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      COVID-19 Amongst the Ultra-Orthodox Population in Israel: An Inside Look into the Causes of the High Morbidity Rates

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          Abstract

          The current paper focuses on the circumstances that have led to the high COVID-19 infection rates amongst the ultra-Orthodox population in Israel. The current study utilizes a qualitative design and is based on in-depth interviews, email correspondence and online records of 25 ultra-Orthodox individuals who either tested positive for COVID-19 or had contact with a verified COVID-19 patient. The data were analyzed through identification of main themes and an interpretation of their meanings. The findings showed that a wide range of causes led to the high infection rate, including aspects that derive from a structural element, a religious element and a social-ideological element—all of which are directly or indirectly connected to religion. These findings demonstrate the central role of religion in health outcomes among the ultra-Orthodox community in general and during pandemics in particular, and they shed light on the central role of religion in health outcomes among closed-religious communities. The findings further reveal the importance of cooperation between the state authorities and the religious ones, and of providing culturally adapted health service solutions in the fight against COVID-19 and promoting health more generally. Study limitations are discussed and recommendations for future research are provided.

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          Disparities in the Population at Risk of Severe Illness From COVID-19 by Race/Ethnicity and Income

          INTRODUCTION Identifying those at heightened risk of severe illness from novel coronavirus disease 2019 (COVID-19) is essential for modeling disease, designing return-to-work criteria, allocating economic assistance, advancing health equity, and limiting morbidity and mortality. The U.S. Centers for Disease Control and Prevention has identified criteria associated with risk of severe complications from COVID-19 infection (Appendix Table 1). 1 Structural inequities have shaped racial, ethnic, and income disparities for many of these criteria. To date, there has been limited analysis of the proportion of the population at risk in the U.S. based on these criteria, 2 or risk factors by race/ethnicity or income. Preliminary national data on cases by race/ethnicity suggest that disparities in hospitalization are already developing. 3 Quantifying disparities in risk is important for allocating resources to prevent, identify, and treat COVID-19-related severe illness and limit diverging outcomes for already vulnerable subgroups. METHODS The authors used data from the 2018 Behavioral Risk Factor Surveillance System, a nationally representative survey of >400,000 adults. This study estimated the proportion of adults that have at least one of the Centers for Disease Control and Prevention criteria for risk of severe illness from COVID-19 (hereafter “higher risk”) (Appendix Table 1) by age group, and by race/ethnicity and household income ( 65 years (63% vs 52%, PR=1.21, 95% CI=1.18, 1.24) (Appendix Table 9). DISCUSSION People who are black, American Indian, or live in low-income households are more likely to have conditions associated with increased risk of illness from COVID-19 relative to those who are white or higher income, respectively. These inequities in risk are compounded by structural disparities in access to medical insurance, 4 wealth, and income volatility. 5 Structural inequities also contribute to heightened exposure to COVID-19. Minorities and people living in low-income households are more likely to work in industries that have remained open during non-essential business closures. 6 They are also more likely to live in crowded conditions 7 and multigenerational households that may elevate exposure and limit options for quarantining family members. It is vital that these race/ethnicity and income disparities in risk be considered in physical distancing policies and other protective measures, particularly for those who work in essential industries. Rationing resources based on comorbidities may exacerbate inequities, whereas prioritizing vaccine delivery on risk may reduce deaths and disparities. Data availability in the Behavioral Risk Factor Surveillance System is a limiting factor; the data do not include all risk criteria and only capture respondents who were aware of their condition. These estimates represent a lower bound of adults at risk of severe illness. It is possible that risk is not uniform and those with multiple factors may be at higher risk. This would be further evidence of race/ethnicity and income disparities.
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                Author and article information

                Contributors
                sarazalcberg@gmail.com
                simazalcberg@gmail.com
                Journal
                Contemp Jew
                Contemp Jew
                Contemporary Jewry
                Springer Netherlands (Dordrecht )
                0147-1694
                1876-5165
                20 July 2021
                : 1-23
                Affiliations
                [1 ]GRID grid.12136.37, ISNI 0000 0004 1937 0546, Religion Studies, , Tel Aviv University, ; Tel Aviv, Israel
                [2 ]GRID grid.9619.7, ISNI 0000 0004 1937 0538, Social Work, , Hebrew University of Jerusalem, ; Jerusalem, Israel
                [3 ]GRID grid.411434.7, ISNI 0000 0000 9824 6981, Social Work, , Ariel University, ; Ariel, Israel
                Author information
                http://orcid.org/0000-0001-6551-1096
                Article
                9368
                10.1007/s12397-021-09368-0
                8290384
                34305203
                0ca3df53-4e03-4df3-b3c8-c6fa10139972
                © The Author(s), under exclusive licence to Springer Nature B.V. 2021

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 2 December 2020
                : 15 March 2021
                Funding
                Funded by: Shandong University - Tel Aviv University Joint Institute for Jewish and Israel Studies
                Categories
                Article

                ultra-orthodox,covid-19,health behaviors,social capital,closed-religious communities

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