Is it Long COVID or Lyme Disease?
Long COVID and Lyme disease can look similar
Brain fog, fatigue, and POTS overlap frequently
Missing Lyme disease may delay diagnosis and treatment
Patients struggling with fatigue, cognitive problems, dizziness, exercise intolerance, and pain are increasingly asking the same question: is it long COVID or Lyme disease? The challenge is that both illnesses can affect multiple body systems and lead to overlapping symptoms.
As clinicians continue seeing patients with persistent symptoms after infections, distinguishing between these conditions has become more important—and more difficult.
Searches for coronavirus with Lyme disease, COVID and Lyme disease, and long COVID reflect the confusion many patients experience when symptoms persist after infection. Distinguishing one illness from another may not always be straightforward.
How COVID and Lyme disease symptoms overlap
Both long COVID and Lyme disease may involve inflammation, autonomic dysfunction, neurologic symptoms, and persistent fatigue.
Shared symptoms may include:
- Brain fog and slowed processing
- Fatigue and exercise intolerance
- Dizziness or lightheadedness
- Sleep disturbance
- POTS or autonomic dysfunction
- Headaches
- Pain syndromes
- Memory difficulties
- Shortness of breath or air hunger
Because long COVID and Lyme disease share multisystem symptoms, clinicians may struggle to distinguish one condition from another. The overlap is especially challenging when patients present months after the initial illness.
Patients searching for answers after COVID sometimes ask whether persistent symptoms represent long COVID, Lyme disease, or both because symptom patterns frequently overlap.
Research increasingly supports this overlap. In one survey of individuals with a history of Lyme disease, symptom burden after COVID infection overlapped substantially with preexisting Lyme-related symptoms, and approximately one in five respondents reported long COVID after infection.1
More recently, investigators reported that machine learning models using cytokine patterns could distinguish long COVID from chronic Lyme disease with high sensitivity and specificity, highlighting that overlapping symptoms may reflect distinct biologic patterns.2
When long COVID symptoms may actually be Lyme disease
Patients diagnosed with long COVID may also have tick exposure histories, missed rashes, outdoor exposures, or coinfections that complicate diagnosis.
Questions that may help include:
- Was there possible tick exposure?
- Did symptoms begin after a viral illness, tick bite, or both?
- Are neurologic symptoms progressing?
- Are symptoms fluctuating or relapsing?
Why labels can delay diagnosis
Diagnostic labels can be useful, but they can also narrow thinking. Once patients receive a diagnosis of long COVID, alternative explanations—including Lyme disease—may receive less attention.
Similarly, patients with Lyme disease may incorrectly assume all new symptoms are tick-related when another process is contributing.
The cost of missing Lyme disease
Delayed recognition may lead to prolonged symptoms, repeated evaluations, and frustration for patients searching for answers.
When evaluating persistent symptoms, maintaining a broad differential diagnosis remains important.
When COVID and Lyme disease require a broader differential
Both illnesses can produce complex, multisystem presentations. Careful history-taking, symptom patterns, exposure history, and appropriate testing remain important in determining the cause of persistent symptoms.
Frequently Asked Questions
Can Lyme disease look like long COVID?
Yes. Both illnesses may cause fatigue, cognitive problems, autonomic dysfunction, exercise intolerance, and neurologic symptoms.
How do doctors tell the difference between long COVID and Lyme disease?
History, timing of symptoms, exposure risk, laboratory testing, and coinfection evaluation may help distinguish these conditions.
Can COVID trigger Lyme symptoms?
Some patients report worsening symptoms after viral illnesses, although the relationship between COVID and persistent tick-borne illness remains under study.
What symptoms overlap between Lyme disease and long COVID?
Brain fog, fatigue, dizziness, sleep problems, exercise intolerance, POTS, pain, and cognitive difficulties may overlap.
Can COVID and Lyme disease occur together?
Yes. Some patients report Lyme disease symptoms after COVID infections or experience overlapping illnesses, making diagnosis more complicated.
Clinical Takeaway
Long COVID and Lyme disease share many symptoms, making diagnosis challenging. Patients with persistent symptoms may benefit from a careful review of exposure history, timeline, and overlapping conditions before conclusions are drawn.
Symptom overlap does not necessarily mean these illnesses are identical, but it may explain why diagnosis is often delayed.
Related Articles
Brain fog and Lyme disease
POTS and Lyme disease
Mechanisms of persistent Lyme disease
Post-treatment Lyme disease syndrome
References
- Cameron DJ, McWhinney SR. Consequences of Contracting COVID-19 or Taking the COVID-19 Vaccine for Individuals with a History of Lyme Disease. Antibiotics (Basel). 2023;12(3):493.
- Patterson BK, Guevara-Coto J, Mora J, et al. Long COVID diagnostic with differentiation from chronic Lyme disease using machine learning and cytokine hubs. Sci Rep. 2024;14(1):19743.
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
Lyme is the #1 misdiagnosed disease, 3x the rate of syphilis, the only other spiral-shaped bacteria that can corkscrew its way into all tissues. Lyme is much worse as it is a persister, has no good early tests, no outward signs and no good late treatment. Medical denialism is a tragedy that has harmed children and families for decades, millions of times worse than the Tuskegee Scandal when syphilis went untreated. The best way to help patients would be to REQUIRE NIH and all gov’t and ducational institutions whose mission is public health to budget at least half to the most costly, disabling and misdiagnosed diseases. Lyme would be on all 3 lists.
Dr. Cameron, thank you for all of this valuable and helpful information. And thank you for all of your research and dedication to lyme and other tick-borne diseases. You have helped so many people, and I for one, am grateful to you. God bless.
“Thank you. I truly believe God led me here for a reason—and it’s been a blessing to serve this community. May He continue to guide and heal us all.”
Thank you Dr Cameron. Going thru a flare up. 2nd one in a month. Last 24 hours and extreme aches , migraine, sweating, low grade fever and then gone just like that. Haven’t had lymes in 15 years but it feels like it. Also, I had meningitis a year after Lymes and it feels like that too. Good times 😉 Praise God for people like you helping people like me 🙏
Thank you 🙏 I’m sorry you’re going through this flare-up. I’ve seen patients experience this even years after initial infection. You’re not alone—and I’m grateful you’re still pushing forward. Praise God indeed.