ABSTRACT
Tourism was a constantly growing industry until the halt brought about by the COVID-19 pandemic. In cities, its negative impact was increasing, with significant cases of overcrowding. COVID-19 has emerged as an exceptional disruptive stage, yet it is also an opportunity to abandon the rush towards unsustainability. This study is a critical analysis of tourism, looking at the most appropriate post-pandemic perspective for urban cultural tourism, based on sustainability and leaving aside the search for profit as the ultimate goal. The main objective is to make proposals for an alternative paradigm. This is a theoretical paper that draws on a literature review of 180 works of scientific reference. Complementarily, information published by the media is accessed and direct observation is carried out as fieldwork. Proposals are made on limiting the number of visitors, improving guided visits, tourist routes, experiential tourism, and virtual tours. We also propose a new centralised tourism governance and regulation of private agents. Therefore, the present text is of interest for public representatives working in the field of urban tourism. © 2021 Asociacion de Geografos Espanoles. All rights reserved.
ABSTRACT
Introduction: Coronavirus disease 2019 (COVID-19) has been associated with stroke, particular characteristics of these patients are not fully understood. The adequate management of these patients depends on the comprehension of factors such as temporality, clinical presentation and etiology. We hypothesize there is a differential temporal relationship between COVID-19 severity and stroke onset. Methods: Considering PRISMA guidelines, a systematic review of the literature as of July 2020 was conducted and registered on PROSPERO. Pubmed and Scopus studies reporting patients with COVID-19 and stroke were included. Clinical, sociodemographic and laboratory characteristics of patients were extracted and analyzed. Results: Forty-seven studies and 176 patients were included, with a mean age of 63.1 years (SD= 16 n=122), most of them were males (63.2% n=171). The most frequent etiology was cryptogenic (40.9% n=66), and a mean National Institute of Health Stroke Scale of 14.4 points was found (SD= 8.6 n=73). Large vessel occlusion (LVO) was reported in 65.9% patients (n=91) and these patients were younger with greater stroke severity. D-dimer, C-reactive protein, fibrinogen, ferritin and lactate dehydrogenase were elevated in most patients with reported findings. Most patients had severe COVID-19. The mean time from onset of respiratory symptoms to stroke was 9 days (SD=9.9), a shorter time was noted in those with mild and moderate disease compared with the longest time in severe disease, this difference was statistically significant (p< 0.001). Conclusions: There is a trend between the severity of COVID-19 and time to stroke onset, in which mild disease is associated with earlier stroke than severe disease. Age and stroke severity are related to the development of LVO. Inflammation and hypercoagulability markers are elevated in this disease, we propose to consider hypercoagulability secondary to COVID-19 as an underlying cause of stroke in these patients.