Is it Long COVID or Lyme disease?

When It’s Not Long COVID—It’s Lyme

In the wake of the pandemic, we’ve become more aware of how a virus can lead to long-term, multisystem illness. That’s been a good thing. Patients with brain fog, fatigue, and shortness of breath are no longer automatically dismissed. They’re told it might be Long COVID—and for many, that’s exactly what it is.

But here’s the problem: not every post-viral–looking syndrome is post-viral. And not every case labeled Long COVID is the full story.

In my practice, I’ve seen patients whose symptoms—fatigue, headaches, lightheadedness, poor sleep, word-finding issues—were immediately attributed to Long COVID. Some had never tested positive. Others recovered from COVID without issue, only to become chronically ill months or even years later.

In many of those cases, it wasn’t Long COVID.
It was Lyme disease. Or a co-infection such as Babesia or Bartonella.
And no one had looked.

Watch related discussion on YouTube

When Labels Limit Us

Long COVID is a real condition. But it can also become a diagnostic shortcut when the work of a thorough differential diagnosis is skipped. When physicians assume post-viral symptoms must be from COVID, they may never ask about:

1. Tick exposure
2. Unexplained rashes
3. Travel or seasonal patterns
4. Prior flu-like illnesses that were never diagnosed
5. Co-infections that do not respond to supportive care

I have seen patients treated for months under the Long COVID umbrella—when the missing piece was an untreated tick-borne illness.

Lyme Can Look Like Long COVID

The overlap is striking. Both Lyme disease and Long COVID can cause:

1. Chronic fatigue
2. Autonomic dysfunction (POTS)
3. Cognitive impairment
4. Exercise intolerance
5. Sleep disruption
6. Mood changes
7. Migratory pain
8. Gastrointestinal complaints
9. Neurologic symptoms

So what’s the difference?
The treatment.
And the risk of missing it.

While definitive treatments for Long COVID are still evolving, persistent Lyme disease and certain co-infections can be treated—if clinicians recognize what they are seeing.

The Cost of Delay

I have had patients who spent a year or more under a Long COVID diagnosis before someone asked the right question: “Could this be Lyme?”

By then, symptoms had worsened. Trust had eroded. Hope had faded.

When testing was finally performed—sometimes imperfect, sometimes clinically suggestive rather than definitive—and treatment for Lyme or Babesia began, improvement followed. Slowly. Unevenly. But unmistakably.

We Owe Patients More Than Assumptions

The Long COVID diagnosis has opened important conversations about post-infectious illness. But it should not become the end of the diagnostic journey—especially when the story does not fully fit.

If a patient carries a Long COVID label but:

1. Never tested positive,
2. Developed symptoms long after mild illness, or
3. Is not improving despite supportive care,

It is worth asking:

• Was Lyme disease ruled out thoroughly?
• Were co-infections considered?
• Or were they simply never explored?

Sometimes the answer is not a new virus.
It is an older infection.
Still waiting to be treated.

For a comprehensive overview of the Long COVID and Lyme disease connection—including peer-reviewed research involving 889 patients—see Long COVID and Lyme Disease: What Patients Need to Know.

Related Resources

• Long COVID and Lyme Disease: What Patients Need to Know
• Autonomic Dysfunction and Lyme Disease
• Lyme Disease Misdiagnosed as Long COVID
• Lyme vs Long COVID: The Overlap Doctors Need to See

Reviewed and authored by Dr. Daniel Cameron, MD, MPH

Dr. Cameron is a nationally recognized expert in Lyme disease and tick-borne infections with over 37 years of clinical experience. A past president of the International Lyme and Associated Diseases Society (ILADS), he writes extensively on overlapping post-infectious syndromes, including Lyme disease and Long COVID.

This article reflects his clinical experience and review of current research.