Does tourism affect the long term course of COVID-19 pandemic in a country of destination? Evidence from a popular Greek island in 2020 where control measures were implemented

Greece opened its points of entry on July 1, 2020, with specific guidelines for travellers arriving by sea, air or land. The aim of this article is to examine the effect of tourism on the long term course of the Coronavirus Disease 2019 (COVID-19) pandemic during the pre-vaccination era (June to December 2020) on the popular Greek island of Crete. To achieve this, a cross-sectional serosurvey, repeated at monthly intervals, was conducted to compare the seroprevalence in Crete with seroprevalence in the mainland of Greece. Crete welcomed nearly 2,000,000 travellers during the 2020 summer season. Left-over serum samples were collected and obtained from public and private laboratories located in Greece, including the island of Crete. These samples were tested for the presence of anti-SARS-CoV-2 IgG antibodies. A total of 55,938 samples were collected, 3,785 of which originated from Crete. In Crete, the seroprevalence ranged between 0% (June 2020) and 2.58% (December 2020), while the corresponding seroprevalence in Greece was 0.19% and 10.75%, respectively. We identified 4.16 times lower seropositivity in Crete (2.58%) in comparison with the mainland of Greece (10.75%) during December 2020. Moreover, the monthly infection fatality rate (IFR) in Crete was calculated at 0.09%, compared with 0.21% in mainland Greece for December 2020. The island of Crete presented more than four times lower seroprevalence than the mainland of Greece, despite being a highly attractive tourist destination. This evidence supports the idea that tourism may not have affected the long term course of the COVID-19 pandemic in Greece. However, due to contradicting results from previous studies, further investigation is needed

Using the Intra-Action Review Methodology at European Level to Assess Effectiveness of Measures for Cruise Ship Operations in the COVID-19 Context

In response to the COVID-19 pandemic, the European Union Joint Action HEALTHY GATEWAYS developed guidelines for cruise operators and authorities to restart operations and provide common COVID-19 public health preparedness and response standards. In February 2022 under the Joint Action framework, a COVID-19 outbreak onboard a cruise ship was analysed, applying the Intra-Action Review (IAR) methodology at a European level. Participants included national public health authorities and local port health authorities involved in the event response, as well as cruise line representatives. Good practices and challenges observed during the COVID-19 event are presented. Moreover, we documented the lessons learned which provided the basis for proposed revisions to future versions of HEALTHY GATEWAYS guidelines

Geographical Variation in Mental Hospital Discharges in Greece: A Nationwide Study (1999–2012)

Background: The primary goal of this study is to estimate the pattern of hospital discharges throughout Greece due to mental disorders between 1999 and 2012. Methods: Data for discharges were obtained from the Hellenic Statistical Authority. A sex- and age-adjusted proportional hospitalization ratio (PHR) was used to estimate the ratio between the hospitalizations in each prefecture and the overall hospitalizations. Additionally, age-adjusted admission rates and hospitalization days were calculated for each sex. Descriptive and time series analysis were conducted to understand the epidemiological characteristics and to investigate the trend of annual PHR, respectively. Correlation between disorders and sociodemographic characteristics was also tested. Global and local spatial analysis was conducted to assess the spatial homogeneity of disorders and to detect any clusters of similar values. Results: More males (55%) were hospitalized. Schizophrenic and other psychoses were stated as the primary diagnosis of discharges (54.3%) for mental disorders, contributing to the highest annual mean number of hospitalization-days for male (296.9) and female patients (341.0). Most patients were out of the workforce, and most patients with drug dependence (74.5%) and schizophrenia and other psychoses (55.9%) remained unmarried. Higher PHRs were discovered in the north, while schizophrenic and other psychoses (R = 0.492), affective psychoses (R = 0.534), senile and presenile organic psychotic conditions (R = 0.543) were correlated with alcohol consumption (p < 0.001). Conclusions: The study provides evidence of geographical variation of discharges due to mental disorders and a significant association between disorders and alcohol consumption, marriage status and absence of the workforce

Using the Intra-Action Review Methodology at European Level to Assess Effectiveness of Measures for Cruise Ship Operations in the COVID-19 Context

In response to the COVID-19 pandemic, the European Union Joint Action HEALTHY GATEWAYS developed guidelines for cruise operators and authorities to restart operations and provide common COVID-19 public health preparedness and response standards. In February 2022 under the Joint Action framework, a COVID-19 outbreak onboard a cruise ship was analysed, applying the Intra-Action Review (IAR) methodology at a European level. Participants included national public health authorities and local port health authorities involved in the event response, as well as cruise line representatives. Good practices and challenges observed during the COVID-19 event are presented. Moreover, we documented the lessons learned which provided the basis for proposed revisions to future versions of HEALTHY GATEWAYS guidelines

Geographical Variation in Mental Hospital Discharges in Greece: A Nationwide Study (1999–2012)

Background: The primary goal of this study is to estimate the pattern of hospital discharges throughout Greece due to mental disorders between 1999 and 2012. Methods: Data for discharges were obtained from the Hellenic Statistical Authority. A sex- and age-adjusted proportional hospitalization ratio (PHR) was used to estimate the ratio between the hospitalizations in each prefecture and the overall hospitalizations. Additionally, age-adjusted admission rates and hospitalization days were calculated for each sex. Descriptive and time series analysis were conducted to understand the epidemiological characteristics and to investigate the trend of annual PHR, respectively. Correlation between disorders and sociodemographic characteristics was also tested. Global and local spatial analysis was conducted to assess the spatial homogeneity of disorders and to detect any clusters of similar values. Results: More males (55%) were hospitalized. Schizophrenic and other psychoses were stated as the primary diagnosis of discharges (54.3%) for mental disorders, contributing to the highest annual mean number of hospitalization-days for male (296.9) and female patients (341.0). Most patients were out of the workforce, and most patients with drug dependence (74.5%) and schizophrenia and other psychoses (55.9%) remained unmarried. Higher PHRs were discovered in the north, while schizophrenic and other psychoses (R = 0.492), affective psychoses (R = 0.534), senile and presenile organic psychotic conditions (R = 0.543) were correlated with alcohol consumption (p < 0.001). Conclusions: The study provides evidence of geographical variation of discharges due to mental disorders and a significant association between disorders and alcohol consumption, marriage status and absence of the workforce

Communication of Public Health Events on Ships through the EU Common Ship Sanitation Database

The coordination of public health events related to ships presents a challenge to the port health authorities, and communication means and routes are not well established. The EU Common Ship Sanitation Database provides a platform for port-to-port communication of public health events on board ships. The last seven years of operation, 64 public health events were communicated through the system by port health authorities from seven EU countries. Although the usage of the platform has been appreciated, promoted, and legislated in several EU MSs, actions at the national and EU levels are needed to promote the use of the platform by all EU MS are necessary

Communication of Public Health Events on Ships through the EU Common Ship Sanitation Database

The coordination of public health events related to ships presents a challenge to the port health authorities, and communication means and routes are not well established. The EU Common Ship Sanitation Database provides a platform for port-to-port communication of public health events on board ships. The last seven years of operation, 64 public health events were communicated through the system by port health authorities from seven EU countries. Although the usage of the platform has been appreciated, promoted, and legislated in several EU MSs, actions at the national and EU levels are needed to promote the use of the platform by all EU MS are necessary

Behavioral and Cultural Insights, a Nationwide Study Based on Repetitive Surveys of WHO Behavioral Insights Tool in Greece Regarding COVID-19 Pandemic and Vaccine Acceptance

Monitoring behavioral and cultural insights during the pandemic is a useful tool to identify factors related to COVID-19 vaccine acceptance and confront the pandemic&rsquo;s vast impact. Data were collected using a questionnaire designed according to the &ldquo;survey tool and guidance&rdquo; provided by the World Health Organization (WHO). Surveys were conducted by a market research company for five consecutive months, with a sample of 1000 individuals recruited per survey. Vaccination acceptance increased from 55.2% to 67.2%, while the percentage of undecisive individuals decreased from 16.3% to 10.6%. The proportion of vaccine resistant participants remained relatively steady (25&ndash;30%). Knowledge about the pandemic and compliance with preventive measures was high (&gt;90%). Factors associated with vaccination included: Increased age, male gender, influenza vaccination, following authorities&rsquo; recommendations, being informed by HCWs or formal information sources, care for others, concern about the country&rsquo;s economic recession and health system overload. Pandemic fatigue was reflected across the surveys, indicated by a decrease in the intention to self-isolate and remain at home when ill. Despite the decrease of undecisive individuals, a firm core of vaccine resistant individuals may be responsible for the relatively lower vaccine coverage compared to northern EU countries. Study results could be useful for developing approaches tailored to a reluctant population

Potable Water Quality on Non-Passenger Ships Calling Belgian Ports

Waterborne disease due to the microbial contamination of potable water onboard ships is a potential threat for seafarers. The results from the samples collected at Belgian ports from 2010 to 2018 during inspections of non-passenger ships are used to evaluate the microbiological and chemical quality of potable water. A small proportion of the samples was found positive for indicator organisms (7.5%), indicating the lack of proper disinfection and possible contamination. Further analyses and risk assessments are recommended for examining possible contributing factors. Inspections for the issuance of SSC should focus on water safety and the prevention of waterborne diseases

Legionella spp. Colonization on Non-Passenger Ships Calling at Belgian Ports

The association of cases of Legionnaires&rsquo; disease and ships has been well documented. Results from potable water samples collected for microbiological analysis during SSC inspections conducted from 2010 to 2018 at Belgian ports were analyzed in order to evaluate the level of colonization on non-passenger ships. Results indicate a high degree of colonization (77.2% of the ships were found to be colonized with Legionella spp. at least once) and further analysis is recommended to examine possible factors associated with colonization. Inspections for issuance of SSC should focus on water safety and prevention of Legionnaires&rsquo; disease