The ultimate low point of social disgrace is revealed in how a community treats a person who is already suffering. The people completely rejected the sufferer, feeling deep disgust and physically moving away from him. However, the pain inflicted upon him did not stop at mere avoidance.
Instead of simply keeping their distance, the people actively showed their extreme contempt by spitting directly in his face. This creates a deeply painful picture of human cruelty. It would have been painful enough if they had only walked away. Yet, even as they turn around and step back to distance themselves, they still make a deliberate point to spit in his face [אלשיך].