Jews and coronavirus

Jews are ‘longlifers’. Everywhere in the world Jews live longer than the non-Jews around them. Jewish men in Israel have one of the highest life expectancies in the world. In 2017, they could expect to live to 81 years, on average; women – to 85 years. With respect to life expectancy, Israeli Jews, and especially men, surpass almost all high-income countries: the average life expectancy for men in the countries belonging to the Organisation for Economic Co-operation and Development (OECD) is 78 years and it is 83 years for women. None of this is new. The situation in the past, for example in the 1950s, was no different. Nor is this unique to Jews in Israel. Jews in the Diaspora live longer than the non-Jews surrounding them in all places where records are kept. The only exceptions to this rule were newly-formed immigrant Jewish communities from low income countries (e.g. the Russian empire) moving to high income countries (the USA and the UK), but even there the longevity advantage of Jews resurfaced quickly as immigrant communities integrated into their new lives.

The Jewish longevity advantage is not due to biology in the strict sense of that word. What kills Jews less than others is what epidemiologists call “avoidable mortality” – quite literally, mortality that can be avoided – if people behave in a way that is ‘health-aware’: exercising,  not overeating or undereating, consulting doctors, avoiding substance abuse, not smoking, not drinking excessively, not engaging in antisocial behaviour and violence, indeed, not taking unnecessary risks in general. Jews are, on average, more health-aware than non-Jews, and that, historically, did not pass unnoticed. Philosophers and physicians in the past commented on the fact that, relative to non-Jews, Jewish behaviour is more reserved and less prone to risk. In a series of lectures delivered to students at the University of Königsberg in the late eighteenth century (later to become a book entitled ‘Anthropology from a Pragmatic Point of View’), Immanuel Kant pointed out, for example, that ‘women, priests and Jews do not get drunk, as a rule, at least they carefully avoid all appearances of it because their civic position is weak and they need to be reserved’. Note the explanation offered! It is the political vulnerability and weakness of Jews that stand behind the phenomenon of their greater sobriety! Jews do not get drunk because they are afraid to enter an uninhibited state in their already-insecure social position…People who are insecure are people who are afraid – of appearing themselves, of being judged by others, of punishment…. Note also the very astute observation: in their more reserved behaviour, Jews are not unlike women!

I could go on to quote others who offered similar observations and explanations, but I am keen to move on to coronavirus. ‘What is the link of all this and coronavirus?’  you may reasonably ask. The answer is that there are many ways to destroy one’s health and, it appears, Jews are less prone to be health-destructive with respect to many of them. For our purposes now, the most important behaviour is smoking. Jewish populations, both in Israel and in the Diaspora, are less profoundly affected by smoking than others, which gives Jews a strong advantage in dealing with various diseases affecting lungs and the respiratory system. Smoking damages health by causing or worsening the course of a wide range of cancers, as well as cardiovascular and respiratory diseases. Of all organs, lungs and the organs of the upper aerodigestive system are most severely assaulted by smoking. The cardiovascular mortality of smokers is 2-3 times higher than the mortality of non-smokers, but the mortality from lung cancer and chronic obstructive pulmonary disease among smokers is 14-24 times higher than among non-smokers. Such were the conclusions of the American Cancer Society’s second Cancer Prevention Study which provided the evidence base for the later anti-smoking public health measures. To put it differently, smoking weakens the lungs. Coronavirus also assaults the lungs, and when coronavirus infects lungs that have been already weakened by something else, the result may be much worse compared to the assault on completely healthy lungs. Because Jewish populations have been less affected by smoking compared to others, we can be reasonably optimistic as to the effects of coronavirus on Jews.

I wish I could explain exactly why and how Jews are less affected by smoking. Perhaps, it is all part of the bigger ‘Jews are comparatively more moderate in their health destructive behaviours’ story. Europeans and Americans took up smoking in very significant numbers in the first half of the twentieth century. The reality of damage caused by smoking remained contested for a long time. Smoking started as a fashion among the high society. It then spread to all social classes. Initially, it was almost exclusively a male habit, then it also spread to women. The adverse effects of smoking took decades to demonstrate, and the anti-smoking policies took decades to implement. The epidemic of diseases related to smoking ravaged the world between the 1960s and the 1980s. And this is another important point to grasp about the way in which smoking kills: its full effects on the health of the population are delayed by about 20-30 years. Smokers start developing smoking-related illnesses not in their youth but when they age. So, the increase in smoking-related mortality in the late twentieth century occurred when the actual prevalence of smoking was already going down. Indeed, smoking is still the number one public health risk and the consequences of mass smoking will be felt at the level of population health for some years to come.

Importantly, however, no matter where one looks, the rates of mortality from smoking-related diseases have been considerably lower among Jews compared to non-Jews. A study published in ‘Population Studies’, a prominent demographic journal, indicated that in the 1970s-1990s, about 13% of all deaths among Israeli Jewish men aged 45 years and over were attributable to smoking; at the same time in English-speaking countries, the proportion of smoking-related deaths was about 30% of all male deaths, while in Southern Europe (Greece, Italy and Spain), it was about 20%. The most recent data indicate that Israelis are still at a considerable advantage when it comes to smoking-related mortality: today, death rates from cancer of the trachea, bronchus and lungs among men aged 65 years and over in the European Union are about 1.5 times higher than among men in Israel (all men or just Jewish men. The story of the Jewish Diaspora is much the same.

The coronavirus pandemic is occasionally compared to the 1918 Spanish flu pandemic. Just how far the comparison is appropriate in biological terms is beyond the scope of this essay, but there is something about the Spanish flu pandemic that is not at all well-known but worth knowing. It can help to make sense of the ‘chances’ of coronavirus among Jews today. The ferociousness of the Spanish flu is partly explained by the fact that in 1918 the flu virus did not act alone. It had help. It attacked people whose lungs were already weakened. Not by smoking, it was too early for that. By tuberculosis. Tuberculosis was genuinely endemic at that time in the West, with a large pool of people with clinical disease and another large pool with latent infection. In 1917 mortality from tuberculosis in the United States of America, for example, was higher than mortality from a stroke and only a little lower than mortality from heart disease, which is another way of saying that in the early twentieth century, tuberculosis was a central feature of life and a major cause of death. Thus, when Spanish flu attacked, it attacked populations with many weakened lungs. The death march of Spanish flu would not have been as spectacular as it turned out to be in the end without some interaction with tuberculosis. Incidentally, mortality from tuberculosis declined sharply after the Spanish flu pandemic. Spanish flu killed off many people with tuberculosis and also reduced the size of the pool of infected individuals in the community.

Back to coronavirus again …The moral of the story is that the health profile of Jews, in Israel and elsewhere, makes them relatively resilient to coronavirus. Others have indicated, correctly, that additional factors should be taken into consideration in assessing the potential impact of coronavirus on Jews. Some Jewish communities in the Diaspora (not Israel though!) are rather aged, and age is a notorious risk factor with respect to coronavirus. Certain subgroups among Jews (e.g. the Orthodox) have intense religious lives which, epidemiologically speaking, translate into the frequenting of – and crowding in – places of worship and religious study. Strictly Orthodox Jews have large families: the average household size in this sector is 5, while it is 3 in Israel as a whole and about 2 in other Western countries. Contagious agents, such as coronavirus, love crowds. (It is worth noting, in passing, that the Haredi constitute a subgroup with especially high longevity, even among Jews.)  The impact of these factors may offset the impact of the generally wholesome Jewish population health profile, to some extent. However, the importance of healthy lungs, at a population level, would be very difficult to neutralise. Positivity and optimism with respect to the outcome of the encounter of coronavirus with Jews are not unwarranted. Quite the contrary.