By late September 2021, 14% of Israel’s population had been infected with Covid-19 – 1.3 million people – and of those, 7,800 people had died. A new Taub Center study by Prof. Alex Weinreb maps out the cumulative patterns of Covid in Israel 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 shows that the highest cumulative rates of testing were found in Jewish non-Haredi yishuvim (those with few ultra-Orthodox Jews), the highest infection rates were in Haredi yishuvim, and the highest hospitalization rates were in Druze and non-Bedouin Arab yishuvim. Controlling for rates of poverty, population density, and the percent of residents over age 65 explained only some of these differences.
In this new Taub Center study, Prof. Weinreb uses data from the government Covid portal that includes daily cumulative testing, infection, and hospitalization rates by locality (yishuv/yishuvim) from the beginning of the pandemic until September 29, 2021. He merges these data with three main yishuv characteristics: the yishuv socioeconomic status (as defined by the Central Bureau of Statistics), the density of the resident population, and the percent of those in the locality over the age of 65. The data include 205 yishuvim in Israel, home to about 8 million people, 88% of the Israeli population in mid-2020. Yishuvim were grouped into one of seven streams based on the dominant affiliation of its resident population: Jewish non-Haredi, Haredi, Arab, Bedouin, Druze, mixed Jewish/Arab, and mixed Haredi/non-Haredi.
The highest Covid testing rates among non-Haredi Jews; the lowest among the Bedouin
By September 29, 2021, 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 Bedouin yishuvim 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 yishuvim was around the national average. In the Arab and Druze yishuvim, the average testing rates were relatively low – 210,000 and 217,000 per 100,000 persons, respectively, although within the Druze sector, the testing rate in the yishuvim in the Galil were 60% higher than in those in the Golan.
A high infection rate primarily among Haredim
A slightly different picture emerges from the data on confirmed infections: the percent of cumulative infections was lowest in the Bedouin sector (about 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 yishuvim. Rekhasim and Beitar Illit led with confirmed infection rates of about 40% and 38%, respectively. Even after controlling for the yishuv’s rates of poverty, population density, the percent of residents over age 65, and a number of other characteristics, infection levels in Haredi yishuvim were 2.4 times higher than in non-Haredi Jewish yishuvim.
The Taub Center study also found a high correlation between infection rate and the share of Haredim in the population in non-Haredi yishuvim as well. Across the ten Jewish non-Haredi yishuvim with the highest infections rates, an average of 45.6% of the students were enrolled in Haredi primary schools (school of enrollment was used as an indicator of religious observance level and the share of Haredim in the yishuv population). For each additional percentage point increase in children learning in a Haredi educational institution in a non-Haredi yishuv, there were more than 130 additional cases of confirmed Covid infections per 100,000 residents.
In the Arab sector, the picture is different: the five Arab yishuvim 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 yishuvim with the lowest infection rate (less than 8%). The rate of confirmed infections in Bedouin yishuvim was 40% lower than the rate in Arab and Druze yishuvim.
High hospitalization rates among Arabs due to pre-existing diseases
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 explanatory factors for the differences in hospitalization rates between sectors. While the highest infection rates were in Haredi yishuvim, the highest hospitalization rates were actually in the Arab yishuvim. Fourteen of the twenty yishuvim ranked highest for Covid-related hospitalizations were Arab: topping the list was Abu Gosh 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 yishuvim, the hospitalization rates were among the country’s highest – 0.9%.
The higher than expected hospitalization rates among the Bedouin sector (relative to the confirmed infection rate) reflect the high incidence of pre-existing 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,” explains researcher Prof. Alex Weinreb. “The highest cumulative infection rates are in the Haredi yishuvim – 2.5 times the rate found in the non-Haredi communities, and the next highest rates are in non-Haredi Jewish yishuvim with a high share of Haredim. In contrast, the lowest infection rates were in the Bedouin sector, in part due to their low testing rates; their hospitalization rates were also relatively low. Non-Bedouin Arab yishuvim and Druze yishuvim were hardest hit in terms of morbidity, presumably due to their population’s high rate of pre-existing health conditions.
More poverty – more infection and hospitalizations
The Taub Center study included a multivariate analysis with variables relating to yishuv characteristics like its socioeconomic cluster, inequality levels in incomes, size of its population, the density of the yishuv, the share of over 65-year-olds, and the yishuv classification as a “development town.” In yishuvim in the lowest socioeconomic cluster, there were the lowest testing rates per resident and the highest rates of confirmed cases and hospitalization. Density of the population was found to have little influence.
The share of the resident population over the age of 65 had an influence on the testing, infection, and hospitalization rates. In those yishuvim with a high share of over 65-year-olds, low levels of testing, infection, and hospitalization were observed. 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 yishuvim with a small percent of older residents – that is, among younger populations, even if they were infected, it is likely that the majority of them experienced light symptoms, if any.
“The data show that the poorest yishuvim also have the lowest testing rates, while in the wealthiest yishuvim with more residents over 65-year-olds, the rates of infection and hospitalization were amongst the lowest. The differences between sectors were also significant – the risk of infection in Haredi yishuvim was 2.5 times greater than in Jewish non-Haredi yishuvim. Even after controlling for the yishuv’s socioeconomic cluster and resident population density, the risk level remained 2.4 times higher,” says Prof. Weinreb.
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.
The findings show a low testing rate in Bedouin yishuvim and a heightened sensitivity in Druze and Arab yishuvim to more serious illness, as well as a high infection rate in Haredi yishuvim. In continuing efforts to fight the Covid pandemic and those that may arise in the future, the differences between the sectors should be taken into account. It is worth considering strengthening 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. 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.
The Taub Center for Social Policy Studies in Israel is an independent, non-partisan socioeconomic research institute. The Center provides decision makers and the public with research and findings on some of the most critical issues facing Israel in the areas of education, health, welfare, labor markets and economic policy in order to impact the decision-making process in Israel and to advance the well-being of all Israelis.