Summary

Nearly three months after the first cases of COVID-19 were detected in Mayotte, SARS-CoV-2 continues to circulate throughout the department. Certain epidemiological indicators now suggest an apparent stabilization of the epidemic. These results should be interpreted with caution, given the contextual factors.

Several surveillance systems have been established by Santé publique France (SpF) in collaboration with its partners to generate the epidemiological data needed to guide policies to combat the epidemic. The data collected make it possible to monitor the progression of the epidemic and measure its severity. Today, the goal is to mitigate the scale and effects of the epidemic wave.

As of May 28, 2020, 1,669 cases of COVID-19 had been biologically confirmed by the laboratory at the Mayotte Hospital Center and the island’s private laboratory. These facilities can perform up to 200 tests per day when testing supplies are available. To date, more than 6,000 tests have been conducted over the past three months, corresponding to 5,835 individuals who have undergone biological testing for SARS-CoV-2.

Currently, the COVID-19 testing strategy remains unchanged in Mayotte: any patient presenting with clinical symptoms suggestive of COVID-19 must undergo diagnostic testing. However, a bias in case detection cannot be ruled out in recent weeks. Indeed, it is possible that certain situations led clinicians to limit testing when the diagnosis appeared clinically or epidemiologically obvious (isolated anosmia, close contact with a confirmed case). Furthermore, the CHM’s mobile testing teams, which are heavily involved in testing activities on the island, temporarily suspended their operations for 10 days. Furthermore, expanded testing operations around clusters are increasing, which may contribute to a decline in the overall positivity rate. To gain a better understanding of the epidemic’s dynamics, it appears essential to facilitate access to testing for individuals meeting the criteria for testing. This is all the more important in the period following the Eid celebrations, which may have created conditions conducive to the spread of the virus.

Despite the rise in COVID-19 cases across the country, each case is still subject to a telephone or in-home investigation when contact information is available. Following the medical assessment, the investigation aims to determine the source of infection, and a social assessment then evaluates the patient’s ability to self-isolate to limit the spread of the virus. Given the socio-economic vulnerability of a large portion of the population, adhering to the 14-day quarantine remains a challenge for many patients. The Specialized Housing Center has thus helped protect the families and friends of nearly 300 people with COVID-19. The isolation of patients, a key measure in the fight against the epidemic, remains inseparable from the contact tracing process. Systematically conducted around each case, it helps identify vulnerable individuals and break transmission chains. At this stage, it is still carried out by the SpF and ARS teams. To make this system increasingly responsive and effective, efforts are underway to integrate general practitioners and the Mayotte Social Security Fund into the process.

While the COVID-19 pandemic has been affecting Mayotte for several months, investigations continue to reveal a lack of understanding of the disease and its impact. It is possible that the relatively mild severity of the outbreak (low proportion of cases admitted to intensive care and deaths) limits awareness of the risk and, consequently, adherence to prevention recommendations. These findings reaffirm the low level of health literacy among the population, as observed elsewhere in France. Improving this health determinant is a major public health challenge. Progress in this area requires listening to the needs of the public and professionals and jointly developing interventions with all stakeholders involved in public health.

As the population gradually resumes its normal activities, new challenges have emerged regarding epidemic risk prevention. With the reopening of businesses, certain schools, and places of worship, and the lifting of travel restrictions, the focus is now on supporting the population through the easing of lockdown measures by adopting the right habits (physical distancing and mask-wearing). Furthermore, the coming weeks will see numerous events take place that, by their very nature, are conducive to the emergence of outbreak clusters: municipal elections, ceremonies (weddings/manzaraka), festive events... During these gatherings, a single infected person could potentially infect a large proportion of those present, either during their symptomatic phase or within the 48 hours preceding it.

Prevention strategies can now draw on experiences from the early stages of the Mayotte outbreak (clusters linked to municipal elections, law enforcement, and healthcare settings). Indeed, to prevent an increase in viral transmission during the southern hemisphere winter, concrete measures must be implemented by local stakeholders to prevent the emergence of outbreaks.