Is it coronavirus or Lyme disease? Similar symptoms could create confusion

Lyme disease, which is caused by bacteria or a parasite in a tick, has a reputation for imitating other conditions.

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By Maxine Lipner

Feeling sick with a fever — even a slight one — along with chills, fatigue and achy joints during this pandemic era may all seem to point to the coronavirus, particularly in summer with flu season still months away. But there may be another culprit: Lyme disease.

“Lyme disease is just as common this year as it was last year or the year before,” Dr. Daniel Cameron, a Lyme disease specialist in private practice in Mount Kisco, New York, told TODAY.

What’s more, Lyme disease, which is caused by bacteria or a parasite in a tick, has a reputation for imitating other conditions.

“It triggers cytokines, the inflammatory process, and by triggering the whole natural immune system, it will mimic some other infections that affect the immune system,” Cameron said. When the immune system is working hard to clear the infection, it may cause symptoms very similar to COVID-19.

There are a number of symptoms that could indicate either COVID-19 or Lyme disease. These symptoms, according to the Centers for Disease Control and Prevention, include:

  • Fever
  • Chills
  • Muscle aches
  • Fatigue

Diagnosing correctly

Figuring out which of these two diseases someone may have is key, Dr. Edward Jones-Lopez, assistant professor of clinical medicine at Keck School of Medicine at the University of Southern California, told TODAY.

There is treatment for Lyme, but the timing of when this medication is administered is crucial.

“The important thing about Lyme is that if you diagnose it and treat it early on you avoid the serious complications from the disease,” Jones-Lopez said.

To tell if it’s really Lyme disease, looking at everything is important. For example, knowing the regions of the country where Lyme disease rates are more common can give some clues.

“The ticks that transmit Lyme, they’re expanding more rapidly through the country, but historically they have been restricted to very particular areas of the country,” Jones-Lopez said.

The CDC pegs Northeastern states as having a high incidence, as well as Illinois and Minnesota. Lyme also tends to occur in the warm summer months, Jones-Lopez told TODAY.

One unique characteristic of Lyme is a bullseye rash that forms exactly where the tick bite occurs.

“That initial rash is very characteristic and is an enormous opportunity to differentiate the two diseases,” Jones-Lopez said. But the bullseye rash doesn’t occur in all cases. If the rash is somehow missed, the disease moves to more general symptoms of unwellness and can be more difficult to pin down.

Since one body area that Lyme tends to spare is the lungs, if there is lung involvement that would quickly distinguish COVID-19 from Lyme, said Jones-Lopez. He added, however, that it’s the overall general pattern of symptoms that’s most important here.

Testing possibilities

Testing is also part of the equation. Tests can be used to confirm or exclude a diagnosis of Lyme or COVID-19. For Lyme, testing involves measuring antibodies, which can take a few days or up to two weeks to develop after a tick bite, Jones-Lopez explained.

Meanwhile for COVID-19, there’s the possibility of using PCR (polymerase chain reaction) to detect the actual genetic material of the virus or testing for antibodies to see if someone has been infected by the virus in the past, he continued.

Still, Cameron points out, not all antibody tests are necessarily as reliable as doctors would like.

“We know in Lyme disease there are false negatives,” Cameron told TODAY. “It’s nice to have a test, but there are people who just can’t get a positive result.”

Likewise, there may be similar difficulties for some with COVID-19 to verify they have the disease. “There are patients who are convinced they had COVID; they went through all kinds of issues, but they don’t get a positive test,” Cameron said.

However, based on the clinical picture overall, even though the two diseases have similarities in some stages, an experienced doctor will be able to make the call, Jones-Lopez told TODAY.

Treatment options

For treatment, knowing the difference is critical because managing a case of Lyme is completely different than dealing with COVID-19. Most commonly, adults and teens with Lyme disease are treated with the antibiotic doxycycline, while those under age eight are given amoxicillin, Cameron said.

Meanwhile, COVID-19 treatments continue to evolve. At this time, the antiviral drug remdesivir has shown promising results in patients with moderate COVID-19, according to a late-stage study. The anti-inflammatory medication dexamethasone has been reported to reduce deaths in critically ill patients.

One last thing to keep in mind this summer is that it’s actually possible to have both diseases at the same time.

“Because of the current situation with COVID where there is, in essence, uncontrolled transmission right now as daily cases are showing, you could definitely have both if you’re adventurous enough, meaning you’re in contact with both nature and with other humans,” Jones-Lopez said.

What this means for the course of either disease is still anybody’s guess. Cameron advises people to be extra careful.

“I just don’t like to beat two illnesses,” Cameron said. “I don’t know whether it makes it worse; I just assume the worst — it could be.”