Pandemic Recedes Research Articles

Developing Asia's fiscal landscape and challenges

While tax revenues steadily rose in the decades prior to the onset of COVID‐19, they continue to lag well behind high‐income countries and some developing peers. The region continues to rely predominantly on indirect taxes, particularly relatively efficient consumption taxes. However, developing Asia's tax structure is less progressive compared to high‐income countries. Government expenditures on education and health, vital for promoting equitable growth, were comparatively modest. Substantial fiscal policy stimulus in response to COVID‐19, combined with the impact of the downturn on revenues, has severely weakened public finances in many countries. The combination of falling revenues and higher spending during COVID‐19 has markedly widened deficits and caused a further rise in debt levels that were already rising. As the pandemic recedes, governments will need to carefully calibrate fiscal consolidation to safeguard fiscal sustainability while protecting the poor and vulnerable.

Lessons from Covid‐19: A narrative and reflective practice review of non‐pharmacological treatments for agitation in Alzheimer’s dementia, in a time of social distancing

AbstractBackgroundAgitation as a behavioural and psychological symptom of dementia is common and distressing for patients and their carers. There are several non‐pharmacological approaches to managing agitation in Alzheimer’s Dementia (AD). Many of these require close interactions with the patient. However, social distancing during the coronavirus pandemic has made many of these interventions impractical. As busy clinicians working on a psychiatric unit managing AD patients with agitation, we wished to explore what we could offer in a time of social distancing. Our study sought to review the literature looking at the non‐pharmacological management of agitation in dementia and reflect on this as clinicians working amid a pandemic. While the pandemic recedes, this review and reflection still offers guidance for the management of agitation in AD whilst reducing the risk of disease transmission. The review would help to keep our most vulnerable safe during future outbreaks of infectious disease.MethodWe conducted a systematic review of the literature to identify non‐pharmacological treatments for the management of agitation in Alzheimer’s disease related dementia. Specifically, we sought evidence related to treatment in inpatient and care facilities. We appraised the evidence about these treatments. We then went on to use practitioner reflection on this evidence to consider the practicalities of implementation during the social distancing restrictions of the Covid‐19 pandemic.ResultMyriad non‐pharmacological therapies exist to help treat agitation in individuals with AD. Of these the evidence suggests music therapies and caregiver education interventions reduced agitation most significantly. We found that the most effective methods tailor treatment to the individual’s preferences and needs and use active engagement in therapies. Non‐group activities and those which do not involve shared equipment are most easily implementable during Covid‐19.ConclusionInterventions which are individually tailored to the patient and involve an active element to them are most effective, however those with an active element are less easily used during a pandemic. Given the evidence base and practicalities of implementation, our review suggests music therapy for those with agitation in AD.

Optimizing Acute Sickle Cell Care at Community Health Partners Medical Center

CONCLUSION Sickle cell disease (SCD) is an inherited disease affecting more than 100,000 Black and Hispanic patients in the US. An adult with SCD has an average life expectancy of 54 years compared to 76 years in a typical US adult. This poor survival rate can be attributed to disease and race-related biases, a lack of standardized procedures and dedicated care providers, and delayed or insufficient pain management in the acute care setting. Delays and disparities in care, particularly pain management in acute care setting, have been identified as one of the key deficiencies leading to a decreased quality of care and patient reported outcomes. This SCD quality improvement project seeks to improve the quality and timeliness of acute sickle cell vaso-occlusive care by utilizing an ED pain pathway, SCD-specific inpatient order sets, and educating providers on care-related biases for patients seeking acute care at Community Health Partners Medical Center (CHP). The primary objective is to improve efficacy, timeliness and patient-centered care in order to optimize health outcomes for patients with SCD seeking acute care at CHP. This is a collaborative effort between ED, Hospitalist and Pain Management teams. By identifying areas of strength and areas for improvement, we can work towards delivering more efficient, effective, and patient-centered care, ultimately leading to better health outcomes for patients with SCD disease in need of emergency services. Using the Epic EMR, a metric dashboard was created for SCD patients to measure time from arrival to ED order placement, time from arrival to medication administration, number of inpatient admissions, and length of stay. We focused on crucial time metrics and patient outcomes to gauge the department's efficiency and quality of care for SCD Vaso-occlusive pain crisis. Our intervention included delivering an educational presentation to the ED providers regarding appropriate recognition and treatment of SCD pain episodes, and by creating ED and inpatient SCD-specific order sets. The baseline data was evaluated from 3/1/2021-2/28/2022, and metrics were followed for one year after implementation of the intervention from 3/1/22-2/28/23. After implementation, the average time from arrival to ED order placement improved from 94.9 minutes to 69.4 minutes, a difference of 25.5 minutes or 27%. The average time from arrival to medication administration improved from 158.5 minutes to 135.3 minutes, a difference of 23.2 minutes or 14.6%. The average length of stay increased from 5.7 days to 8.4 days, an increase of 2.7 days or 32.2%. By providing education and SCD-specific order sets, we were able to significantly decrease the total amount of time to medication administration for SCD patients experiencing acute pain crises. While our methods were aimed at ED providers to simplify the input of orders, it did not address the time for nursing to obtain and administer the medication; future improvements could be made towards educating nursing staff to help administer medications sooner. One complicating factor is that these metrics were evaluated during the COVID pandemic, which was responsible for an overall increase in patient admissions and length of stay during this time period. These additional burdens have strained the ability of providers and nurses to provide timely care to SCD patients, though this will hopefully continue to improve as the pandemic recedes. Additionally, the proportion of ED patients who were admitted for further management decreased marginally from 25/39(61%) to 36/63(57%) though the overall number of patients seeking care in our acute care setting has increased. This increase in the number of patients utilizing our acute care may be partly due to an expanding Sickle Cell program at our facility. This analysis shows that by providing appropriate education and using a standardized order set and pathway, we observed a significant decrease in time to order placement to facilitate a faster administration of medications. While the results indicate positive changes in the acute setting, there are opportunities for continued improvement, particularly in reducing the time from order placement to medication administration to ensure more efficient, effective, and patient-centered care.

AI, Analytics and a New Assessment Model for Universities

As the COVID-19 pandemic recedes, its legacy has been to disrupt universities across the world, most immediately in developing online adjuncts to face-to-face teaching. Behind these problems lie those of assessment, particularly traditional summative assessment, which has proved more difficult to implement. This paper models the current practice of assessment in higher education as influenced by ten factors, the most important of which are the emerging technologies of artificial intelligence (AI) and learning analytics (LA). Using this model and a SWOT analysis, the paper argues that the pressures of marketisation and demand for nontraditional and vocationally oriented provision put a premium on courses offering a more flexible and student-centred assessment. This could be facilitated through institutional strategies enabling assessment for learning: an approach that employs formative assessment supported by AI and LA, together with collaborative working in realistic contexts, to facilitate students’ development as flexible and sustainable learners. While literature in this area tends to focus on one or two aspects of technology or assessment, this paper aims to be integrative by drawing upon more comprehensive evidence to support its thesis.

Estimating the uncertain effect of the COVID pandemic on drug overdoses.

U.S. drug-related overdose deaths and Emergency Department (ED) visits rose in 2020 and again in 2021. Many academic studies and the news media attributed this rise primarily to increased drug use resulting from the societal disruptions related to the coronavirus (COVID-19) pandemic. A competing explanation is that higher overdose deaths and ED visits may have reflected a continuation of pre-pandemic trends in synthetic-opioid deaths, which began to rise in mid-2019. We assess the evidence on whether increases in overdose deaths and ED visits are likely to be related primarily to the COVID-19 pandemic, increased synthetic-opioid use, or some of both. We use national data from the Centers for Disease Control and Prevention (CDC) on rolling 12-month drug-related deaths (2015-2021); CDC data on monthly ED visits (2019-September 2020) for EDs in 42 states; and ED visit data for 181 EDs in 24 states staffed by a national ED physician staffing group (January 2016-June 2022). We study drug overdose deaths per 100,000 persons during the pandemic period, and ED visits for drug overdoses, in both cases compared to predicted levels based on pre-pandemic trends. Mortality. National overdose mortality increased from 21/100,000 in 2019 to 26/100,000 in 2020 and 30/100,000 in 2021. The rise in mortality began in mid-to-late half of 2019, and the 2020 increase is well-predicted by models that extrapolate pre-pandemic trends for rolling 12-month mortality to the pandemic period. Placebo analyses (which assume the pandemic started earlier or later than March 2020) do not provide evidence for a change in trend in or soon after March 2020. State-level analyses of actual mortality, relative to mortality predicted based on pre-pandemic trends, show no consistent pattern. The state-level results support state heterogeneity in overdose mortality trends, and do not support the pandemic being a major driver of overdose mortality. ED visits. ED overdose visits rose during our sample period, reflecting a worsening opioid epidemic, but rose at similar rates during the pre-pandemic and pandemic periods. The reasons for rising overdose mortality in 2020 and 2021 cannot be definitely determined. We lack a control group and thus cannot assess causation. However, the observed increases can be largely explained by a continuation of pre-pandemic trends toward rising synthetic-opioid deaths, principally fentanyl, that began in mid-to-late 2019. We do not find evidence supporting the pandemic as a major driver of rising mortality. Policymakers need to directly address the synthetic opioid epidemic, and not expect a respite as the pandemic recedes.

A dynamic approach to supply chain reconfiguration and ripple effect analysis in an epidemic

The COVID-19 pandemic has illustrated the unprecedented challenges of ensuring the continuity of operations in a supply chain as suppliers’ and their suppliers stop producing due the spread of infection, leading to a degradation of downstream customer service levels in a ripple effect. In this paper, we contextualize a dynamic approach and propose an optimal control model for supply chain reconfiguration and ripple effect analysis integrated with an epidemic dynamics model. We provide supply chain managers with the optimal choice over a planning horizon among subsets of interchangeable suppliers and corresponding orders; this will maximize demand satisfaction given their prices, lead times, exposure to infection, and upstream suppliers’ risk exposure. Numerical illustrations show that our prescriptive forward-looking model can help reconfigure a supply chain and mitigate the ripple effect due to reduced production because of suppliers’ infected workers. A risk aversion factor incorporates a measure of supplier risk exposure at the upstream echelons. We examine three scenarios: (a) infection limits the capacity of suppliers, (b) the pandemic recedes but not at the same pace for all suppliers, and (c) infection waves affect the capacity of some suppliers, while others are in a recovery phase. We illustrate through a case study how our model can be immediately deployed in manufacturing or retail supply chains since the data are readily accessible from suppliers and health authorities. This work opens new avenues for prescriptive models in operations management and the study of viable supply chains by combining optimal control and epidemiological models.

Assessing access: Surveying user services at library high density storage facilities

Millions of library items are held in storage locations, but how well are libraries providing access to those materials? A survey of North American research libraries was conducted to examine the services that were available at library storage facilities for researchers and students before the global pandemic, during the pandemic, and as libraries adjust and plan for the new normal as the pandemic recedes. In addition, results of previous studies of storage facilities are compared to understand historical trends in access to library materials held in storage. A better understanding of user services as a component of library storage facilities will allow libraries to better serve the needs of scholars and researchers as well as provide insight to those who may be planning future library storage facilities.

Delivery of Comprehensive Medication Management and Other Clinical Services via Telehealth by Pharmacy Type

Background: The recent coronavirus pandemic accelerated the need to deliver pharmacy-related services remotely. Objective: To describe experiences with providing comprehensive medication management (CMM) and other clinical services via telehealth by pharmacy type, before and during the COVID-19 pandemic. Methods: An online survey of pharmacists, representing 27 pharmacies, was conducted to capture telehealth usage in three pharmacy types: independently owned, integrated into a clinical setting, and retail chain. A sub-analysis was performed to assess if providing CMM services via telehealth helped, resulted in no change, or worsened the care of different patient groups (e.g., those with diabetes, were low-income, aged 65+ years). Results: During the pandemic, telehealth usage among independently owned pharmacies and those integrated into a clinical setting increased, but no change occurred among retail chain pharmacies. This usage increase in the first two pharmacy types occurred despite limited investments in connectivity-related resources to support telehealth services. Pharmacists from both independently owned pharmacies (63%) and those integrated into a clinical setting (89%) reported CMM via telehealth reached patients they would not otherwise have been able to reach during the pandemic. Most pharmacists/pharmacies found telehealth to be a feasible and acceptable method of delivering CMM. Conclusion: Pharmacists and pharmacies are now experienced with and have interest in continuing CMM via telehealth, even as the pandemic recedes. However, investments in telecommunications resources, training support, technical assistance, and continued telehealth reimbursement from health plans are needed to sustain this service delivery model.

COVID-19 PANDEMIC: LESSONS FOR THE FUTURE THROUGH A WINDOW OF OPPORTUNITIES

The Coronavirus Disease (COVID-19) pandemic has caused substantial overt and covert damage in terms of mortality, morbidity, and socioeconomic losses. This adversity has provided healthcare professionals with an opportunity to examine worldwide patterns and inadequacies in order to develop appropriate strategies for anticipating, preventing, detecting, and managing such disasters in the future. It has also provided the world with a unique opportunity to explore the patterns of the global inequalities. Some of the positive effects of the pandemic are highlighted and food for thought presented to the global scientific community to permit a focus on assessing the impact on other aspects, too. It is imperative to note that many developing countries, like Pakistan, were able to tackle the problem effectively through their national organisations. There is a need to ensure perpetuation of the services of these agencies, even as the pandemic recedes. The experience and lessons of monitoring, evaluation and data collection capabilities are of immense importance with regard to planning, utilising resources and mitigating outcomes of similar or different situations. The experiences gained can serve as a basis for the development of disease registries, community-based prevalence studies, particularly mental disorders, to permit development of a variety of public health strategies.

Facing the future of transit ridership: shifting attitudes towards public transit and auto ownership among transit riders during COVID-19.

The online version contains supplementary material available at 10.1007/s11116-022-10344-2.

What's best, online or on-site? The write a scientific paper course.

The ability to publish is a career-critical skill but requires the acquisition of a wide and disparate skill set. The Write a Scientific Paper (WASP) course was created in Malta in 2010, an intensive, three-day event. WASP is an accredited event held in Malta, London, and Bahrain. The COVID pandemic forced WASP to go online. This study compared satisfaction with WASP online as opposed to in-person by analyzing course feedback pre- and post-pandemic. Google forms are used to collect anonymous feedback on a Likert scale for various aspects of each WASP. The period 2017 to 2022 was used to compare four courses on-site and five courses online. Feedback on: Rate lectures, handouts, WASP overall and how likely are you to recommend WASP was compared. Response rates were >60% and almost all Cronbach's Alpha values were >0.7. High satisfaction scores were achieved in all four questions (>4/5). There were no significant differences except in lectures, which scored well but fared slightly worse overall online. Migrating online does not necessarily lead to change/s in presentation contents but transforms delivery. Our results indicate that WASP is accepted online but the slightly lower lectures score implies that WASP might be better delivered in-person than online. However, students remained happy to recommend WASP and this accords with other studies that overall, student satisfaction with online education is common. It is hoped that as the pandemic recedes, webinars complement and not continue to totally replace traditional in-person meetings.

Formation mechanism of the quarantine hotel booking intention of potential consumers.

In this paper, we investigated the quarantine hotel (QH) booking intention (BI) of potential consumers from a corporate social responsibility (CSR) perspective. Mixed methods were adopted to explore the formation mechanisms of QH BI of potential consumers when the COVID-19 pandemic recedes. In Study 1, we constructed a theoretical model of QH BI of potential consumers based on grounded theory and put forward research propositions. In Study 2, we tested the robustness of the model and identified the mediating effect through two situational experiments. The research results showed that: (1) Potential customers are more willing to book QHs than normal hotels (NHs). (2) Multiple mediating mechanisms are involved in the effect of the operation as a quarantine facility on BI of potential consumers, including “QH-corporate social responsibility (CSR)-customer trust (CT)-BI” and “QH-CSR-customer gratitude (CG)-BI.” This research not only has theoretical significance for deepening and expanding social exchange theory and hotel CSR theories but also provides guidance for the participation of the hotel industry in the prevention and control of the COVID-19 pandemic and hotel marketing after the pandemic ends.

The TROLLEY Study: assessing travel, health, and equity impacts of a new light rail transit investment during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic disrupted life in extraordinary ways impacting health and daily mobility. Public transit provides a strategy to improve individual and population health through increased active travel and reduced vehicle dependency, while ensuring equitable access to jobs, healthcare, education, and mitigating climate change. However, health safety concerns during the COVID-19 pandemic eroded ridership, which could have longstanding negative consequences. Research is needed to understand how mobility and health change as the pandemic recedes and how transit investments impact health and equity outcomes.MethodsThe TROLLEY (TRansit Opportunities for HeaLth, Livability, Exercise and EquitY) study will prospectively investigate a diverse cohort of university employees after the opening of a new light rail transit (LRT) line and the easing of campus COVID-19 restrictions. Participants are current staff who live either < 1 mile, 1–2 miles, or > 2 miles from LRT, with equal distribution across economic and racial/ethnic strata. The primary aim is to assess change in physical activity, travel mode, and vehicle miles travelled using accelerometer and GPS devices. Equity outcomes include household transportation and health-related expenditures. Change in health outcomes, including depressive symptoms, stress, quality of life, body mass index and behavior change constructs related to transit use will be assessed via self-report. Pre-pandemic variables will be retrospectively collected. Participants will be measured at 3 times over 2 years of follow up. Longitudinal changes in outcomes will be assessed using multilevel mixed effects models. Analyses will evaluate whether proximity to LRT, sociodemographic, and environmental factors modify change in outcomes over time.DiscussionThe TROLLEY study will utilize rigorous methods to advance our understanding of health, well-being, and equity-oriented outcomes of new LRT infrastructure through the COVID-19 recovery period, in a sample of demographically diverse adult workers whose employment location is accessed by new transit. Results will inform land use, transportation and health investments, and workplace interventions. Findings have the potential to elevate LRT as a public health priority and provide insight on how to ensure public transit meets the needs of vulnerable users and is more resilient in the face of future health pandemics.Trial registrationThe TROLLEY study was registered at ClinicalTrials.gov (NCT04940481) June 17, 2021, and OSF Registries (https://doi.org/10.17605/OSF.IO/PGEHU) June 24, 2021, prior to participant enrollment.

Trauma, Compassion Fatigue, and Burnout in Nurses: The Nurse Leader’s Response

Within health care, trauma-informed care has become an embedded approach in caring for patients; however, nurse leaders are not always prepared to lead nurses with a background of trauma. Nurses’ past trauma, coupled with workplace stressors, may result in compassion fatigue, burnout, and secondary traumatic stress. Nurse leader engagement and trauma-informed leadership approaches are imperative to mitigate and mediate the effects of trauma in nurses as the COVID-19 pandemic recedes.

Bhutan: 2022 Article IV Consultation-Press Release; Staff Report; and Statement by the Executive Director for Bhutan

The pandemic has had a substantial impact on the economy, straining pre-pandemic gains in income and poverty reduction. The wide-ranging policy measures, including containment protocols, rapid vaccination and booster campaigns, direct income support, and policy support for borrowers and businesses, mitigated the adverse impact on lives and well-being. As the pandemic recedes and in light of the uncertainties from the war in Ukraine, the focus needs to be on securing livelihoods and ensuring strong and job-rich medium-term growth, while minimizing any persistent adverse effects from the pandemic and mitigating risks.

Stack Ensemble Oriented Parkinson Disease Prediction Using Machine Learning Approaches Utilizing GridSearchCV-Based Hyper Parameter Tuning

Since the coronavirus came into existence and brought the entire world to a standstill, there have been drastic changes in people's lives that continue to affect them even as the pandemic recedes. The isolation reduced physical activity and hindered access to non-COVID related healthcare during lockdown and the ensuing months brought increased attention to mental health and the neurological disorders that might have been exacerbated. One nervous system disorder that affects the elderly and needs better awareness is Parkinson's disease. We have machine learning and a growing number of deep learning models to predict, and detect its onset; their scope is not completely exhaustive and can still be optimized. In this research, the authors highlight techniques that have been implemented in recent years for prediction of the disease. Models based on the less redundantly used classifiers-naive Bayes, logistic regression, linear-support vector machine, kernelizing support vector machine, and multilayer perceptron-are initially implemented and compared. Based on limitations of the results, an ensemble stack model of hyper-tuned versions using GridSearchCV out of the top performing supervised classifiers along-with extreme gradient boosting classifier is implemented to further improve overall results. In addition, a convolutional neural network-based model is also implemented, and the results are analyzed using two epoch values to compare the performance of deep learning models. The benchmark datasets-UCI Parkinson's data and the spiral and wave datasets-have been used for machine and deep learning respectively. Performance metrics like accuracy, precision, recall, support, and F1 score are utilized, and confusion matrices and graphs are plotted for visualization. 94.87% accuracy was achieved using the stacking approach.

Networking While Long-Term Unemployed: Why Long-Term Unemployment Will Likely Persist Long after the COVID-19 Pandemic Recedes

By early 2021, due to the economic downturn accompanying the COVID-19 pandemic, over four million Americans were long-term unemployed (LTU). Getting rehired requires overcoming employer stigmas about LTU workers, which most LTU workers believe is most plausible with the help of referrals from social ties. While research on the structures and effects of networks abound, this paper examines the far less studied process of networking among LTU jobseekers. Exploring the networking process is imperative for understanding the emotional toll and structural obstacles facing LTU workers in the post–COVID-19 pandemic period. Going beyond individualizing explanations, I use in-depth interviews to uncover the structural conditions that make networking challenging for all LTU jobseekers. Contrary to static conceptualizations of ties as social capital, a metaphor implying that ties are static resources, this paper argues that more attention needs to be paid to the processes and structural conditions that facilitate or hinder the activation or formation of socialties. Specifically, it shows that, under conditions of precarity and stigma, networking can undermine workers’ identities as valued and moral, leaving them feeling discouraged and ethically challenged in a way similar to used car salespeople.

Public Health Scotland - the first year: successes and lessons.

Over its first year Public Health Scotland (PHS) played a key role in the national vaccination programme by providing professional leadership and expertise. We expedited the reporting of all aspects of the pandemic, and accelerated rapid evidence reviews. We contributed to rigorous research showing that: vaccination reduced hospitalisation by 90%, and the transmission of COVID-19 within households by 55%; hence vaccination works. Lessons for the future included strengthening whole genome sequencing to manage COVID-19 and to prepare for future pathogens. COVID-19 also stimulated the redesign of many health and social care services: by exploiting digital media; by implementing evidence on reducing barriers to service delivery; and by greater integration - of projects rather than organisations - enabling groups who had not worked together to address common issues. PHS and partners soon recognised the need to mitigate the adverse impact of the pandemic on existing inequalities. So we aim to 'build back fairer' as the pandemic recedes, by pursuing PHS's four priorities: poverty; children and young people; place and community; and mental health and well-being.

INNV-38. COVID-19 INDUCED TELEMEDICINE LESSONS FOR CLINICIANS CARING FOR PATIENTS WITH PRIMARY BRAIN TUMORS

BACKGROUNDThe COVID-19 pandemic triggered a rapid conversion from in-person to video-visits for new patient consultations and follow-up visits. Now with available vaccines and declining case rates efforts are underway to return to in-person visits as they provide more revenue and are viewed as best for patients and clinicians. This abstract reviews these assumptions.METHODSElectronic medical records from seven full-time faculty neuro-oncologists at Johns Hopkins Hospitals were retrospectively reviewed from 4/1/20 to 3/31/21 to examine the use of video visits over time and their patient demographics.RESULTSFrom 4/1/20 to 3/31/21, 279 new patients were seen (57% video-visits) with a median age of 52 years for both video and in-person visits. Patients came from 15 states for video and 17 states for in-person visits. There were also 2247 follow-up visits (85% video-visits) with a median age of 47 yrs for video and 50 yrs for in-person visits. Patients came from 28 states for video and 14 for in-person visits. No show visits were more frequent for in-person visits. During early months of the pandemic, few patients were seen in the clinics. Thereafter, video-visits rose sharply comprising 93% of follow-up visits in June 2020 and 62% of new patient consultations in September 2020. These rates have remained high (in March 2021, 72% of all follow-up visits and 59% of new patient consultations).CONCLUSIONSDespite reductions in COVID-19 infection rates, our neuro-oncologists continue to favor video-visits for new patient consultations and follow-up visits. Video-visits save patients and caregivers travel time, parking costs, and time away from work. They also allow an acceptable history and neurological exam, participation by many family members, easy sharing of MRI scans and laboratory data, and discussions unencumbered by face masks and shields. These advantages to video-visits remain significant even as the pandemic recedes.

Exploring the role of tourism dependency on COVID-19 induced economic shock in the Small Island Developing States

ABSTRACT All countries have suffered significant economic losses due to COVID-19 but some are affected more than others. A number of vulnerabilities explain the magnitude and differences in the economic shocks felt worldwide. This paper uses Ordinary Least Squares regression techniques to estimate the role of tourism dependency in explaining the differences in the COVID-19 induced economic shock in a sample of Small Island Developing States. The model also includes remittances, natural resource dependency, government debt and a measure of the quality of governance. The results confirm tourism dependency plays a significant role in explaining the cross-country differences in economic shocks. The economies that are more dependent on tourism have suffered larger economic shocks but remittances and natural resources have mitigated the negative impacts. The differences in the quality of governance also matter but debt levels do not explain the cross-country variations in the economic shocks. Hence, these fragile and small island economies need to develop appropriate economic diversification strategies, strengthen traditional economic activities and adapt new strategies, products and innovative business models for their tourism industry as the pandemic recedes and global travel resumes.