WATERTOWN — In the era of COVID-19, with the world preoccupied, it can be easy to overlook other more common diseases such as Lyme disease. Because both COVID and Lyme are flu-like and share some similar symptoms, one can easily be mistaken for the other in the beginning stages of the diseases.
“At the beginning, it might not be clear which one is what,” said Marylene J. Duah, MD, of the Infectious Disease department at Samaritan Medical Center. “And now everybody thinks everything’s COVID, so my knee jerk response would be first test for COVID to get it out of the way.”
COVID symptoms differ widely, but the most common indicators are fever, muscle or body aches, headache, shortness of breath, nausea, and vomiting. According to the CDC, symptoms appear two to 14 days after exposure to the virus.
Typical symptoms of Lyme disease include a fever, headache, fatigue, and a characteristic skin rash called erythema migrans, but 20 percent of Lyme disease patients do not present with a rash. Symptoms appear three to 30 days after a tick bite, according to the Centers for Disease Control (CDC). Both the bites and rashes are painless.
Lyme often manifests with flu-like symptoms, but not everyone has the same reaction, so it is important to seek medical care.
If there is shortness of breath or a cough involved, it’s clear that the patient is most likely suffering from COVID or something related, rather than Lyme, but at the beginning, when these symptoms have not yet presented themselves, it’s not as clear. According to Dr. Duah, these COVID symptoms don’t hit a person until day six or seven. Because of this, she said it is better to seek medical advice and get tested to get COVID out of the way if symptoms are nonspecific.
COVID tests can be done and results given within about an hour, but Lyme tests take three to five days to get results.
“I actually saw a patient in the hospital and they tested him twice for COVID,” Dr. Duah said. “He was hospitalized for a week and nobody tested for Lyme, he sounded more Lyme than any COVID symptoms, he had no pulmonary symptoms, and nobody tested him for Lyme until I saw him. Patients and doctors are panicked so much about COVID that it takes over your thinking, COVID has taken over our world.”
Lyme disease is the most common vector-borne disease in the United States and is transmitted to humans through the bites of infected blacklegged ticks. If left untreated, infection can spread to joints, the heart, and the nervous system. Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics.
For COVID, some antiviral therapy is available in the form of a drug known as Remdesivir, which was given an emergency-use authorization by the FDA for the treatment of COVID. For Lyme disease, the best treatment for adults is the drug Doxycycline, according to Dr. Duah, and patients could need anywhere from two to four weeks of treatment, depending on the state of the illness. For children, Amoxicillin should do the trick.
The primary stages of Lyme disease are called early localized Lyme, a rash, headache, and fever, but the secondary stage, early disseminated Lyme, could cause meningitis, some nerve paralysis, or Bell’s Palsy. According to Dr. Duah, progression could lead to the need for a pacemaker and a stay in the Intensive Care Unit. There can also be late line complications of disabling arthritis, joint swelling, and pain and sometimes patients may have neurocognitive dysfunction and chronic Lyme symptoms like fatigue and lack of concentration.
Steps to prevent Lyme disease include using insect repellent, removing ticks quickly, applying pesticides, and reducing tick habitat. Tick exposure can occur year-round, but ticks are most active during warmer months, from April to September.
After coming indoors, check clothing for ticks, examine gear and pets, and shower soon after being outdoors. Showering may help wash off unattached ticks and it is a good opportunity to do a tick check, according to the CDC. Common places to check for ticks include under the arms, in and around the ears, the back of the knees, in and around the hair, and around the waist.
“We’ve definitely seen an increased number of Lyme disease over the years,” Dr. Duah said. “I’ve been here for 15 years and I’ve seen more Lyme than ever, I’ve seen more deer than ever, they’re living in the city with us, so there’s definitely a lot more deer, a lot more tick bites, and a lot more ticks. Definitely Lyme disease prevalence has increased.”