Israel’s Arab community has until now experienced a surprisingly low rate of coronavirus infection, but there is mounting concern that the outbreak could gain strength during Ramadan, showing the true gaps in public health between Israel’s communities.
As of Sunday evening, only 193 of around 8,000 confirmed coronavirus cases in Israel could be found in Arab communities, according to Health Ministry figures. Not one Arab community appears among the first 60 on the Ministry’s list.
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Experts say the gap can be partially explained by a relatively small number of tests conducted in Arab communities, as well as a lack of epidemiological investigation to locate those who had been in contact with COVID-19 patients, as Haaretz previously reported. As of Sunday, 6,479 people in Arab communities were tested in contrast to more than 80,000 in Jewish communities.
But the gap in testing can’t explain the fact that among the 46 fatalities, there are apparently no Arabs. Health maintenance organizations and local clinics have also not reported any sharp rise in the spread of the virus in Arab society.
“In my opinion we don’t know enough and it’s possible that there is more illness than we are aware of,” says Prof. Eran Segal of the Weizmann Institute of Science in Rehovot. “It’s also possible that there is underreporting, that the threshold at which they call Magen David Adom [rescue services] is higher,” he adds. According to Segal, there may have been Arab Israelis who died of the coronavirus but went undiagnosed and a different cause of death was listed.
Nevertheless, the Arab community seems to have been less affected by two accelerators of the disease. The first circles of infection in Israel was mainly composed of people who returned from abroad carrying the virus, and then of people who attended celebrations around the Jewish holiday of Purim.
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Dr. Hagai Levine, chairman of the Israeli Association of Public Health Physicians warns that the high number of Arab health care workers puts the community at the center of the outbreak. “If these workers are at high risk, we’ll start seeing a much higher rate of infection. It’s important to follow what’s happening there,” Levine says.
The low rate of infection among Arabs could also be due to the fact that they followed instructions and avoided public gatherings, shuttering churches and mosques, an assessment that the national committee on public health in the Arab community cautiously agrees with. “The attempt to rope the Arab and the ultra-Orthodox communities together is not correct,” Levine says. “The Arab population responded positively to public health recommendations, much more than the Jewish community,” he adds, noting the higher rate of vaccination among Israeli Arabs.
Levine warns however that the Health Ministry doesn’t know enough about what is happening in Arab communities. And health professionals believe that, although these factors have helped to slow the spread of the virus, it did not stop it; and an outbreak in one Arab community would be on par with an outbreak in an ultra-Orthodox neighborhood, a possibility which has received widespread attention.
“It won’t last forever”
Hundreds of tests were conducted over the last few days in Arab communities, and could reveal a more accurate trend. “In another week, we’ll know more,” says Dr. Fuad Abu Hmad, director of the local branch of an Israeli health maintenance organization in the Palestinian neighborhood of Beit Safafa. “But meanwhile we’re not seeing sickness,” he added.
Dr. Khaled Awawda, a member of the national committee on health in the Arab community, agrees with Abu Hmad’s assessment. “It’s hard to reach conclusions at this point. The number of confirmed patients is relatively low, [but] so is the number of tests,” and at the same time, family physicians are not reporting a rise in coronavirus patients in local clinics. “We expect in a week or two to have a clearer picture,” Awawda added.
Members of the health committee are now concerned about what might happen during the month of Ramadan, which begins at the end of April. People are less likely to adhere to social distancing rules during the holiday, which will increase the risk of infection. It is especially worrying given the infection rate could be compounded by the high number of smokers and diabetes sufferers, both considered risk factors, in the community. The fact that many Arab senior citizens live with their families could also put them at risk, especially if this wave of the disease breaks out after general social distancing rules are eased.
“At the moment, there are many theories, but it must be said that we don’t know entirely what is happening,” said Prof. Nadav Davidovitch, head of the school of public health at Ben-Gurion University in Beer Sheva. The government responded late in its efforts to spread information, in testing and improving access to services in the Arab community, he said.
If an outbreak occurs among Israeli Arabs, the situation will reflect the status of the system in general and gaps in public health in Israel, Davidovitch, said, adding: “It won’t last forever. It’s not logical for there not to be an outbreak in Arab community.”