Can tourism development and economic growth mutually reinforce in small countries? Evidence from Singapore

This study investigates the causal relationships between international tourism development and the economic growth of a global city-state - Singapore - drilling into the temporal details of the tourism-economy nexus in small countries. Many studies have examined whether the tourism-led growth hypothesis or the economy driven-tourism growth hypothesis holds in large developed and emerging countries. Still, relatively few studies examine small countries' tourism-economy nexus, and the temporal details of the nexus have not been adequately examined. We examine the tourism-economy nexus in Singapore using quarterly data from 1991Q1 to 2020Q4 and the Autoregressive Distributed Lag (ARDL) Model, with the long- and short-run dynamics and the feedback loop of the nexus considered. Our statistical findings show that international tourism development leads economic growth by two quarters in Singapore. Also, there are both 'consistent' and 'contemporaneous' positive feedback loops between tourism development and economic growth, but those loops cannot last for more than a quarter. From the economic perspective, our study reveals that improving tourism activities may accelerate the post-Covid economic recovery of some small countries that rely on tourism. Yet, continuous input is required to sustain the tourism-economy synergy.

Epidemiology, Risk Factors, Clinical features and Outcome of Candida auris in Royal Hospital over the Last Four Years (2017-2020)

Objectives: Candida auris is a new strain of fungal pathogen that had emerged in many countries worldwide, including Oman. Te invasive infections were linked to high mortality, one of the reasons being multidrug-resistant to major classes of antifungals. Te ability to spread from patient to patient, or from contaminated environment to patients within health care settings and tendency to cause major outbreaks. Te study mainly aims to describe the trend of Candida auris emergence and distributions during the last four years and its outcome. Moreover, we identify the risk factors associated with Candida auris infection or colonization to assess the incidence, susceptibility, and resistance pattern as well as asses the implementations and efectiveness of the infection prevention and control measures applied to control the outbreak. Method(s): A retrospective descriptive cohort was conducted in Royal hospital. Target population are adult patients admitted to Royal hospital from 2017 to 2020, looking for patients positive with Candida auris from any sample (screening and clinical) during the study period were defned as infections or colonization cases. Result(s): Overall incidence increasing in trend since 2017, which is contributed to many reasons including implementation of active surveillance and COVID pandemic. Diabetes milletus and recent admission in another hospital within 6 months were considered statistically significant risk factors in relation to the infection. Mortality rate was 40.0%. Median of length of hospital stay = 31 (1-380). Statistically Significant risk factors in relation to mortality were chronic kidney disease, intubation, infection, and age. Conclusion(s): Early notifcation of the cases is vital for early implementation of infection control preventive measures. Active surveillance at Royal Hospital was refected efectively in controlling the outbreak at the intensive unit care in few months. Current data on the signifcant risk factors will be utilized later to set a criteria for screening high risk patients for colonization.

Retrospective study to measure the uptake of the influenza vaccine in patients with cystic fibrosis

Introduction/Aim: To determine (1) the influenza vaccine uptake of children with cystic fibrosis from 2016 to 2020 and (2) the impact of the COVID pandemic of 2020 and increased uptake of Telehealth outpatient appointments on vaccination rates. Methods: A retrospective audit of children with cystic fibrosis aged 6 months to 18 years who reside in South Australia was performed using the Women's and Children's Respiratory Department cystic fibrosis database from 2016 to 2020. The Australian Childhood Immunization Record (ACIR) was used to determine vaccination status during this period. Results: One hundred eighty-two children with cystic fibrosis were identified, 172 of whom vaccination records were available on the ACIR. Proportion of eligible patients who were vaccinated ranged from 66% to 88% over the 5 year period. There was nil significant decrease in uptake during the COVID pandemic in 2020 (75%). Despite the introduction of Telehealth reviews in 2020 majority (66%) of patients continued to have exclusive face-to-face appointments, of which 73% received the vaccination. Vaccination coverage of those who received combination of Telehealth and faceto- face was 81%. Conclusion: The high influenza vaccination rate of South Australian children with cystic fibrosis is consistent with rates seen in other tertiary centres globally. This audit demonstrated that the COVID pandemic and introduction of Telehealth appointments did not have any measurable uptake of the influenza vaccination our South Australian population.

Paediatric ED attendances viewed through the COVID lens-perspective from an emergency department

Background The COVID-19 pandemic has resulted in significant changes in the healthcare system. Whilst adult services were overwhelmed with sick patients there was an unprecedented decline in paediatric attendances. Objectives The objective is to monitor the trends and understand change in PED attendances so that we can make decisions regarding any planned restructuring post COVID-19. Methods Data from PED attendances and admissions from March 2020 to date was extracted and compared to the same period in 2019. Case notes of children who presented with sepsis/serious illness were analysed to learn if there was a delay in presentation, Results The noticeable difference in 2020 was the 65- 75% reduction in PED attendances for minor acuity illness (URTI, tonsillitis, otitis media, gastroenteritis) Injury visits fell to 65% below normal just after lockdown was announced, increasing to 50% below normal by July and August falling to less than 50% during the second lockdown. Fractures, likely include a significant number of playground injuries, fell to 70% below normal. The 60 - 70% reduction in PED attendances in soft tissue injuries was consistent with both lockdowns and children no longer attending school and possibly reduced participation in sporting activities. There was an initial decrease(20% in April 2020 compared to 2019) followed by an increase in children to the same numbers as seen in 2020 August and September presenting to PED with mental illness as the pandemic progressed with an increasing proportion of children who had not presented to PED before the onset of the pandemic. Dramatic (80%) reduction in respiratory illness(bronchiolitis, pneumonia, croup) was noted in the winter months. December is normally peak season for bronchiolitis and asthma/viral induced wheeze, for the first time such a dramatic reduction in attendance and admissions were noted in winter. The children who presented to PED in 2020 with a serious illness and sepsis presented in a timely manner. Analysis of the timeline of events showed that parents had tried to manage them at home with the help of 111 and virtual GP clinics. When they could not be successfully managed at home, parents were able to correctly identify this and brought them to PED. Conclusions Over the years it has been observed that many children present to the emergency department with minor acuity illness that can be managed at home or by primary care. The pandemic data provides a unique opportunity to view this data, insights from this can be translated into planning services resulting in a sustained reduction in PED visits for minor acuity and self limiting illness. Social distancing to combat COVID-19 and universal precautions appear to have prevented circulation of communicable diseases. Improved compliance with home asthma medication, reduced air pollution levels, and reduced exposure to viral triggers and allergens likely contributed to the reduced number of children with wheeze or asthma. Parents know that hospitals are open and ready to care for their children when they need them, but also feel confident to manage minor ailments at home with watchful waiting.

COVID-19 Case and Contact Investigation in an Office Workspace.

This investigation report describes a case of COVID-19 in a combined military and civilian office workspace and the contact investigation and mitigation efforts that followed. This office space included an embedded public health officer who was able to conduct the contact investigation and advise on the outbreak response. Over a 3-day period, the index case unintentionally exposed 150 coworkers to SARS-CoV-2 through participation in carpools, conferences, and small meetings. Of these exposures 37 were considered medium risk at the time and 113 were considered low risk. A total of 5 contacts reported COVID-like-symptoms at the time of the investigation and another 5 developed symptoms during the 14-day quarantine period and all were directed to self-isolate. None of the contacts required hospitalization and all the symptomatic contacts tested negative for SARS-CoV-2. With the advice and aid of the embedded public health officer, the office authorized telework, conducted thorough cleaning of spaces, distributed informative messaging, conducted virtual question-and-answer forums, and evaluated outbreak policies. This report demonstrates that the close integration of public health and office management can lead to rapid identification of those at risk of infection and implementation of mitigation and control efforts to stop the spread of disease.