Tag Archives: covid-19

COVID-19_Vaccine_GLA-Kobre POV

COVID-19: Is a Vaccine the Answer?

Point of View: Looking through the Lyme disease lens in weighing the vaccine and treatment path for COVID-19

 

by Robert Kobre, Chairman, Global Lyme Alliance

The United States is currently in a struggle between “opening up” to alleviate economic hardship and self-isolation to protect against infection from the current coronavirus. The nation can only return to pre-COVID-19 economic and social levels when the fear of death or grave illness is eliminated. As Chairman of the Global Lyme Alliance (GLA) I bring a unique perspective to this issue, as I have been deeply involved in our leading scientific research program for the last 10 years. The immune system is an extremely complex system that protects us from everyday exposure to harmful agents. Although new discoveries are constantly being made, one thing is clear that the public needs to understand, –the human immune system is not fully understood by scientists and doctors, and neither are most infectious agents. This incomplete knowledge of our immune system does not mean there is no hope, – it does mean that the general public must become well informed of this “knowledge gap” so there is no rush to judgment on any proposed solution to the current health crisis.

Thought leaders in industry, the media, and government constantly sing the same COVID-19 recovery song: “when there is a vaccine we can operate normally again.” The stock market is overreacting to morsels of embryonic vaccine research news. Dr. Anthony Fauci, head of infectious disease at NIH, has consistently referred to the development of a SARS-Cov-2 vaccine and its necessity before society can return to a ‘new’ normal. Friends, colleagues, and clients echo this all the time. The problem is that this proposition is short-sighted and focused on the wrong target. While a safe, effective vaccine is an important long-term objective, the primary focus must be effective treatments that can eradicate the virus, prevent it from infecting cells and also turn down the massive inflammatory “cytokine storm” triggered by the infection. Perhaps a genetic component in our immune system also plays a role in determining who cannot fight the disease. All angles should be intensely explored.

We should take comfort that scientific leaders and large pharmaceutical companies understand the need for speed and are focusing heavily on therapeutics while vaccine work continues in parallel. If Americans knew a simple trip to the pharmacy would stop their COVID-19 symptoms, fear would cease and the economy could safely reopen. If this were given prophylactically, it would also reduce the infection rate while a safe vaccine is finally developed. According to ClinicalTrials.gov and the World Health Organization, there are at least 1,300 COVID-19 clinical trials underway worldwide, and importantly the number of trials focused on therapeutics (drugs) outnumber those searching for a vaccine by almost 10 to 1. Why, despite the rhetoric, should there be a greater focus on a drug to stop the symptoms of COVID-19 over a vaccine?

Drugs provide great flexibility, their side effects are typically reversible once a patient stops using them, and they are easily acceptable and accessible by the general population. Vaccines are an important arsenal in the fight against disease, yet vaccines carry risks because they tamper with an immune system we don’t fully understand. Further, vaccines are one dose fits all versus a drug whose dose and usage can vary depending upon the patient’s profile like age or their symptom severity. A vaccine’s side effects (other than fever) are typically harder to measure because they occur over long time periods.

Since a vaccine’s serious side effects tend to be autoimmune in nature, they are typically not reversible as opposed to an approved drug where the side effects tend to cease when the drug is stopped (excluding those taken during pregnancy). Lastly, not everyone will be quick to be vaccinated but would be more likely to take a drug for a period of time. The COVID-19 crisis provides an opportunity for the drug approval process to be reinvented in a creative way to expedite the process with reduced costs. Vaccines do not offer that luxury. A vaccine is critical to wiping out the disease, but it must not be rushed.

A case in point occurred in the late 1990s. A new Lyme disease vaccine was introduced which was developed by some of the top researchers in the world. The vaccine was widely distributed and for most people, it worked, but for some, it may have triggered the devastating symptoms of Lyme disease. Measuring the side effects of vaccines once launched is difficult as it requires patients or their doctors to realize that current symptoms are related to a vaccine taken many months before and have enough confidence in that causal effect to report the side effect voluntarily to the federal Vaccine Adverse Effect Reporting System (or “VAERS”). While some specialists today claim the side effects of the Lyme vaccine were overplayed, there was in fact a component of the vaccine that caused an auto-immune reaction consistent with Lyme disease. The vaccine was taken off the market three years after it was introduced.

At GLA, we have Ph.D.s on staff who work closely with top immunologists and microbiologists at the world’s leading research universities. What we know is important for the American public to understand – not only are researchers still learning how the immune system works, but scientists across the globe and GLA are also looking closely at the interplay between the immune system, nervous system, and the brain. Unfortunately, we are only in the 2nd inning of a 9-inning game. As such, the neurological and psychological side effects of any new SARS-Cov-2 vaccine must be included in the suite of side effects measured – in kids, teens, young adults, adults, and the elderly. A new vaccine must be carefully developed, tested, and all side effects measured over an extended period so the public can be fully informed of the risks.

So Lyme disease again provides a lens into which we can view the COVID-19 landscape. We learned that vaccines can have real downside risks if not developed correctly. We learned that in most cases they do not help those already ill. We learned that a safe vaccine is extremely important but in the short term drugs to stop the virus and its symptoms are critical. Let’s hope that the constant discussion in the media tying economic recovery to a vaccine does not lead to rushed vaccines that may unwittingly carry side effects that negatively impact more people than the vaccine saves. Global governmental leaders, media pundits, the financial markets, and captains of industry must get in sync with pharmaceutical firms and academic researchers who understand the quickest way to normalize life again is with effective drugs. We all want a vaccine that eliminates COVID-19 from the globe like was developed for polio and smallpox. In the meantime, as that vaccine is being developed, GLA has confidence that American and global researchers will come up with effective drug treatments as long as they are provided abundant resources, inducements to collaborate and encouragement to think outside the box. GLA has been fighting a rapidly growing, crippling disease for a long time, and our research program has developed more scientific breakthroughs than any other Lyme focused not-for-profit organization. We are uniquely qualified to bring what we have learned in the lab and our experiences to the COVID-19 problem in an effort to educate and bring relief to the nation and the world.


Additional COVID-19 and Lyme Disease Resources:

GLA POV: Parallel Pandemics: COVID-19 and Lyme Disease
Blog: Q&A on COVID-19 and Lyme Disease with LLMD
Blog: Personal Patient Experience with COVID-19 and Lyme Disease
Video: Webinar with Dr. Cameron and Lyme-COVID-19 patient
Letter: GLA CEO Addresses COVID-19 and GLA Community
Letter: GLA Chairman on What We Can Learn from COVID-19 Response

pandemics_ecology_food production

Pandemics, Ecology, and Food Production: Is There a Connection?

Why and how do pandemics emerge? Is there a connection between our ecosystems and global food production?

 

by Mayla Hsu, Ph.D., Director of Research and Science, GLA

Why do infectious disease pandemics emerge? In the Lyme disease community we think a lot about how Lyme and tickborne diseases originated as infections in wildlife. Ticks transmit Borrelia burgdorferi, the bacteria which causes Lyme disease. Interestingly, COVID-19, which has killed more than 200,000 people on six continents, also emerged from animals.

SARS-CoV-2, the virus that causes COVID-19, has been traced to live animal markets in China. Lyme disease and COVID-19 are both zoonotic infectious diseases, meaning illnesses that originated from animals. Digging deeper we find parallels between Lyme, COVID-19, and other emerging infectious diseases which not coincidentally link ecosystems, species diversity, and global food production systems.

An important study found that since 1940, 70% of emerging infectious diseases arise from wildlife. Humans become infected by proximity to animals that are hosts to pathogens, which initially infect only a low number of either animals or humans. The relative density of these new hosts amplifies the pathogens’ ability to further transmit disease. In recent years, the role of diverse ecosystems on human health has become better understood. A systematic review published in 2010 concluded that when ecosystem biodiversity declines, human disease emergence and transmission are likely to increase.

Lyme disease illustrates this principle well. The natural host for B. burgdorferi is the white-footed mouse, which is not only the most abundant small mammal in the northeastern U.S., but also the most competent at allowing B. burgdorferi to replicate and support immature tick feeding. Together with its resilience in surviving in both species-rich and species-poor ecosystems, the white-footed mouse is an ideal reservoir species for the Lyme pathogen.

In contrast, the Virginia opossum is a poor host for B. burgdorferi replication, and it kills most ticks it encounters. So if opossums and mice share a forest, opossums act as a buffering species by reducing both tick numbers and the quantity of infected ticks. Predators are important too—foxes and coyotes hunt mice and thereby reduce Lyme disease risk. However, opossums, foxes, and coyotes are less abundant in the fragmented forests where humans now live in increasing numbers. In these places, mice are plentiful. Thus, diminished species diversity is tied to the increasing transmission of Lyme disease to humans.

The importance of diverse species in reducing pathogen transmission has been observed in other human disease systems as well. West Nile virus, for example, is harbored by specific species of birds, and is transmitted to humans through mosquito bites. Schistosome worms grow in snails, and infect humans who come into contact with contaminated water. Both West Nile virus and schistosomes are reduced when their hosts live among a healthy diversity of non-host birds or snails, respectively.

But what drives species loss, diminished ecosystem diversity, and disease emergence? The United Nations estimates that by 2100, there will be more than 11 billion people. Feeding this increasing population is a major stimulus of these linked problems. This is because expanding and intensifying agriculture, aquaculture, and food distribution will mean industrialization of natural ecosystems, which will reduce native biodiversity on a scale that will dwarf present-day endeavors.

Historically, economic development has reduced infectious diseases and poverty. For instance, increasing sanitation, access to clean water, and medical infrastructure, especially in rural areas, are undeniably positives. But irrigation, land-use changes, and increased agrochemical and antibiotic use have had an enormous impact on species diversity, and human-animal proximity.

Dams, reservoirs, and irrigation networks, though beneficial in distributing fresh water, have also been associated with increased mosquito-borne diseases such as malaria and filariasis. Moreover, the increased density of farm animals has led to large increases in antibiotic use, which has been linked to drug-resistant bacterial infections in humans. Influenza epidemics due to recombined viruses that circulate between domestic poultry and swine, and Mad Cow disease are also the result of industrialized agriculture.

Bushmeat hunting also demonstrates how food imperatives lead to disease. Human immunodeficiency virus (HIV) reached pandemic levels in the 1980s. Closely related to a monkey virus, it first gained the ability to infect humans when hunters ate monkeys. Increased development and travel facilitated the spread of the virus, with poverty, civil conflict, and malnutrition further fueling the crisis. By the end of 2018, 32 million people had been killed by HIV/AIDS.

And COVID-19 illustrates this paradigm as well. Pangolins are the most trafficked mammal on the planet, despite being a highly endangered species. They are valued as food and their scales are used in traditional Asian medicine. Comparison of the viral genomes of SARS-CoV-2 with coronaviruses isolated from bats and pangolins shows their close relatedness. The pangolin virus, in particular, is very similar to the human virus in a key part of the virus’s spike protein. This part of the protein binds to the receptor on human airway cells, known as ACE2, and may account for the ability of the virus to infect humans. Isolating such coronaviruses from multiple illegally smuggled pangolins strongly suggests they very well may be the animal host from which the virus moved to humans.

It is discouraging that feeding the world means the destruction of ecosystems and human exposure to new diseases. What can we do to mitigate or prevent these problems? First, preservation of healthy ecosystems, with adequate numbers of predators and competitors of pathogen hosts like rodents, may keep vector-borne diseases in check. Helping local communities improve healthcare infrastructure, human population control, and education may further reduce deforestation or overhunting of single species like pangolins.

Future human population growth is expected to occur mostly in developing, tropical countries. In these places, subsistence farming, hunting, fishing and gathering must be optimized to sustain local biodiversity and improve crop yields. Further, improved animal and human hygiene would reduce antibiotic use, and boosting nutrition in humans will improve immune functioning in people who are the first to be exposed to new pathogens.

Globally, enhancing genetic diversity in food plants and animals will help mitigate disease risk. Research on optimal land use may identify better ways to preserve habitat while farming. And, as always, improved education, early disease surveillance followed by action can help us to prevent the next zoonotic pandemic.


Additional COVID-19 and Lyme Disease Resources:
Video: Watch Webinar Q&A with Dr. Daniel Cameron and patient Jennifer Crystal
GLA POV: Parallel Pandemics: COVID-19 and Lyme Disease
Blog: Q&A on COVID-19 and Lyme Disease with LLMD
Blog: Personal Patient Experience with COVID-19 and Lyme Disease
Letter: GLA CEO Addresses COVID-19 and GLA Community
Letter: GLA Chairman on What We Can Learn from COVID-19 Response

GLA_COVID-19 resistant_Antibiotics_Virus

Why Are Virus Infections Like COVID-19 Resistant to Antibiotics?

While many bacteria can be treated with antibiotics, it’s not the same for virus infections like COVID-19

 

by Mayla Hsu, Ph.D., Director of Research and Science, GLA

Why can’t we treat COVID-19 with antibiotics? The disease, which has now caused billions of people to be isolated at home, starts as a mild flu-like illness that is self-limiting in most people, but can be devastating or fatal in others. Without effective treatment or a vaccine, reducing the community burden by closing down all public gatherings and practicing social distancing when we do venture out is one of the few ways to slow down the rate of new infections by SARS-CoV-2, the virus that causes COVID-19 disease.

Treating the sick before advanced disease develops would reduce the need for precious intensive-care hospital beds and ventilators, and keep people alive. A course of outpatient medication, like using antibiotics to treat bacteria, could prevent localized outbreaks from becoming epidemics. But antibiotics aren’t the answer because they don’t work on viruses.

There are key differences between bacteria and viruses as life forms. Bacteria are independent, free-living organisms. When they are given the right growth media that supplies nutrients and energy sources, they can multiply in test tubes or on culture plates. Their DNA encodes the potentially hundreds of proteins they need for growth, survival and replication.

Viruses are much smaller in size and are dependent on other living organisms to survive. They are obligate parasites, which means they must hijack cells in order to survive. In the case of SARS-CoV-2, the viruses stick to cells of the human airway epithelium, infect and then commandeer the cell’s own machinery to manufacture progeny virus particles. After efficiently copying themselves, and often killing the host cell in the process, the new viruses go on to infect neighboring cells.

The genomes of viruses can be made of RNA or DNA, and being much smaller than bacterial genomes, they sometimes encode as little as a handful of proteins. In the early days of virology, biologists debated whether viruses were truly alive, because of their lack of replication in the absence of living cells. Many viruses synchronize their division with cell division, since the host cell’s own functions can be  co-opted for virus replication.

Since the virus life cycle is intimately tied to the life of the host cell, antibiotics, which target bacterial components and metabolism alone, are useless for killing them. Antibiotics specifically target bacterial proteins or organelles, the building materials within bacteria, that are absent in viruses. An example is doxycycline, an antibiotic that is commonly used as an inhibitor of Borrelia burgdorferi, the bacterial cause of Lyme disease. During bacterial protein synthesis, doxycycline binds to bacterial 30S ribosomes. This prevents proteins from being made, and without proteins, bacteria can’t grow and replicate. Viruses don’t have ribosomes. Instead, they use the ribosomes of host cells to make their proteins.

The entwining of the viral life cycle with host cells also means that we must take care not to harm our cells with antiviral drugs. The first HIV nucleoside analog drug, azidothymidine (AZT), was originally tested as a potential anticancer drug because it showed promise at blocking DNA replication. Such a drug would thus slow or stop tumor growth. However, it showed much higher inhibitory activity against the HIV replication enzyme, which is called reverse transcriptase, than for cellular DNA polymerase. While treatment of HIV with AZT alone was unsuccessful, its discovery opened up an entirely new class of drug development, that paved the way for more successful combination therapy used today. Finding or discovering drugs that selectively target proteins of the virus relative to those of the host cell means that toxicity can be minimized.

What does this mean for treating COVID-19? Experience and understanding shows us that antibiotics that target bacteria will be ineffective for killing SARS-CoV-2. But active drug discovery programs that include a thorough grasp of how the virus replicates and an understanding of antiviral drug candidates will lead to effective treatments. For example, remdesivir, a drug that targets the SARS-CoV-2 RNA replication protein is now in clinical trials, with results expected in late April.

Other promising drugs are also undergoing rigorous trials. With testing that includes proper controls, we can maximize drug efficacy, avoid toxicity and save lives. We can also hope to “flatten the curve,” or reduce hospital admissions, if we can find effective therapies to treat people early in the course of their COVID-19 disease. In these tough times, science and knowledge will bring us our answers.  Such drugs might also be effective when, not if, the next novel coronavirus begins its sweep across the globe.


Additional COVID-19 and Lyme Disease Resources from GLA:

GLA POV: Parallel Pandemics: COVID-19 and Lyme Disease
Blog: Q&A on COVID-19 and Lyme Disease with LLMD
Blog: Personal Patient Experience with COVID-19 and Lyme Disease
Letter: GLA CEO Addresses COVID-19 and GLA Community
Letter: GLA Chairman on What We Can Learn from COVID-19 Response

covid-19_lyme disease_robert kobre

What Can We Learn from Our Response to COVID-19?

What can we learn from Lyme disease patients and our work in tick-borne disease research that can be applied to the current COVID-19 crisis?

 

by Robert Kobre, Chairman of the Board, Global Lyme Alliance

Most of us in the United States are currently living in extreme fear of contracting the new coronavirus, and our anxiety levels are at all-time highs. Few populations in the U.S. can empathize with this extreme anxiety more than those who already suffer from weakened immune systems, and the debilitating health condition known as Lyme disease. Infection by SARS-CoV-2—the virus that causes COVID-19—is transmissible person-to-person while Lyme disease is a bacterial infection contracted through the bite of an infected tick. However, Lyme patients can relate to the uncertainty of diagnosis, fear of failed treatment, and the impact of isolation.

There are an estimated 427,000 new cases of Lyme disease in the U.S. each year, with as many as two million people projected to suffer from post-treatment Lyme disease by the end of 2020. Global Lyme Alliance is leading the research effort to find the answers through science that will provide for a reliable diagnostic test and effective treatments. We also work every day to address the fears, anxiety, and pain faced by Lyme patients and their families. So, what have we learned trying to tackle Lyme disease that can be applied to the COVID-19 crisis?

Timely and accurate diagnostic testing is the key factor in the management and treatment of both diseases. Current diagnostic testing for Lyme disease infection is very unreliable, with as many as 57% of patients falsely testing negative. Like COVID-19, symptoms may be indicative of something other than Lyme, leaving the patient stressed, unsure of what to do and frightened. The consequences of a missed diagnosis in both diseases can be devastating. Unlike COVID-19, death resulting from Lyme disease is rare. However, Lyme disease can be crippling physically, mentally and emotionally for months, years or even a lifetime, and unless treated early there is no definite cure. The Coronavirus and Lyme bacteria are complex pathogens, both of which will require massive focus and funding to eradicate.

As of the morning of April 14, 2020 there are more than 550,000 confirmed cases of COVID-19 in the U.S., and the number continues to grow rapidly. However, when COVID-19 first came to the U.S., both its presence and severity were minimized. People who were afraid and cautious about limiting contact with others were mocked, told they were paranoid, that it was “in their heads”, and that it was no different than the regular flu. This same dismissive and belittling attitude has consistently been directed against long-suffering Lyme patients, who are similarly told they are paranoid, alarmist and irrational for worrying about being in high-risk places outdoors.

COVID-19 has forced sheltering-in-place and social distancing on people who live in fear of interacting with others who may be infected. Similarly, people who live in endemic areas of Lyme disease fear going outdoors and interacting with nature where they can easily contract Lyme disease and other debilitating tick-borne diseases. Every step on the grass, walk in the woods, or something as simple as going to one’s mailbox could mean a lifetime of incapacitation. So, the Lyme community understands what America is going through.

Everyone hopes that a cure or vaccine for COVID-19 will arrive soon. The virus’s eradication, and the immune response to it, must be the top priority of our governmental leaders, America’s research universities, R&D centers, and pharmaceutical companies.

In time, and thanks to American know-how, creativity, outside-the-box thinking, and pure grit, we will find ourselves on the “other side” of this pandemic nightmare. When we do, let us hope that we have learned to be more compassionate and sensitive toward our fellow citizens who may be suffering from other devastating illnesses where testing is uncertain, cures elusive, and fears very real. At GLA, our hearts and prayers go out to all those suffering from COVID-19 or have lost loved ones to this cruel and isolating disease.


Additional COVID-19 and Lyme Disease Resources:

GLA POV: Parallel Pandemics: COVID-19 and Lyme Disease
Blog: Q&A on COVID-19 and Lyme Disease with LLMD
Blog: Personal Patient Experience with COVID-19 and Lyme Disease
Letter: GLA CEO Addresses COVID-19 and GLA Community

parallel pandemics_covid-19_lyme disease

Parallel Pandemics: COVID-19 and Lyme Disease

Are there connections between COVID-19 and Lyme disease?

by Timothy J. Sellati, Chief Scientific Officer, GLA

There is only one region on the globe with no cases of COVID-19. Except for Antarctica, every continent has confirmed cases of disease. Total cases in the rest of the world are quickly nearing one million, according to data from Johns Hopkins University, with nearly 50,000 deaths reported due to the virus. COVID-19, caused by the novel SARS-CoV-2 virus, is a pandemic of the highest magnitude, and was officially declared as such by the World Health Organization (WHO) on March 11, 2020.1

What defines a pandemic?

According to the Centers for Disease Control and Prevention (CDC), infectious diseases are defined by the number of cases usually present in a community. The starting point or baseline is the endemic level of the disease. On the other end of the spectrum, highly transmissible and/or deadly infections that spread across the globe and can impact tens or hundreds of millions are considered pandemic diseases. Throughout history, a rogue’s gallery of pathogens have caused pandemics that include influenza, cholera, HIV/AIDS, and smallpox, to name a few.

Believe it or not, two infectious diseases from which interesting parallels can be drawn are COVID-19 and Lyme disease. Both began as sporadic, clusters of disease, referring to an aggregation of cases grouped in place and time that are suspected to be greater than the number expected. COVID-19 emerged in Wuhan, within Central China’s Hubei province, and Lyme disease in Lyme, Connecticut in the northeastern U.S. Both rapidly evolved to become hyperendemic, characterized by persistent, high levels of disease occurrence. When the amount of disease in a community rises above an expected level, it becomes epidemic in nature, with sudden increases in the number of cases over a larger geographic area than anticipated. Sometimes, an epidemic stays contained to a specific area—but when it extends into other countries and spreads across continents, it becomes a full-blown pandemic. That was the case in 2003 with the outbreak of severe acute respiratory syndrome (SARS), the 2009 outbreak of swine flu caused by the H1N1 flu virus, and now SARS-CoV-2 in 2020, which is a close ‘cousin’ of SARS.

Is Lyme disease a pandemic like COVID-19?

While Lyme disease clearly meets the definition of an epidemic one could persuasively argue it too has achieved the level of a pandemic. Although Lyme disease lacks the mortality rates associated with COVID-19 it certainly meets the definition of a pandemic with regard to its global distribution, along with other tick-borne diseases (TBDs), and its annual case incidence rate of hundreds of thousands of people globally is estimated to be as high as 500,000. According to WHO, in addition to the U.S. there are concentrated areas of Lyme disease cases in northwestern, central and eastern Europe, and forested areas of Asia.2 It’s estimated that as many as 427,000 cases may occur annually in the U.S.

How are pandemics treated differently?

When epidemics evolve into pandemics, the biggest difference is that more governments are involved in and more financial resources – public and private – dedicated to preventing the progression of the disease and, potentially, treating the people who have it. Unfortunately, this is where similarities between COVID-19 and Lyme disease diverge. Unlike for COVID-19, there is no concerted and comprehensive effort to stem the global increase in TBDs or to treat patients suffering from them.

Despite this difference, another unfortunate commonality between COVID-19 and Lyme disease is the fear, anxiety, and confusion experienced by individuals who are unsure whether they are infected or not. Do the sometimes subjective, non-specific symptoms they are experiencing mean they are infected, or are they suffering from something else? This is true of both SARS-CoV-2 or Borrelia burgdorferi, the causative agent of Lyme disease. Where can they get tested, how accurate are the tests, what treatment options are available and will they work for everyone, etc.? Can tests distinguish uninfected from asymptomatic infected individuals and how about people who are actively infected vs. those with prior exposure who have recovered?

The medical community is rallying to develop a set of rapid and reliable direct diagnostic tests for SARS-CoV-2 or indirect tests to detect antibodies raised against the virus. Although many clinics still lack access to a robust, accurate and sensitive SARS-CoV-2 test, impressive progress has been made in a matter of weeks. In contrast, it took almost six months to identify and establish assays for the coronavirus responsible for the 2002–2003 SARS outbreak.3 Following the 1995  recommendation of the CDC, the majority of laboratory tests performed for diagnosis of Lyme disease are based on a two-tiered test algorithm that detects antibodies against B. burgdorferi in serum of suspected Lyme patients.4 These original recommendations for serodiagnosis of Lyme disease relied on an initial enzyme immunoassay (EIA, 1st tier) followed by separate IgM and IgG Western blots (2nd tier), if the EIA test result is positive or borderline. While the two-tiered test algorithm works well for later stages of the infection, it has low sensitivity during early infection. With accuracy ranging between ~43% to 65% for early Lyme disease diagnoses, as many as 57% of these patients may receive a false negative result.5 Such poor diagnostic performance would be devastating to current efforts to stem the spread of SARS-CoV-2 across the globe!

Recently revised CDC recommendations now allow for replacing the Western immunoblot assay with a second EIA6 and efforts are underway to develop tests with improved accuracy in early detection of Lyme disease. This is important as it is recognized that early detection increases the likelihood of effective treatment with antibiotics such as Doxycycline. Another significant draw back to existing indirect, Lyme diagnostic testing, which looks for the presence of antibodies against B. burgdorferi, is that it cannot distinguish active vs. prior infection. In the latter case, people have been successfully treated and no longer experience symptoms associated with the original infection. Not knowing whether someone is actively infected or not makes the medical decision to continue or alter treatment particularly difficult.

Many of these same diagnostic shortcomings in the Lyme disease field also hamper efforts to fully understand who is infected with SARS-CoV-2 and likely to be shedding virus, who is not, and who has recovered. This uncertainty results in a great deal of fear, anxiety, and confusion on the part of those seeking diagnosis and treatment. Although Lyme disease patients do not suffer the same mortality rates as those with COVID-19, the long-term consequences of prior infection associated Lyme disease can encompass arthritis, carditis, and neurological complications, particularly cognitive deficit and neuropsychiatric disorders. Collectively, such debilitating and chronic symptomatology leads to diminished quality of life and the increased likelihood of depression and suicidality. And in rare cases, Lyme disease can result in death.7

In summary, while Lyme does not share the same rate of infection and death as other pandemics it can have a negative impact on patients by imposing long-term health and immune-compromising challenges that can linger for years. It is important to appreciate that diminished immunity, as a result of Lyme disease and other TBDs, can make patients more susceptible to a pandemic like COVID-19. Ideally, investment of sufficient resources to mount a concerted and comprehensive effort to stem the global increase in Lyme disease and other TBDs would be made, as it is being made to combat COVID-19.

References:
1https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020
2https://www.who.int/ith/diseases/lyme/en/
3https://www.nejm.org/doi/full/10.1056/NEJMoa030747
4https://www.cdc.gov/mmwr/preview/mmwrhtml/00038469.htm
5https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168613
6https://www.cdc.gov/mmwr/volumes/68/wr/mm6832a4.htm
7https://academic.oup.com/cid/article/52/3/364/307928

Additional COVID-19 and Lyme Disease Content:

Blog: Q&A on COVID-19 and Lyme Disease with LLMD
Blog: Personal Patient Experience with COVID-19 and Lyme Disease
Letter: GLA CEO Addresses COVID-19 and GLA Community

Lyme Disease Physician Answers Questions About COVID-19

Patient-Doctor Q&A: Lyme Disease and COVID-19

Interview by Alex Moresco

I have spent the last few weeks like many of you inundated and overwhelmed by the sheer enormity of the news coverage about COVID-19. Separating fact from fiction is growing increasingly difficult as panic permeates our community. Typically trustworthy media sources are misreporting the COVID-19 pandemic. As someone living with Lyme disease, POTS and SAD, I sought out factual, science-based knowledge on COVID-19. Toward that end, I recently sat down with Dr. Casey Kelley, an Integrative and Functional Medicine specialist (and LLMD), and the founder of Case Integrative Health, who has been reporting live from Chicago as an Illinois COVID-19 expert on Fox 32, Chicago.

Dr. Casey KelleyDr. Kelley graduated from The Ohio State University College of Medicine and completed her residency in Family Medicine at St. Joseph Hospital in Chicago.  She is a ten-year member of the Institute of Functional Medicine (IFM), a Director on the board of The International Lyme and Associated Disease Society (ILADS), and is a Founding Member of the Academy of Integrative Health and Medicine (AIHM).  Dr. Kelley is also on the faculty at the Feinberg School of Medicine at Northwestern University.

Dr. Kelley answered the following questions submitted by members of the tick-borne disease community.

Q:  First of all, what is COVID-19, and what are the early symptoms we should look out for?

A:  COVID-19 is a new type of coronavirus that is causing mild to severe symptoms in our population. Most people will have a mild form of the illness while some who have underlying medical conditions, those who are over 60,  smokers and those who are immunocompromised are at a higher risk of developing a more severe form of the illness.

Check in with yourself regularly. The most common symptoms to look out for are a fever of 104 or higher, a dry cough and difficulty breathing. Some people are also noting a loss of smell and taste. Less common symptoms include headache and GI upset. Keep in mind, it is also cold, allergy and flu season—if you start to show COVID-19 symptoms, do not panic!

Q:  How is COVID-19 spread so quickly from person to person? Is this virus airborne?

A: As a doctor that is sitting with patients all day, every day, I am constantly seeing respiratory illness. If you have respiratory symptoms it might not be COVID-19, but all respiratory illness is generally contagious so treat this like any other illness and self-quarantine.

COVID-19 can spread through respiratory droplets produced when an infected person coughs or sneezes. It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it, and then touching their own mouth, nose, or possibly their eyes. So you are not likely to catch it just from being in the same grocery store with someone who is sick.

Many of my patients have been asking me—does this spread before you show symptoms? Yes, just like with the flu, it is possible to spread the infection before you know you are sick. Just because you feel well doesn’t mean that you cannot transmit the infection.

Q:   As someone with other conditions—like Lyme disease—are there extra steps I should be taking to stay safe from COVID-19?

A: There are certain precautions we can take to stay safe. Remember, do not panic, but be cautious. Avoid contact with people who are presenting COVID-19 symptoms. Stay home and self-quarantine if you feel like you are sick. Avoid public gatherings and practice social distancing, this is how we will keep from spreading the illness faster than our hospital systems can handle. At the most basic level, do not touch your face, do not shake hands, use hand sanitizer with 60% or more alcohol content, and avoid touching things like doorknobs, elevator buttons, and credit card scanners.

Talk to your doctor about ways you can help boost your immune system: supplements, IVs, peptides, etc. One of the most important aspects to treating Lyme disease is boosting the immune system so it can fight off the infection) and protect you from viruses and other illnesses you might come in contact with.

Q:  What should I do if I think that I could have possibly come into contact with someone who has COVID-19?

A: First, assess your symptoms, a persistent fever of 103-104, a dry cough and difficulty breathing could be symptoms of COVID-19. If you feel you are unwell, self isolate and then you should call your doctor to discuss your condition and situation. They can help best determine if you need testing.

Q:  As someone who is chronically ill, and now worried about COVID-19, what are some simple things I can do to reduce my anxiety?

A:  Manage your anxiety and stress (which suppresses your immune system) the best way you can.  Find time to reach out to loved ones, take time for self-care—bubble bath anyone?— gratitude, laughter. These are some of the strongest things you can do to stay safe in this time. Set up a phone call with your therapist if you regularly see one. Try not to consume too much news. Set time limits on how much news you watch day to day, and your anxiety should lessen.

Let’s also touch on the importance of lifestyle and self-care. Get adequate levels of sleep, avoid processed foods, eat foods rich in vitamins and minerals. Exercise if you can and get outside!

Q: With the medical community having to adapt to accommodate the COVID-19 outbreak, what has the greatest challenge been?

A: With COVID-19 sweeping the U.S. our work feels like it has greater purpose— to keep patients safe from the progression of the novel coronavirus, and aid in keeping our hospital systems from becoming overburdened and kept available for the most critical COVID-19 cases. In our efforts, we have moved all of our patients to virtual visits. We have also launched small group visits virtually, so we can aid more patients day to day to support their health and immune function during such a critical time. We are happy to help those who are immune-compromised, at any time.

Q:   If you aren’t considered high risk but do have cold and flu symptoms, what is the best course of action?

A: The best thing you can do is call your doctor and immediately socially isolate yourself. The important thing to remember during this time is that most will recover from COVID-19, but we must protect our immunocompromised friends.

Q:  Generally-  what antiviral and immune support protocols should we be following?

A: Supplemental support is crucial right now and we should all be practicing preventative medicine in the coming weeks. If you want to boost your immune system, I recommend: vitamin A 25,000 IU 1-2x/day (NOT if pregnant or if trying to become pregnant), vitamin D 10,000-15,000 IU daily, vitamin C 3,000-6,000 mg daily (watch for upset stomach as a side effect and if so reduce dose), zinc lozenges, elderberry and anti-viral herbs as directed. As always, this is not meant to be taken as medical advice, so please consult your doctor.

Q:  Is it safe to take walks in the neighborhood while you are working from home and you are considered healthy?

A: Yes, absolutely! Get outside to breathe fresh air! And exercise is necessary for everyone right now, if possible. Please practice social distancing and stay six feet away from others on the sidewalks. But don’t forget to make eye contact and wave hello to people you see.

You can find Dr. Casey Kelley on Instagram and her website.

*If you suspect you may have COVID-19, please call the office of your health care provider.

Related Posts:
Letter from CEO About COVID-19 and GLA Community 
Corona With a Twist of Lyme
Alex Moresco’s Podcast: In The Lymelight


Alex Moresco on StageOpinions expressed by contributors are their own.

As someone who lives with Lyme & other illnesses, Alex Moresco’s mission in life is to help others and better the lives of those living with tick-borne illness. As the co-founder of two separate fundraising events in Chicago, She’s raised over  $350,000 for Global Lyme Alliance.

You can find Alex Moresco on Instagram.

covid-19_letter from ceo_GLA

Letter from CEO About COVID-19 and GLA Community

The well-being of our community is an ongoing priority for Global Lyme Alliance (GLA). The current COVID-19 pandemic has created a new set of challenges for everyone, especially those whose health is already challenged due to tick-borne illness. We sincerely hope that you and your families are staying safe.

Based on guidance from the CDC and trusted health authorities, the GLA staff is working remotely. While we are not physically in the office, I want to assure you that we are working and here to support you. We have also asked our family of volunteers, including our Lyme education ambassadors, to postpone all live, in-person education programs for the time being.

Virtual and online resources:

  • Virtual support groups. If you regularly attend in-person support groups, consider finding an online group, or ask your local group if they will be conducting meetings virtually
  • Peer mentor support. GLA offers free peer-to-peer mentor support for patients and caregivers. Learn more if you’re interested in finding a mentor to connect with or would like to volunteer as a mentee.
  • Engage in social communities to connect with others in the Lyme community: Instagram, Facebook, and Twitter

On a final note, while we navigate social distancing, many health experts are recommending people go outside for fresh air and exercise. Getting outside is a great idea, but as ticks are already out in force, remember to Be Tick AWARE™, whether you’re walking to your mailbox, going to the park, or out for a hike.

Most importantly, take care of yourself and your family. We will get through this together.

Please feel free to reach out to our team if we may be of any assistance.
Web: GLA.org
Email: [email protected]
Phone: 203-969-1333

Sincerely,

 

 

 

Scott Santarella
CEO
Global Lyme Alliance