Suffering from cabin fever due to the COVID-19 pandemic, many have taken to hiking and biking trails as a great way to get some exercise while social distancing.

While these trails have seen a recent surge in popularity, it’s important to remember that it is also tick season which can lead to Lyme disease and other tick-borne infections.

Lyme disease, also known as Lyme borreliosis, is an infectious disease caused by the Borrelia bacterium which is transmitted to humans through the bite of an infected black-legged deer tick. It is the most common tick-borne infectious disease in the United States.

What happens when coronavirus and Lyme disease intersect?

Many of the symptoms of Lyme disease and COVID-19 are “nonspecific.” That means a wide variety of health conditions may cause them.

Some symptoms of the disease overlap with those of COVID-19.  Lyme and other tick-borne diseases, may be associated with general flu-like symptoms, such as fever, head and body ache, and fatigue. These are also symptoms of COVID-19.

Tick-borne diseases are not likely to cause respiratory symptoms like those seen in COVID-19 and Lyme Disease often causes a distinctive bulls-eye rash that can expand into the shape of a target.  This distinctive rash can help doctors recognize Lyme disease, but it doesn’t occur in all cases and may go unnoticed when it does occur.

According to Dr. David Banach, Hospital Epidemiologist at UConn Health, Lyme disease most commonly has a bullseye rash, but two other infections, carried by the same deer ticks are different.

He said patients with babesia and anaplasma infection, transmitted by the same tick that transmits Lyme Disease, can have a fever.

“We’re still in the early phase of that overlap between COVID and tick-borne infection, but it just reminds us to think broadly about patients and not focus in too much on one particular diagnosis,” said Dr. Banach. “Anyone in the summer who presents with flu-like symptoms warrants consideration of a tick-borne infection.  We don’t really see the flu in the summertime here in Connecticut so think about those other tick infections, particularly if you’ve had any outdoor exposure, especially in wooded areas.”

Dr. Mary Snayd, a member of the Infectious Disease team at UConn Health explains there are three stages of Lyme disease, early localized, early disseminated, and late disseminated.

Early Localized Lyme Disease

Early localized Lyme disease may occur days or weeks after the tick bite. In addition to flu-like symptoms, this stage is often characterized by an increase in symptoms such as:

• Skin rash, which may or may not look like a bull’s eye,
• Fatigue
• Headache and stiff neck
• Muscle soreness and joint pain
• Swollen lymph nodes
• Sore throat

At this stage of infection patients treated with appropriate antibiotics usually recover rapidly and completely. If left untreated, the infection can spread to joints, the heart, and the nervous system.

Early Disseminated Lyme

Early disseminated Lyme may occur several weeks or months after the tick bite. In addition to the symptoms of early localized, this stage is often characterized by an increase in symptoms such as:

• Pain, weakness or numbness in the arms or legs
• Vision changes
• Disturbances in heart rhythm
• Facial paralysis called Bell’s palsy
• May present similar to meningitis

Bacteria are beginning to spread throughout the body during early disseminated Lyme disease, however similar to the first stage of Lyme, can be treated with antibiotics and patients can fully recover.

Late Disseminated Lyme

If Lyme disease isn’t promptly or effectively treated in the first two stages, late disseminated Lyme occurs weeks, months, or even years after the tick bite. The Lyme bacteria have spread throughout the body and many patients develop chronic arthritis as well as an increase in neurological and cardiac symptoms. Symptoms may include:

• Arthritis and joint effusions
• Migrating pains that come and go in joints/tendons (repetitive as described in bullet point #1)
• Brain disorders, such as encephalopathy, which can cause short-term memory loss, difficulty concentrating, mental fogginess, problems with following conversations and sleep disturbance
• Numbness in the arms, legs, hands or feet

Late Lyme disease often requires antibiotic treatment for a duration of 28 days. Sometimes these antibiotics must be administered intravenously.

PREVENTION

To lower your risk for contracting Lyme disease or other tick-borne illnesses, Snayd recommends taking precautions when you’re spending time outdoors in areas where ticks live. Those spending time in a wooded area should use tick repellents, treat clothing with products containing permethrin, perform tick checks after coming inside, wash clothes in hot water, and shower after outdoor activities.

Be vigilant. Check your children, pets, and yourself for ticks. Ticks also tend to hide in areas under the arms, back of knees, and hairline.

REMOVAL OF TICK

If you find a tick on you, your family or pet, use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible. Pull upward with steady, even pressure. Don’t twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers.

If you’ve had Lyme disease, don’t assume you can’t be infected again. You can get Lyme disease more than once.  Depending on the patient’s symptoms and medical history, Snayd says their doctor may encourage them to get tested for COVID-19.

Patients who have spent time outdoors in areas where Lyme disease-infected ticks live are more likely than others to develop the disease.

“For this reason, the patient needs to tell the clinician if they have spent time outside and in potential habitats where ticks are prevalent,” she continued.

If you suspect that you might have symptoms of Lyme disease or another tick-borne illness, contact your doctor right away.