Do not travel unless it’s very urgent

The novel Corona Virus Disease 2019 (COVID-19) which originated in Wuhan, China in December 2019 has spread globally affected more than 200 countries and territories across the world with substantial morbidity and mortality as on August 2020.The World Health Organization (WHO) officially declared the COVID-19 epidemic as a public health emergency on 30th January 2020. The high prevalence and fatality rates of the ongoing COVID-19 in developed countries points to the fact that developed economies and rich populations are not immune to the outbreaks of such infectious diseases….
By Dr R K Goyal

Many researches have been published on epidemiology and pathophysiology of COVID-19 which depict that its single strand RNA virus damages the respiratory system in patients. Most of the people who are infected with the Corona Virus may experience mild to moderate respiratory illness and recover without requiring special treatment. Old age people and the patients with underlying medical problems like cardiovascular disease, chronic respiratory diseaseand diabetesare more likely to develop serious illness with human to human transmission without a vector involved. Although the fight against any disease has been an endless task for humanity, the emergence of COVID-19 with characteristics of the top five causes of mortality in the world with no specific therapeutic options available till date. The extensive clinical spectrum of the infection may be a possible reason for increase in mortality rate (figure-1).

When we traced back in December 2019, the first case of COVID-19 was reported by health officials in Wuhan city of China, one of the major reasons for the spread of coronavirus infection was due to the tourists who visited Wuhan. Geographically, Wuhan, capital of China’s Hubei Province, is actually three cities rolled into one. Wuchang, Hankou and Hanyang, which are divided by the Yangtze and Hanjing Rivers, make up the “Wuhan Three Towns.” Wuhan city holds an important place in the country’s military, economic and political development. It is also a major transportation hub in China.

A study done in the initial days indicated that the total number of infections in five major Chinese cities, Beijing, Guangzhou, Shanghai, Shenzhen and Chongqing will peak between late April and early May, according to a model developed by researchers at The University of Hong Kong. During this period 150,000 new cases were reported in Chongqing each day due to the city’s largest population and the high volume of travel from Wuhan to Chongqing. The same model predicts that the number of people showing symptoms in Wuhan will increase more than 50,000 by that weekend. The things were changing rapidly and the model’s estimates rely on many unknowns.

When we tried to analyse, in the initial stages most of the Corona virus patients were travelers. More over many of the Corona virus cases were found in the top most tourism countries where as few cases were reported in the countries where tourism is less. It is evident from the reports that one of the most seriously affected sectors due to COVID-19 is tourism, which is a huge global business that accounts for 10.4 per cent of global Gross Domestic Product (GDP) and 10 per cent of global employment. Nothing seems to slow its growth as year-over-year increases outpace the economy. The United Nations World Tourism Organization predicted further growth of three per cent to four per cent in international tourist arrivals for 2020, with international departures worldwide particularly strong in the first quarter of this year.

In tourism industry, most of the jobs are labour intensive which require relatively short training and spread over different sub sectors like hotels, travel agents, tour operators, transport services, tourist resorts, tourist complexes, and shopping facilities including sales outlets for souvenirs, handicrafts, and so on. A focus on travel and tourism industry can be extremely beneficial for providing jobs for the millions and helps in developing the country’s economy.

In the present perspective article, we have analyzed the relationship of the spread of tourism with the rampant spread of COVID 19.During this analysis conducted in the month of May 2020, the data appeared from the top tourism countries were the most affected areas during COVID-19pandemic. We have analyzed the data reported from various parts of the world by the web portal of Ministry of Health and Family welfare, press reports and some reputed websites. In most of the cases it was observed that tourism played a dangerous role in the Corona virus spread all over the world in the initial days.

In the figure-2, if we analyze critically the Corona virus affected cases are more in the top tourist visited countries. America and Europe are the famous places which attract the tourist on a very large scale and many people visited these countries in comparison to Asia and African region. The Corona virus cases are also high in America and Europe as compared to other regions in the world suggesting tourism can be a contributing factor.

Most of the people visited America as a tourist every year and one of the famous destination for travelers. From the figure, the data indicates that the 54% of Corona virus cases were found in America and it may be due to the travelers visiting from different countries to USA.

TOP AND LEAST TOURISM REGIONS AFFECTED BY COVID-19: AN ANALYSIS

The United Statesof America (USA) is an extremely diverse place in the world culturally and ethnically. The United States of America is a vast country serving a large number of attractions to the global travelers. According to U.S. News & World Report, the three American locations: Yosemite National Park, the Grand Canyon, and Maui, Hawaii comes under the 10 best vacation spots in the world. The best thing about U.S.A is that it offers a wide options for tourism as there are quite nice warm places to go in the winter and cooler places to visit in the summer. New York is the most-visited city in the USA welcomes more than 13 million tourists each year.

The USA was among the first few countries to report cases of COVID-19 infection, since the Wuhan corona virus outbreak in China in December 2019. A public health emergency was declared in USA on 21 January 2020 after the first case in the country was confirmed. More states in USA started reporting COVID-19 cases and rest of the story world knows.

According to the United Nations specialized agency, the global health crisis could lead to an annual tourism decline between 60-80% when compared with the 2019 data. The global international agency said that the pandemic had caused a 22 % fall in international tourist arrivals during the first quarter of 2020.

In Europe, Italy offers some of the most beautiful scenery in all of Europe. The Coliseum of Rome and the canals of Venice are just two of the wonders that bring many tourists every year. According to The World Economic Forum, Spain is the most competitive country in tourism due to its cultural and natural resources for attracting the tourists. Millions of people all over the world visit France for its historic sites, exquisite cuisine, and beautiful scenery every year. In France, Paris is one of the most visited tourist destinations in the world. The European Union instituted a 30-day ban on nonessential travel to at least 26 European countries from the rest of the world.

      

 

       

In the Middle East countries, Jordan is one of the friendliest countries and many things attracts tourists to Jordan. Dubai is one of the best places to visit in the Middle East. The main attraction for tourists is “The Burj Khalifa”, which is taller than two Eiffel towers kept one on top of the other. Oman and Qatar are also the most visited places of attraction for tourists. Doha, the capital city is known as the Shining Jewel of Qatar. In the night, when Doha shines bright, take a long calm walk along the Corniche, walkways beside the sea, and see the glittering lights reflected and immerse yourself in the soothing atmosphere.

In the Middle East as well the reported data shows that Coronavirus cases were more in top tourism destination countries like Iran, Saudi Arabia, and UAE whereas fewer cases found in Israel and Libya due to the less tourism in these countries.

In Africa as well the Coronavirus cases were more in top tourism countries like South Africa, Egypt, and Morocco and fewer cases in Madagascarand Mali due to the less tourist visits in these countries. Asia is a popular destination amongst tourists. Tourism in Asia offers a variety of sightseeing and entertainment options. China, Hong Kong, Malaysia, Singapore, Thailand, Macau, Indonesia, Japan, South Korea, and Taiwan were the top ten and most visited countries in Asia Pacific Countries. China tops the list with 55.6 million tourists annually and is the third most visited country in the world. Second, on the list is Hong Kong which receives 27.8 million visitors every year. The third most popular country in Asia Pacific is Malaysia was 27.4 million people come to visit annually.

In this figure-9,Coronavirus cases were more in Asia Pacific countries like China, Thailand, Japan, and Hong Kong which are popular tourism destinations. In Fact, China is the origin of COVID-19. There are very fewer cases found other countries of Asia Pacific.

What about India
India is the second most populous nation with a large number of young workforces which gave the great opportunity for employment to be provided by tourism. India as a nation is privileged with wide historical and cultural diversity. It presents a wide range of tourist destinations for people of different ages and tastes. This ranges from forest, wildlife, history to a panoramic view of Himalayas. The demand for the Travel and Tourism industry in India is expected to grow by 8% by 2019. The industry was planning to employ 4 million people by the end of 2019-20. The hospitality sector is also expected to double the size in the coming five years. The country seems to be a great destination for tourists worldwide but unfortunately, the tourist arrival growth rate is abysmally low due to the COVID-19 pandemic.

TOP AND LEAST TOURISM STATES OF INDIA AFFECTED BY COVID-19

In India, the states which are majorly affected by COVID-19 are those a state in which foreign travelers visits on large scale. As shown in the figure-10, most cases of covid-19 were recorded in Maharashtra i.e. 25922 till 14th May 2020 as Maharashtra is the top most visited state in India by foreign tourists and boasts of a large number of popular monuments, Bollywood and colonial architecture. Aurangabad is the tourism capital of Maharashtra and the tourism hub for historical monuments and heritage sites.

The Coronavirus cases are more in top tourism states like Maharashtra, Tamil Nadu, Uttar Pradesh, Delhi, and Rajasthan whereas fewer cases found in the least tourism states in India like Arunachal Pradesh, Chhattisgarh, Jharkhand, Manipur, and Tripura. One among the seven wonders of the world, Taj Mahal in Agra is the most popular monument among the foreign travelers, and in Uttar Pradesh, the higher number of cases were reported in Agra.

GOVERNMENTAL CONTROL
The outbreak of COVID-19 has brought the world to a standstill, and tourism has been the worst affected of all major economic sectors. The spread of infectious diseases is universally linked to travel. But the theory was way before the new Corona virus hit China and then started spreading very rapidly to the rest of the world with two hundred countries. The impact of travel to and from China and rapid spread of this new Corona virus however, has been devastating. Airlines, including Air Canada, have cancelled all flights or significantly reduced the number of flights in and out of China. China closed its land border and Hong Kong shut down its borders, cross-border ferries and railways.

The rapid spread of COVID-19 around the globe has thrown the international travel industry into chaos. The WHO is recommending that elderly travelers and those with underlying health conditions delay or avoid travel to areas that are experiencing ongoing transmission of COVID-19. Many countries around the world, including the United States of America, have imposed travel restrictions to help curb the spread of the Corona virus Airport closures, the suspension of all incoming and outgoing flights, and nationwide lockdowns are just some of the measures countries are adopting in an effort to contain the pandemic.

On March 19, the State Department issued a Level 4 “Do not travel” advisory, recommending that United States of American citizens to avoid any global travel. This is the highest travel advisory any federal agency can issue. During the same week, the European Union instituted a 30-day ban on nonessential travel to at least 26 European countries from the rest of the world. At least 93% of the global population now lives in countries with coronavirus-related travel restrictions, and with approx. 3 billion people residing in countries enforcing complete border closures to foreigners, as per the recent analysis by the Pew Research Center. This list of countries and territories that have restricted travel, pulled from official government reports and the State Department, will be updated as new measures are announced.

When Chinese officials were underplaying the intensity of the Corona virus outbreak, no travelers from China were screened for potential exposure to the virus during the first half of January 2020. Health screening began in mid-January, but only for some travelers who had been returning from Wuhan and only at the airports in Los Angeles, San Francisco, and New York. By that time, about 4,000 people had already entered the United States of America directly from Wuhan, according to Vari Flight, an aviation data company based in China. The measures were expanded to all passengers from China two weeks later. Ex President Trump didn’t impose bans on European travelers, including those from Corona virus -ravaged Italy, until mid-March. That, along with events such as Mardi Gras, and returning cruisers from nine Nile River cruises in February and early March contributed to the rapid spread of Covid-19 in the United States.

When the first two Covid-19 cases were detected in Maharashtra in India the state did not impose the lockdown in January and February right up to March 9. Dr. Avinash Bhondwe, President of the Indian Medical Association, Maharashtra, put the blame on travelers returning from the United Arab Emirates for the initial spurt in cases. “In Maharashtra, more than 40% of the infections were through the travelers who returned from the UAE,” he said. “Even though Maharashtra’s first case was of a Dubai returnee, the state government waited for 10 days to start screening of travelers from the UAE. That was a major loophole in the screening process.”

Indian airports began universal screening only in the third week of March. By then, on average, 42,000 international travelers landed in Mumbai every day. On March 22, India banned all domestic and international passenger flights to and from Indian airports. “By then, it was too late,” said a Maharashtra state health department official, who wished to remain anonymous. “We had thousands of fliers coming into Mumbai every single day and only a handful of them were screened for symptoms. What we cannot know for certain is the number of asymptomatic patients from the United States, the United Kingdom, Singapore, and other south-east Asian countries that may have passed through Mumbai international airport between February and March 22.” Dr. Bharat Purandare, infectious diseases expert, Deenanath Mangeshkar Hospital, Pune, said in an earlier interview to HT, “In retrospect, we can say that the government should have implemented the universal screening of all passengers mandatory at the initial stage. Also, we should have stopped the international flights in the first week of March.”

LOOPHOLES IN TRAVEL RESTRICTIONS
 No travelers from China were screened potentially by the US government till Mid-January.
 Ex President Trump didn’t impose bans on European travelers, including those from Corona virus ravaged Italy, until mid-March.
 Italy implemented the ban on travelers quite later.
 In Maharashtra, more than 40% of the Corona virus cases were the travelers who returned from the UAE. Even the state government waited for 10 days to start the screening of the UAE travelers.
 In India the initial screening started for only china travelers who were coming from china not from other countries. In result we have seen the 14 cases were found of the Italy travelers at very initial stage.

The Corona virus affected countries would have been focused to control tourism on time so that the situation could be managed effectively. But at that time there was not much idea how aggressively this tourism will be the source of Corona virus spread all over the world. If they would have taken precautionary measures like to stop the entry of tourist, complete lockdown in the premises, not allowing the tourist to travel during the pandemic situation, screening of tourists, etc.

To conclude, we presume that the Corona virus cases were more in top tourism countries as compared to least tourism countries. We have also discussed the implications and the measures that could have been taken by different countries to combat the transmission of this deadly infection which has heightened the global Corona virus those tourism destination countries might have given preference to tourism for economy rather than the lives of people.

(The author is Vice Chancellor, Delhi Pharmaceutical Sciences & Research University, New Delhi)