Lyme Disease and Long COVID: Nearly 1 in 5 Developed Long COVID

Nearly 1 in 5 individuals with Lyme disease history developed Long COVID.
Neurologic symptoms and fatigue were especially common.
This peer-reviewed study examined 889 individuals with prior Lyme disease.

In my peer-reviewed study published in the journal Antibiotics (2023), I examined the experiences of 889 individuals with a history of Lyme disease who contracted COVID-19. The findings were striking: nearly one in five developed Long COVID.

This rate was higher than estimates reported in the general population, where approximately one in ten individuals develop Long COVID after infection.

Key Findings

Participants with a history of Lyme disease were recruited through a snowball sampling strategy via social media. Of 1,168 individuals who completed the survey, 288 contracted COVID-19.

The symptom burden, measured by the GSQ-30 questionnaire, was significantly higher for individuals with both Lyme disease and COVID-19 compared to those with Lyme disease alone (48.2 vs. 43.1, p = 0.008).

The most common symptoms reported were:

1. Feeling fatigued or having low energy
2. Feeling worse after normal physical activity
3. Not feeling rested on awakening
4. Muscle aches or pains
5. Trouble falling or staying asleep
6. Feeling panicky, anxious, or worried
7. Trouble finding or retrieving words
8. Joint pain or swelling

Neurological symptoms drove the difference between those who developed Long COVID and those who did not.

Many participants also described brain fog, exercise intolerance, and worsening neurologic symptoms after COVID-19 infection.

Why Lyme Disease and Long COVID Can Overlap

The symptom overlap between Long COVID and Lyme disease creates a diagnostic challenge. Patients may be told they have Long COVID when an underlying or concurrent tick-borne infection has been missed.

Conversely, Lyme patients who contract COVID-19 may face compounding illness that worsens their overall symptom burden.

Both conditions can cause fatigue, brain fog, autonomic dysfunction, pain, post-exertional worsening, and sleep disturbance. Without careful evaluation, one condition may mask the other.

Clinical Implications

These findings suggest that individuals with a history of Lyme disease may be at increased risk for developing Long COVID.

Clinicians should:

1. Screen Long COVID patients for possible tick-borne illness, especially in endemic areas
2. Recognize that Lyme patients who contract COVID-19 may experience worsening symptoms
3. Avoid dismissing persistent symptoms as “just Long COVID” without ruling out other causes

Frequently Asked Questions

Can Lyme disease increase the risk of Long COVID?

In this peer-reviewed study, nearly one in five individuals with a history of Lyme disease developed Long COVID after COVID-19 infection.

Do Lyme disease and Long COVID share symptoms?

Yes. Both conditions may involve fatigue, brain fog, autonomic dysfunction, pain, sleep disturbance, and exercise intolerance.

Can Long COVID be mistaken for Lyme disease?

The symptom overlap between Long COVID and Lyme disease can complicate diagnosis. Careful evaluation may be necessary to distinguish between the two conditions or identify overlapping illness.

Can COVID worsen Lyme disease symptoms?

Some patients with a history of Lyme disease reported worsening fatigue, neurologic symptoms, pain, and exercise intolerance after COVID-19 infection.

Editor’s note:

We need more research to ensure individuals with persistent tick-borne infections are not dismissed as having Long COVID alone. Both conditions deserve thorough evaluation and individualized care.

For a comprehensive overview of the Long COVID and Lyme disease connection, see Long COVID and Lyme Disease: What Patients Need to Know.

---

Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention