Lyme Disease and COVID-19 Symptoms
Highlights
Question: What is the clinical presentation of individuals with a history of Lyme disease who later develop COVID-19?
Findings: In a cross-sectional survey of 1,168 individuals with Lyme disease, the highest symptom burden occurred among the 288 participants who reported both Lyme disease and COVID-19. Nearly one in five developed long COVID, and 20 required hospitalization.
Meaning: Individuals with a history of Lyme disease who develop COVID-19 may experience a higher symptom burden and an increased risk of hospitalization and long COVID.
Background
COVID-19 has been associated with a wide range of clinical manifestations, including the persistent symptoms now referred to as long COVID. Many of these symptoms—fatigue, cognitive impairment, pain, and functional limitations—overlap with symptoms commonly reported in Lyme disease.
This raises an important clinical question: How severe are symptoms in individuals who have both Lyme disease and COVID-19?
To address this question, researchers examined survey responses from individuals with Lyme disease who later developed COVID-19.
Methods
This analysis is based on a cross-sectional survey investigating symptom burden in individuals with Lyme disease. A total of 1,168 individuals participated in the survey.
The analysis focused specifically on 288 participants with a history of both Lyme disease and COVID-19, regardless of vaccination status.
Participants were recruited through social media using a snowball sampling strategy. The survey was conducted in accordance with the Declaration of Helsinki and approved by the Western Institutional Review Board.
Symptom burden was assessed using the General Symptom Questionnaire-30 (GSQ-30), a validated tool designed to measure symptom severity in Lyme disease.
The GSQ-30 evaluates four symptom domains:
- Pain and fatigue
- Neuropsychiatric symptoms
- Neurologic symptoms
- Flu-like symptoms
Each symptom is rated on a five-point scale, producing a total score ranging from 0 to 120.
Symptom Burden in Lyme Disease Patients with COVID-19
The GSQ-30 score for individuals with both Lyme disease and COVID-19 was significantly higher than the score for those with Lyme disease alone.
Average GSQ-30 score:
- Lyme disease + COVID-19: 48.2
- Lyme disease without COVID-19: 43.1
This difference was statistically significant (p = 0.008).
Symptom burden in the Lyme-COVID group was also higher than that reported in several comparison populations, including:
- Healthy controls (mean 6)
- Erythema migrans patients (mean 24.15)
- Traumatic brain injury (mean 32.28)
- Depression (mean 42.28)
- Post-treatment Lyme disease syndrome (mean 42.38)
Most Common Symptoms
The most frequently reported symptoms among individuals with Lyme disease and COVID-19 included:
- Fatigue or low energy
- Feeling worse after physical activity
- Unrefreshing sleep
- Muscle aches or pain
- Difficulty falling or staying asleep
- Needing more sleep than usual
- Anxiety or panic symptoms
- Word-finding difficulty
- Neck stiffness or pain
- Joint pain or swelling
Long COVID and Other Complications
The most common long-term complication reported by participants was long COVID, affecting 20.1% of individuals.
Other frequently reported symptoms included:
- Shortness of breath (19.8%)
- Loss of smell (19.4%)
- Loss of taste (16.3%)
Pneumonia (4.9%) and clotting disorders (1.7%) were less common.
Among the 288 individuals with Lyme disease and COVID-19, 20 were hospitalized (7%). Twelve required supplemental oxygen, and three required non-invasive ventilation such as CPAP.
Discussion
The findings suggest that individuals with Lyme disease who develop COVID-19 may experience a higher symptom burden than those with Lyme disease alone.
Approximately one in five participants developed long COVID. This rate appears higher than that reported in some general population studies, where long COVID has been estimated to affect roughly 10% of individuals.
Many of the symptoms reported by Lyme patients with COVID-19 were similar to those described in long COVID research, including fatigue, cognitive dysfunction, and shortness of breath.
If confirmed in future studies, these findings may suggest that individuals with chronic illnesses such as Lyme disease could be more vulnerable to persistent post-viral symptoms.
Study Limitations
This study has several limitations. Because the survey was cross-sectional, it cannot determine cause-and-effect relationships.
Participation was voluntary and may introduce selection bias. In addition, the survey was not designed to determine whether symptoms were related to persistent tick-borne infection or other medical conditions.
Conclusions
Individuals with Lyme disease who develop COVID-19 appear to have a higher symptom burden and an increased risk of long COVID compared with those with Lyme disease alone.
Further longitudinal research is needed to better understand the interaction between Lyme disease and COVID-19.
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
