This article aims at analysing the role of international tourism attractiveness as a potential factor for the outbreak and the early spread of the recent COVID-19 disease across the world (also called the first wave) with a special focus on small Island economies. Econometric testing is implemented over a crosscountry sample including 205 countries/territories (with 59 small islands) after controlling for several usual suspects. The results state a positive and significant relationship between COVID-19 prevalence and inbound tourism arrivals per capita. Thus in the early stages of the spread (before travel restrictions), international tourism could be seen as one of the main responsible factors for the recent pandemic, validating the "tourism-led vulnerability hypothesis". Accordingly, considering that such health shocks should be more frequent in the near future, this finding suggests that the tourism specialization model in the context of small islands is too vulnerable to be considered as sustainable in the medium and long-run. Policymakers must opt for economic diversification when possible. Otherwise, building up a strong public-health system alongside a specialized tourism sector is required.