Tourism represents an important economic lifeline and driver of development for small islands. However, the COVID-19 pandemic and its containment measures, in particular travel restrictions are taking a heavy toll on the industry. This chapter aims at analysing the impact of COVID-19 on tourism in two islands in the Indian Ocean region namely La Réunion and Mauritius. The chapter uses information from secondary sources and qualitative data from 55 semi-structured interviews with key stakeholders in the two islands to probe into the impact of the pandemic on the industry. The study examines the effects of the health containment measures on tourism in terms of tourist arrivals, earnings, employment and business activities. We further differentiate between fiscal policies and recovery plans implemented in both islands. The results reveal that despite the containment measures imposed across both islands, La Réunion has more COVID-19 cases compared to Mauritius but the case-fatality rate is much higher in the latter with 1.40 which is nearly twice as much as that of La Réunion at 0.73. Mauritius has been more stringent in terms of reduced mobility and mandatory 14 days quarantine on travellers which have had a larger negative impact on its tourism industry relative to La Réunion. The fight against COVID-19 in both islands is framed as a trade-off between public health (lost lives) and the economy (lost livelihoods). The policy dilemma seems to bend more towards the tourism industry for La Réunion to prevent economic slowdown. Instead, Mauritius has opted for public health and as such lost livelihoods from the tourism industry but its fatality rate tends to be much higher.