasim and Beitar Illit led with confirmed infection rates of about 40% and 38%, respectively. Even after controlling for the rates of poverty, population density, the percent of residents over age 65 in these places and a number of other characteristics, infection levels in haredi locations were 2.4 times higher than in non-haredi Jewish cities, towns and settlements.
The Taub Center study also found a high correlation between infection rate and the share of haredim in the population in non-haredi locations as well. Across the 10 Jewish non-haredi places with the highest infections rates, an average of 45.6% of the pupils were enrolled in haredi primary schools. For each additional percentage point increase in children learning in a haredi educational institution in a non-haredi location, there were more than 130 additional cases of confirmed COVID infections per 100,000 residents.
In the Arab sector, the picture was different: the five Arab towns and settlements with over 17% infection rate seem to have no shared characteristics in terms of geography, religious affiliation or socioeconomic status; the same goes for the two places with the lowest infection rate of less than eight percent. The rate of confirmed infections in Beduin locations was 40% lower than the rate in Arab and Druse locations.
The main individual risk factors for COVID-related hospitalizations are age and a personal history of heart disease, diabetes or obesity. These are the main factors responsible for the differences in hospitalization rates among sectors. While the highest infection rates were in haredi loations, the highest hospitalization rates were actually in the Arab locations. Fourteen of the 20 places ranked highest for COVID-related hospitalizations were Arab: topping the list was Abu Gosh just outside Jerusalem with a hospitalization rate of 1.2% of the population.
The risk of hospitalization in the haredi communities was for the most part low, since the majority of their population is under age 65. In Bnei Brak, where a relatively large share of the resident population is over age 65 (more than 8%) – which is exceptional among other haredi placeds, the hospitalization rates were among the country’s highest – 0.9%.
The higher-than-expected hospitalization rates among the Beduin sector reflect the high incidence of chronic diseases alongside low testing rates that mask the true infection rate.
“The overall pattern of Covid testing, infection and hospitalization rates indicates that the haredi sector experienced COVID differently from the rest of the population,” noted Weinreb. “The highest cumulative infection rates are in the haredi locations – 2.5 times the rate found in the non-haredi communities, and the next highest rates are in non-haredi Jewish locations with a high share of haredi Jews. In contrast, the lowest infection rates were in the Beduin sector, in part due to their low testing rates; their hospitalization rates were also relatively low. Non-Beduin Arab and Druse locations were hardest hit in terms of disease, presumably due to their population’s high rate of pre-existing health conditions.
The share of the resident population over the age of 65 had an influence on the testing, infection and hospitalization rates. In those locations with a high share of over 65 year olds, low levels of testing, infection and hospitalization were noted. This finding speaks to the success of efforts to lower infection rates among this age group. Low infection and hospitalization rates were also found in places with a small percent of older residents; among younger populations, even if they were infected, it is likely that the majority of them experienced mild symptoms, if any.
“The data show that the poorest locations also have the lowest testing rates, while in the wealthiest places with more residents over 65 years of age, the rates of infection and hospitalization were amongst the lowest. The differences between sectors were also significant – the risk of infection in haredi places was 2.5 times greater than in Jewish non-haredi locations,” Weinreb commented.
Factors like poverty level, density of the population and age structure of the population explain about 30% of the excess infection rate among haredim, and the rest presumably can best be explained by behavioral factors. In the Arab sector, the high hospitalization rates correlate with the high incidence of preexisting health issues in this population.
As the state continues to fight this pandemic and those that may arise in the future, the differences among the different populations should be taken into account, Weinreb concluded. Improving access to health services in distressed areas and allocating resources to clinics and investing in local manpower that will have the trust of the local population should be carried out. “In addition, it is important to take a consistent approach to enforcement of restrictions to prevent the spread of the virus. Biased enforcement taken by the government thus far has allowed the spread of the virus, and the authority of the government must be strengthened in those areas where it has been eroded.”