What Do Coronavirus And Lyme Disease Have In Common? More Than You Might Think
By Judy Stone Senior Contributor
Ill woman with headache and fever. What does she have? GETTY
Like an unwanted stepchild, Lyme keeps getting lost in the shuffle. This time, it is Covid-19 pandemic that is understandably overshadowing it. But Lyme continues to infect an estimated 300,000 people in the US each year and there are some parallels between the two illnesses, as well as obvious differences.
Clinical notes
While Lyme and Covid-19 are very different infections, the former caused by the bacteria (Borrelia burgorferi) and the latter a virus (SARS-CoV-2), there are a couple of notable similarities. The most striking to me is that both are great masqueraders. Covid-19 symptoms range from asymptomatic, to life-threatening respiratory failure from pneumonia. More surprising symptoms include loss of smell (anosmia) and the multisystem inflammatory syndrome in children (MIS-C) (initially thought to be Kawasaki disease), clotting abnormalities, and heart involvement. This can include arrhythmias and heart inflammation or damage as is seen with heart attacks. The virus appears to attack the endothelial cells lining blood vessels, causing some of the array of peculiar symptoms.
Both Lyme and coronavirus often start with non-specific flu-like symptoms with fever, headache, and general achiness and fatigue. Lyme has protean presentations, ranging from the typical skin rash, to arthritis, and heart or neurologic involvement.
Both infections are also notable for having “long-haulers,” patients with inexplicably prolonged and very debilitating symptoms, and for patients complaining of “brain fog” and marked fatigue. This is been more quickly recognized and accepted following Covid-19. Perhaps this is because the whole infection is peculiar and we are more open to learning about it; perhaps it is because Covid-19 seems to strike men more than women, whose symptoms are often taken less seriously.
Diagnostics
One of the major problems with coronavirus is our difficulty diagnosing it. The antigen tests have been unreliable with false negatives in up to 30% of tests (saying that someone is not infected when they are) and lesser inaccuracies (< 5% for false positives). With coronavirus, scientists have only been working on diagnostics for ~6 months. Researchers just announced what appears to be a major breakthrough with a more accurate and rapid test using saliva, SalivaDirect.
Yet with Lyme, despite years of study, diagnostic tests are likely only ~50% accurate in diagnosing the disease.
Research and funding
The government has thus far authorized $3.7 trillion for coronavirus support, including $25 billion for testing.
In contrast, funding for Lyme and other vector-borne diseases is consistently far lower than for other infectious diseases. The CDC reported to me that:
“The FY20 enacted appropriation was:
—$38.6M for vector-borne diseases, which is being used to prevent and control mosquito-borne, tickborne, and fleaborne diseases, and
—$14M for Lyme and other tickborne diseases, which was dedicated entirely to tickborne disease prevention and control activities.
—We do not further delineate between the budget dedicated to mosquito-borne vs. tickborne disease funded by the vector-borne disease line.”
Federal funding for Lyme vs other infections HHS
According to the Tick-Borne Disease Working Group’s 2018 report to Congress, “ Federal funding for tick-borne diseases is less per new surveillance case than that of other diseases. The U.S. National Institutes of Health (NIH) and CDC spend $77,355 and $20,293, respectively, per new surveillance case of HIV/AIDS, and $36,063 and $11,459 per new case of hepatitis C virus, yet only $768 and $302 for each new case of Lyme disease. Federal funding for tick-borne diseases today is orders of magnitude lower, compared to other public health threats, and it has failed to increase as the problem has grown."
Given the devastating scope and toll of the coronavirus pandemic, it is understandable that many approved drugs are being studied for Covid-19. Somewhat surprisingly, there are still more than twenty trials ongoing with hydroxychloroquine, in addition to novel therapies. There are almost no active treatment studies for Lyme disease.
Lyme and other tick-borne diseases are expanding in the US along with the range of ticks.
Between Covid-19 and Lyme, is this how we will be getting our exercise--alone and inside? Triathlete ... [+] XINHUA NEWS AGENCY/GETTY IMAGES
There are small glimmers of hope for progress on Lyme disease. New diagnostic tests are in development by Columbia University with NIAID support, for example. NIH has also recently granted $3 million to HelixBind to develop a new assay for Lyme. Their approach has been successful in diagnosing blood stream infections. Currently, early Lyme is diagnosed by the presence of a large and expanding rash sometimes with a bull’s eye clear center, but 30% of patients never get a rash, or it can be atypical and misdiagnosed. Blood tests negative early on, because it can take several weeks for antibodies to develop. HelixBind uses a molecular diagnostic assay which can detect <1 cell of Borrelia per milliliter of blood, Alon Singer, HelixBind’s CEO explained. Their assay can also differentiate between B. burgdorferi and other species like B. miyamotoi, which causes relapsing fever. The grant will enable them to test clinical samples; the hope is that they will be able to detect Lyme much earlier and to better follow the course of disease.
The other good news regarding Lyme is the approval of nootkatone for use as an insect repellent. This chemical is present in grapefruit skin, giving it the characteristic smell and taste. It already was approved for flavoring and in perfumes. The CDC’s Dr. Ben Beard said, “There’s a huge need for a soft soap or shampoo…ticks that you don’t wash away could potentially be killed by a soft soap or shampoo.” Nootkatone would hopefully thus prevent acquiring Lyme or other tick-borne diseases. It is also effective against mosquitoes and is being developed for these uses by Evolva.
If Lyme had a fraction of the funding that coronavirus or many other infections do, imagine the progress that might be made.