Effect of Socioeconomic and Ethnic Characteristics on COVID-19 Infection: the Case of the Ultra-Orthodox and the Arab Communities in Israel

Background: During infectious disease outbreaks, the weakest communities are more vulnerable to infection and its deleterious effects. In Israel, the Arab and Ultra-Orthodox Jewish communities have unique demographic and cultural characteristics that place them at higher risk of infection. Objective: To examine socioeconomic and ethnic differences in rates of COVID-19 testing, confirmed cases and deaths, and to analyze patterns of transmission in ethnically diverse communities. Methods: A cross-sectional ecologic study design was used. Consecutive data on rates of COVID-19 diagnostic testing, lab-confirmed cases, and deaths collected from March 31 through May 1, 2020, in 174 localities across Israel (84% of the population) were analyzed by socioeconomic ranking and ethnicity. Results: Tests were performed on 331,594 individuals (4.29% of the total population). Of those, 14,865 individuals (4.48%) were positive for COVID-19 and 203 died (1.37% of confirmed cases). Testing rate was 26% higher in the lowest SE category compared with the highest. The risk of testing positive was 2.16 times higher in the lowest socioeconomic category, compared with the highest. The proportion of confirmed cases was 4.96 times higher in the Jewish compared with the Arab population. The rate of confirmed cases in 2 Ultra-Orthodox localities increased relatively early and quickly. Other Jewish and Arab localities showed consistently low rates of confirmed COVID-19 cases, regardless of socioeconomic ranking. Conclusions: Culturally different communities reacted differently to the COVID-19 outbreak and to government measures, resulting in different outcomes. Socioeconomic and ethnic variables cannot fully explain communities’ reaction to the pandemic. Our findings stress the need for a culturally adapted approach for dealing with health crises.