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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