Tag Archives: Lyme disease and COVID-19

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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

Corona With a Twist of Lyme

by Jennifer Crystal

Our nation is in a crisis about novel coronavirus COVID-19, and no one is more fearful than those with pre-existing conditions. These patients, along with the elderly, are at high risk if they contract the virus. Lyme patients are rightfully concerned that their underlying tick-borne infections makes them especially susceptible to COVID-19, and that getting COVID-19 will make their original underlying infection worse, landing them in the hospital on a ventilator. 

I understand these worries, because I have them, too. While recognizing and not downplaying the risks, I want to give some measure of reassurance based solely on my own experience as a patient with Lyme, babesia, and ehrlichia, who is also recovering from a suspected case of COVID-19.

I first became symptomatic two weeks ago. As of this writing, my symptoms have diminished dramatically. I haven’t had a fever in five days, and my cough and shortness of breath are becoming less evident by the day. Despite my tick-borne infections, my immune system is fighting this respiratory virus very well. Moreover, the presumed virus does not seem to have worsened my response to tick-borne infections. 

I’ve been lucky, and I know that won’t be the case for everyone. But there are steps Lyme patients can take now, either to prevent themselves from getting sick or to treat the virus if it’s a mild case:

  • Call your doctor. If you are not symptomatic, ask your Lyme Literate Medical Doctor (LLMD) what you should do to boost your immune system. My doctor had me increase the dose of some of my supplements. Do not just increase supplements or add new ones on your own, or based on advice you get off the internet. If you become symptomatic, call both your LLMD and your Primary Care Doctor before you do anything or go anywhere, unless you are in critical condition.
  • Do not immediately go to a hospital, doctor’s office, or testing center unless you are in critical condition. If you are mildly symptomatic, call your doctor and ask if it makes sense for you to be tested, if you need acute medical care, or if you can self-treat at home. The latter is the safest option. If you don’t already have COVID-19, you can contract it at a doctor’s office, hospital or testing center. If you do have it, you could infect others while you’re out and about. The exception is if you have a high fever or are in severe respiratory distress. Had I known a week ago what would happen when I did go for a test, I would have just stayed home, assumed I had COVID-19 and self-quarantined. 
  • Do not pre-order hydroxychloroquine or take it prophylactically unless prescribed by your doctor. If you are already on hydroxychloroquine for Lyme and you contract COVID-19, the drug may help kill the virus. But there is not yet evidence taking it as a preventive measure might not help protect you from COVID-19, and it might worsen your Lyme symptoms. More importantly, it will diminish the supply for patients who have a genuine need for the medication, including certain Lyme patients and those with lupus and rheumatoid arthritis. 
  • Electrolyte-enhanced water: COVID-19 is dehydrating. Stock up now, before you get sick, on as much electrolyte water as your family would reasonably need for a two-week period. Don’t buy more than that amount; leave some for other people, too. Do not hoard. 
  • Fever reducers: Again, have these on hand before you get sick, but also do not hoard supplies. 
  • Inhaler: Like hydroxychloroquine, this is not something you can or should use prophylactically, but if you already use an inhaler, this would be a great time to make sure it’s not expired or to get it refilled. If you experience mild COVID-19 symptoms, your doctor may prescribe a non-steroid bronchodilator. This has helped me immensely. Again, if you can, it’s better to use this treatment at home than to require a ventilator at a hospital. 
  • Stay home! This time of social distancing is about you, the immunocompromised. Protect yourself! Don’t socialize with anyone outside of your immediate family. Even if that person seems healthy, they could be a carrier who could unknowingly pass COVID-19 on to you. Order groceries online and wipe them down with antiseptic wipes before bringing them into the house. 
  • Wash and sanitize: Wash your hands as much as possible, for at least 20 seconds with warm soapy water. Sanitize an object before you touch it. 
  • Do not panic! Lyme spirochetes thrive on stress. So don’t give them reason to start replicating while you’re trying to fend off an acute infection. The calmer you can stay, the healthier your body will remain. 
  • And finally, Be Tick AWARE: Don’t let protecting yourself from one illness leave you vulnerable to another. Tick season has started and the ticks are out in full force, expanding their geographical reach more than ever. Make sure to protect yourself and your pets if you do go outside by using repellant and undertaking tick checks. 

As Lyme patients, you may be compromised immunologically, but you are ahead of the game when it comes to convalescence and social distancing. You know what it’s like to be sick for much longer than the standard length of time for COVID-19. You know what it’s like to be isolated at home. You know how to take care of yourself and advocate for your needs. You already have resilience. 

With these suggestions, appropriately considering, I hope that you will stay healthy, or, that if you do contract COVID-19, that you will fight it off effectively and promptly. 

Be well. 

Related Post:
Letter from CEO About COVID-19 and GLA Community 


jennifer crystal_2

Opinions expressed by contributors are their own.

Jennifer Crystal is a writer and educator in Boston. Her memoir about her medical journey is forthcoming. Contact her at [email protected].