Is international tourism responsible for the outbreak of the COVID-19 pandemic? A cross-country analysis with a special focus on small islands

The impact of anti-COVID measures on accommodation performance

Background

This article analyses mass accommodation facilities to examine the development of Czech tourism during the COVID-19 pandemic of 2020 and 2021.

Methods

The questionnaire survey was carried out in March 2021 in mass accommodation facilities. 131 responses were received from hotels and guesthouses throughout Czechia, which represents a return rate of 20%. Data were processed using Pearson's chi-square test to determine the effect of changes in facility type and category, quality, location, and primary focus before the outbreak of the pandemic. A statistical analysis of data on overnight stays was also used with data from the public database of the Czech Statistical Office.

Results

The study confirmed the increasing importance of domestic tourism and the greater sensitivity of destinations dependent on foreign tourists. Future strategies should be associated with destination rather than corporate management. The challenges are linked to the strengthening of environmentally friendly and sustainable tourism. To what extent the post-covid situation will return to the original model and to what extent it will at least partially reflect the changes that took place during the crisis period is a question for future research.

Conclusions

Moving from operational to strategic measures would be advisable.

Does the resumption of international tourism heighten COVID-19 transmission?

Reopening countries also carries the risk of another wave of infections in many parts of the world, raising the question of whether we are ready to reopen our countries. This study examines the impact of reopening countries to receive foreign tourists on the spread of COVID-19 in 2022, encompassing 83 countries worldwide. We employ spatial quantile models capable of analyzing the spatial impact of tourism on the spread of the virus at different quantile levels. The research categorizes countries into three groups: low infection rate (10th-30th quantiles), moderate infection rate (40th-60th quantiles), and high infection rate (70th-90th quantiles). This allows for a more comprehensive and detailed comparison of the impacts. Additionally, considering the spatial dimension enables the explanation of both the direct and indirect effects of tourists on the country itself and neighboring countries. The findings reveal that the number of international tourists has a significant effect on the COVID-19 infection rate, particularly in countries with high initial infection rates. However, countries that effectively controlled their infection rates at a low level could maintain a low infection rate even after reopening to foreign tourists. It is also observed that reopening a country's borders negatively impacts the infection rate of neighboring countries. These important findings imply that governments of highly infected countries should shift their focus towards bolstering their economy by promoting domestic tourism and should delay reopening until the number of infections decreases.

Does tourism affect the long term course of COVID-19 pandemic in a country of destination? Evidence from a popular Greek island in 2020 where control measures were implemented

Greece opened its points of entry on July 1, 2020, with specific guidelines for travellers arriving by sea, air or land. The aim of this article is to examine the effect of tourism on the long term course of the Coronavirus Disease 2019 (COVID-19) pandemic during the pre-vaccination era (June to December 2020) on the popular Greek island of Crete. To achieve this, a cross-sectional serosurvey, repeated at monthly intervals, was conducted to compare the seroprevalence in Crete with seroprevalence in the mainland of Greece. Crete welcomed nearly 2,000,000 travellers during the 2020 summer season. Left-over serum samples were collected and obtained from public and private laboratories located in Greece, including the island of Crete. These samples were tested for the presence of anti-SARS-CoV-2 IgG antibodies. A total of 55,938 samples were collected, 3,785 of which originated from Crete. In Crete, the seroprevalence ranged between 0% (June 2020) and 2.58% (December 2020), while the corresponding seroprevalence in Greece was 0.19% and 10.75%, respectively. We identified 4.16 times lower seropositivity in Crete (2.58%) in comparison with the mainland of Greece (10.75%) during December 2020. Moreover, the monthly infection fatality rate (IFR) in Crete was calculated at 0.09%, compared with 0.21% in mainland Greece for December 2020. The island of Crete presented more than four times lower seroprevalence than the mainland of Greece, despite being a highly attractive tourist destination. This evidence supports the idea that tourism may not have affected the long term course of the COVID-19 pandemic in Greece. However, due to contradicting results from previous studies, further investigation is needed.

Pandemic refuges: Lessons from 2 years of COVID-19

This paper relates evidence from the COVID-19 pandemic to the concept of pandemic refuges, as developed in literature on global catastrophic risk. In this literature, a refuge is a place or facility designed to keep a portion of the population alive during extreme global catastrophes. COVID-19 is not the most extreme pandemic scenario, but it is nonetheless a very severe global event, and it therefore provides an important source of evidence. Through the first 2 years of the COVID-19 pandemic, several political jurisdictions have achieved low spread of COVID-19 via isolation from the rest of the world and can therefore classify as pandemic refuges. Their suppression and elimination of COVID-19 demonstrates the viability of pandemic refuges as a risk management measure. Whereas prior research emphasizes island nations as pandemic refuges, this paper uses case studies of China and Western Australia to show that other types of jurisdictions can also successfully function as pandemic refuges. The paper also refines the concept of pandemic refuges and discusses implications for future pandemics.

Did Human Microbes Affect Tourist Arrivals before the COVID-19 Shock? Pre-Effect Forecasting Model for Slovenia

In 2020, with a substantial decline in tourist arrivals slightly before the time of COVID-19, the innovative econometric approach predicted possible responses between the spread of human microbes (bacteria/viruses) and tourist arrivals. The article developed a conceptually tested econometric model for predicting an exogenous shock on tourist arrivals driven by the spread of disease using a time series approach. The reworked study is based on an autoregressive integrated moving average (ARIMA) model to avoid spurious results. The periods of robust empirical study were obtained from the data vectors i) from January 2008 to December 2018 and ii) from January 2008 to December 2020. The data were obtained from the National Institute of Public Health (NIPH) and the Statistical Office of the Republic of Slovenia. The ARIMA model predicted the number of declines in tourist arrivals for the approaching periods due to the spread of viruses. Before the outbreak of COVID-19, pre-pandemic results confirmed a one-fifth drop in tourist arrivals in the medium term. In the short term, the decline could be more than three-quarters. A further shock can be caused by forecasted bacterial infections; less likely to reduce tourist demand in the long term. The results can improve the evidence for public health demand in risk reduction for tourists as possible patients. The data from the NIPH are crucial for monitoring public health and tourism management as a base for predictions of unknown events.

How to evaluate surgical tourism service organizations in China: indicators system development and a pilot application

Background

Surgical tourism is an emerging economic sector, with the most growth potential demonstrated in China's health industry before the COVID-19 pandemic. Surgical tourism accounts for a large part of medical tourism services in China, with high requirements in terms of quality and safety. By contrast, China suffers from insufficient measurement tools and theoretical research. The aim of this study was to develop a set of reliable and feasible indicators by augmenting the Donabedian model to evaluate the quality of surgical tourism services.

Methods

A literature review and focus group interview were used to generate indicators for the quality of surgical tourism services. The basic framework of the evaluation system was based on the structure–process–outcome Donabedian model. The screening and weight setting were conducted through an analytical hierarchy process (AHP) and a two-round Delphi consultation with 13 panelists. The validity and reliability of experts were tested by the experts' positive coefficient, authority coefficient, and coordination coefficient. The reliability of the questionnaire was assessed by a pre-test distributed within an International Medical Department of a public hospital in China.

Results

Based on the Donabedian quality theory, a novel evaluation system of surgical tourism service institutions was constructed with three dimensions, nine first-level items and 39 second-level items. The three dimensions consisted of the structure (0.315), process (0.287), and outcome (0.398), with several indicators for each dimension and each indicator was given a weight. Of the two rounds of Delphi consultation, the response rates were 86.67% and 100%. The coordination coefficient of expert opinions in the two rounds of consultation were 0.49 and 0.65 (p < 0.05). For the empirical study, the self-evaluation score of a public hospital was 86, which could rate as a two-star institution.

Conclusions

Our evaluation system identified three suitable quality dimensions of surgical tourism services to improve the safety and quality of practical healthcare. It reflects the access criterion of surgical tourism institutions, provides references for the best choice of surgical services for tourists, and can be applied by healthcare managers and policy makers to allocate resources more efficiently and promote more surgical tourism services with international standards.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41256-022-00262-2.

Tourism Sustainability and COVID-19 Pandemic: Is There a Positive Side?

The COVID-19 pandemic has wreaked havoc on the tourism industry like never before, resulting in massive losses of revenue and jobs around the world. Accordingly, the pandemic exacerbated the already existing sustainability challenges of the tourism industry. However, there is also a positive side of the pandemic which is often overlooked by international scholarship. Thus, the present study aims to review the extant literature in the area of COVID-19 and the tourism industry’s sustainability and resilience in future crises. Through a synthesis of secondary data, it was possible to bring attention to the negative as well as the positive effects of COVID-19 on the global tourism industry. This article contributed to a better understanding of the positive side of the pandemic in terms of rethinking, resetting, and redefining the industry in a more sustainable way. The study lays out a conceptual framework for tourism managers and destination planners to identify the pandemic as an opportunity and adopt sustainable solutions to deal with the post-pandemic challenges, thereby developing more sustainable and resilient tourism businesses and destinations.