Can COVID Make Lyme Disease Worse? Long COVID Risk Explained
Can COVID worsen Lyme disease symptoms?
Are Lyme patients at higher risk for long COVID?
New cases suggest a higher symptom burden.
COVID and Lyme disease symptoms can overlap in ways that are difficult to recognize. Some patients with a history of Lyme disease report more severe symptoms after COVID-19, including fatigue, brain fog, and autonomic dysfunction.
Some patients also search for coronavirus and Lyme disease, especially when symptoms persist after infection.
This raises an important question: can COVID make Lyme disease worse—or trigger long COVID in vulnerable patients?
Can COVID Make Lyme Disease Worse?
Case reports suggest that individuals with a history of Lyme disease may experience a higher symptom burden after COVID-19 infection.
In one case, a 16-year-old with a history of Lyme disease and post-treatment Lyme disease syndrome (PTLDS) developed prolonged fatigue, cognitive symptoms, and long COVID after infection.
Another patient described severe weakness, shortness of breath, and neurologic symptoms during COVID-19, followed by persistent episodes of tachycardia, cognitive dysfunction, and symptoms consistent with POTS.
COVID and Lyme Disease Symptoms Overlap
Patients with both COVID-19 and Lyme disease may experience:
- Fatigue and low energy
- Brain fog and memory problems
- Headaches
- Muscle and joint pain
- Sleep disturbances
- Heart rate changes or palpitations
These overlapping symptoms can make it difficult to distinguish between active Lyme disease, post-treatment Lyme symptoms, and long COVID.
Risk of Long COVID in Lyme Patients
Survey data suggests that individuals with a history of Lyme disease may be at increased risk for prolonged symptoms after COVID-19 infection.
In one survey of individuals with a history of Lyme disease, nearly one in five who developed COVID-19 went on to report long COVID symptoms.
These patients reported a high symptom burden, including fatigue, cognitive impairment, and autonomic dysfunction.
Start here: Lyme symptoms guide
Why Symptoms May Be Worse
Several factors may contribute to worsening symptoms:
- Immune system dysregulation
- Persistent inflammation
- Autonomic nervous system dysfunction
- Overlap with post-infectious syndromes
These mechanisms are seen in both Lyme disease and long COVID, which may explain the overlap.
Related: Why Lyme symptoms come and go
Clinical Takeaway
COVID may worsen symptoms in some patients with a history of Lyme disease.
Patients may experience fatigue, brain fog, POTS, and prolonged recovery consistent with long COVID.
When symptoms persist or worsen after COVID-19, it is important to consider both Lyme-related and post-viral causes—not just one or the other.
Related Reading
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
This is an exceptionally important survey and article. Besides pointing toward the susceptibility that Lyme patients have toward long haul Covid ( twice the risk pointed toward here), there are implications of serious viral impacts on long haul ( chronic) Lyme that further validates patients claims that two weeks of doxycycline is not an adequate protocol for those with tick borne illness. Imagine that someone with a broken leg has their ankle set and the cast taken off about three days later, and if they complain of pain afterwards they are sent to a psychiatrist? That is what chronic Lyme patients feel when their complaints are dismissed. Altered immune systems ( many describe chronic Lyme as a B cell type of HIV), and co infections, especially bartonella which becomes an opportunistic infections once the immune system is crippled, and is easily caught from domestic animals etc., are being ignored. Indeed we need accurate Lyme tests ( such as a cross sectional survey of the general population using accurate testing ) to know the true prevalence. Since Borrelia B has been repeatedly proven to be an STD, our community should demand a similar budget as HIV. This ignoring of what might be a driving factor in bankruptcy of our National and perhaps global health care budget needs to stop.
I have been particularly concerned that someone with Lyme disease or related tick borne infection might be dismissed as long covid.
At least, maybe then we’ll get some help!
What do you suggest for treatment of chronic Lyme with symptoms? Can we ameliorate some of the burden?
I often identify treatment options that are overlooked during my patient evaluations. I always advise working with a doctor with experience treating Lyme disease in addition to other doctors if they remain ill.
I think it would be VERY interesting for a study to evaluate if long Covid patients test positive for Lyme Disease with a blood culture (not the useless CDC Western blot that results in 71% false negatives at best, BALF 2020).