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Chapter 1
Health Risks, Pandemics and Epidemics Affecting Tourism: Understanding COVID-19 Pandemic
A. M. Abrantes, J. L. Abrantes, C. Silva, P. Reis and C. Seabra
Abstract
Tourism activity is a global industry and, as such, it is subject to global risks. International travel has developed exponentially over the last few decades. At the same time, diseases have increased their geographical spread influenced by ecologic, genetic and human factors. Currently, the increasing virus, epidemic and pandemic outbreaks represent some of the most negative consequences of globalization, causing deaths and significant economic losses due to the negative impacts they have on the tourism industry, one of the sectors that have been the most affected by health crises.
This work presents insights on the epidemics, pandemics and virus outbreaks that have occurred throughout the twenty-first century and how those occurrences have affected the tourism industry and the global economy. A brief literature review on health risks in tourism is presented, followed by a clinical perspective to help people understand the differences between endemics, outbreaks, epidemics and pandemics. Then, the study offers a presentation of the most significant pandemics in recent human history and a deep analysis of the COVID-19 disease. Finally, the effects that the different pandemics, epidemics and outbreaks that occurred in the present century had on tourism are explained, and the challenges tourism has to face are presented and discussed.
Keywords: Health risks; epidemics and pandemics; impacts on tourism; COVID-19; virus outbreaks; challenges for tourism industry
1. Introduction
The spread of infectious diseases via human travel has become a huge risk to tourism. When a pandemic occurs, the tourism industry is profoundly affected because tourists tend to avoid travelling (Qiu, Park, Li, & Song, 2020).
Given the growing insecurity driven by health epidemic, the attractiveness of a tourism destination is mostly influenced by the safety it provides (Poku & Boakye, 2019). On the other hand, tourists are becoming increasingly aware of health risks and safety conditions. Consequently, they adjust their travel behaviour and destination choice accordingly (Mertzanis & Papastathopoulos, 2021). Therefore, health safety and security are now the central concerns of tourism and leisure settings.
Health risk is one of the factors that could endanger the safety and security of both tourists and host communities, and despite significant progress in medicine, tourists and residents are still susceptible to health risks (Jonas, Mansfeld, Paz, & Potasman, 2011). One of the main factors that can contribute to the spread of infectious diseases is travelling, especially by plane, because a given infection can reach a new area of the globe within few hours (Morens, Folkers, & Fauci, 2009). In fact, the current pandemic showed how travel industry can not only be affected by diseases but also contribute to its spread.
The ongoing COVID-19 global pandemic has disrupted our world. Worldwide, countries have enacted lockdowns and quarantines, imposed social distancing, the closure of schools/universities, public services and non-essential businesses, cancelled flights, closed borders, imposed travel bans and cancelled or postponed global, national, regional and local events. Travel restrictions have affected 90% of the world's population and have had a huge impact on national economies and particularly on the tourism industry as they managed to disrupt the tourism systems at the international and domestic level. At the same time, consequences were felt in various areas of the economy and society. The impacts that this pandemic will have on tourism varied due to the complexity of the situation (Zenker & Kock, 2020). There are changes in tourism behaviour, modification in resident behaviour and alterations in the tourism industry that will have long-term and indirect effects (Zenker & Kock, 2020).
The main goal of this work is to bring insights into the epidemics, pandemics and virus outbreaks that occurred in the course of the twenty-first century and how those occurrences have affected the tourism industry and the global economy. Starting with a brief literature review on health risks in tourism, the chapter continues with a more clinical perspective focussing on concepts that, for a less informed mind, could seem similar, such as endemic, outbreak, epidemic and pandemic. Then, the article presents the main pandemics that the world has had to face in recent years. A deep analysis of the COVID-19 disease and of its impacts on the tourism industry and the global economy is also provided. The final discussion focussed on the challenges that health risks bring to the tourism industry.
2. Health Risks in Tourism
Risks are the sum of negative outcomes (Le & Arcodia, 2018) and the existence of danger, harm or loss (Reisinger & Mavondo, 2006). In this context, risks are related with uncertainty and the undesirable and with the adverse consequences of behaviours, decisions or situations (Dowling & Staelin, 1994). Risk in tourism is a shock, a threat and a crisis that can negatively affect the tourism industry (Law, 2006). Risks are international tourists' major concerns (Schroeder, Pennington-Gary, Kaplanidou, & Zhan, 2013), whether they are absolute or real, subjective or perceived (Haddock, 1993).
There are several types of risk associated with travel and particularly to international tourism: physical, financial, functional, mechanical, organizational, political instability, psychological, satisfaction, terrorism, natural disasters and social and health risks (Adam, 2015). However, physical risks are those that affect tourists' physical and psychological well-being and are related to health issues, natural disasters, crime, political instability, violence and terrorism. Evidence shows that they all have a major impact on tourists' decisions (Seabra, Reis, & Abrantes, 2020).
Health risks refer to the development of diseases as a result of travel and tourism experiences (Huang, Dai, & Xu, 2020). It is the possibility of becoming sick or contracting certain kinds of diseases while travelling (Michalko, 2004). Health risks are inherent to travel activities. Tourists are more likely to catch diseases because of their high-risk exposure to pathogens, bacteria, parasites and viruses when they travel to another unfamiliar region (Aliperti, Nagai, & Cruz, 2020; Jonas et al., 2011). Some of the most common diseases affecting tourists are traveller's diarrhoea, typhoid, amoebic dysentery, hepatitis A and C, HIV/AIDS, cholera, flu viruses or tuberculosis, among others (Uğur & Akbıyık, 2020). The risk of getting one of these diseases depends on the disease itself, on the destination and on the kind of behaviour adopted by tourists, i.e., the prophylactic measures previously taken, the handling of food and beverage, the type of sexual activities they choose to undertake, the way they participate inlocal habits and traditions, etc., that will have a great effect on the likelihood of being infected with one of those contagious diseases (Uğur & Akbıyık, 2020; Mertzanis & Papastathopoulos, 2021).
Among all the health risks faced by tourists, infectious diseases are those potential travellers are more concerned with (Reisinger & Mavondo, 2006). However, epidemics and pandemics are the most frightening health-related concerns in tourism because pathogens are highly infectious, mutate quickly and spread rapidly beyond frontiers (Uğur & Akbıyık, 2020). Although tourists are hesitant to travel to countries facing different infectious diseases, travel arrivals to less developed countries with a strong incidence of such diseases are still growing (Page, 2009). Health problems and infectious diseases are frequently the most commonly perceived health risk for potential tourists when they choose a destination (Steffen, Debernardis, &, Baños, 2003).
3. What Is a Pandemic?
A pandemic is an epidemic occurring worldwide or over a very wide area and affecting a large amount of people. The concept itself does not refer to some essential parameters such as population immunity, virology or disease severity. Furthermore, and despite the theoretical definition, this term cannot be applied to seasonal pandemics (Morens et al., 2009). The phenomenon causes a significant number of deaths worldwide and represents a profound economic and social burden (Akin & Gözel, 2020).
Commonly, epidemiological concepts such as endemic, outbreak, epidemic or pandemic are considered as similar. In fact, they all measure the number of cases of a certain disease over a given moment, comparing the result with the expected number over time and how fast it spreads.
An endemic disease grows at a stable rate. Thus, the number of cases and the case expected are identical. Malaria in Africa, dengue in tropical and subtropical areas, hepatitis B around the world and coccidioidomycosis in the southwestern Unites States and northern Mexico can be included in this category (Morens et al., 2009).
A disease outbreak refers to an unexpected surge in case numbers way above the expected mean. This expression can be applied to an endemic situation with more cases than expected or to a disease that spreads across an area that had never been affected before. This is valid even if a single case is reported in this new region. The phenomenon is usually mentioned when small areas are considered. Some examples are the cholera outbreak after the Haiti earthquake in 2010, Ebola outbreaks in many African countries since 1976 and measles in unvaccinated children that visited a US theme park in 2015 (Brady, Smith, Scott, & Hay, 2015).
An epidemic phenomenon is an outbreak occurred in a larger area. It can be associated with Zika virus initially detected in Brazil in 2014 and that later spread across Latin America and the Caribbean and the Ebola outbreak in West Africa in 2014–2016, later considered as an epidemic given its extension and the US opioid crisis (Morens et al., 2009).
A pandemic is an epidemic situation with a global spread. It is essential to notice that the classification of a certain disease using the aforementioned terms can change over time, as it happened with HIV, for instance, which emerged in West Africa and remained an epidemic disease during decades. Since the late twentieth century, it became a pandemic and has nowadays become an endemic situation (Morens et al., 2009).
4. The Main Pandemics in History
The H1N2 flu pandemic, commonly referred as Spanish flu, was one of the most severe pandemics in history. Approximately one-third of the world's population was infected and 50 million people perished. The disease is caused by an H1N1 virus with genes of avian origin. There is not universal consensus regarding where the virus originated geographically, but it spread worldwide between 1918 and 1919 (CDC, 2018).
The name associated to this disease results from a misunderstanding and there is no clear evidence that proves that it originated from Spain. In fact, Spain assumed a neutral position during World War I, and for that reason, news of the flu was not suppressed by censors, contrasting with what happened in other countries. The first news reporting the flu happened in Spain and King Alfonso XIII got sick one week later. The main vehicles for the spread of pandemics are trade and communication lines, but this flu was disseminated through military mobilization, a fragile healthcare system and poor sanitation. Mortality was high among children under 5 years old, adults between 20 and 40 years old and 65 years and older. Mortality in young groups is a singular fact of this disease. The virus affects mainly the respiratory system because of its ability to produce extensive and rapid damage to the respiratory epithelial cells. About one-third of the population presented clinical symptoms; however, a substantial part of the individuals was asymptomatic or experienced subclinical infect...
