ABSTRACT
Coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China, in December 2019 as an out-break of pneumonia of unknown origin. Previous studies have suggested the utility of chest computed tomography (CT) in the diagnosis of COVID-19 because of its high sensitivity (93%-97%), relatively simple procedure, and rapid test results. This study, performed in Japan early in the epidemic when COV1D-19 prevalence was low, evaluated the diagnostic accuracy of chest CT in a population present-ing with lung diseases having CT findings similar to those of COVID-19. We retrospectively included all consecutive patients (18 years old) presenting to the outpatient department of Keio University Hospital between March 1 and May 31, 2020, with fever and respiratory symptoms. We evaluated the perfor-mance of diagnostic CT for COVID-19 by using polymerase chain reaction (PCR) results as the refer-ence standard. We determined the numbers of false-positive (FP) results and assessed the clinical utility using decision curve analysis. Of the 175 patients, 22 were PCR-positive. CT had a sensitivity of 68% and a specificity of 57%. Patients with FP results on CT diagnosis were mainly diagnosed with diseases mimicking COVID-19, e.g., interstitial lung disease. Decision curve analysis indicated that the clinical utility of CT imaging was limited. The diagnostic performance of CT for COVID-19 was inadequate in an area with low COV ID-19 prevalence and a high prevalence of other lung diseases with chest CT findings similar to those of COVID-19. Considering this insufficient diagnostic performance, CT findings should be evaluated in the context of additional medical information to diagnose COVID-19.
ABSTRACT
Empowering local residents is important for the sustainability of tourist destinations. This study assessed the reactions of residents in tourist destinations towards tourism during and after the COVID-19 pandemic. Models were constructed using variables of place attachment, distinctiveness, positive impact, negative impact, and attitude towards supporting tourism;the effects of COVID-19 were also included. The results demonstrate that residents understand that tourism is important for their region and wish to support it. A dilemma arose for respondents between accepting tourists to aid the recovery of the economy and personal fears that interacting with tourists would raise their possibility of infection. As implications for tourist destination managers, such as governments and destination management organizations, local residents' concerns must be understood and managed accordingly. The destination managers should consider how to accept tourists during and after the pandemic with residents, and empower residents in this process. Communication with residents during the COVID-19 pandemic is important as this might affect their attitude towards tourism after the pandemic.