Lyme vs Long COVID: Why Symptoms Overlap and Get Missed
Lyme vs Long COVID can be difficult to tell apart
Brain fog, dizziness, fatigue, and dysautonomia may overlap
Careful clinical evaluation matters when symptoms persist
“Is this Lyme… or long COVID?”
Patients ask me this with a mix of fear and exhaustion. They describe the same constellation of symptoms — the brain fog that makes conversations feel slippery, the dizziness that hits out of nowhere, the heart that races as if the body is in danger, and the fatigue that wipes out entire days.
Some became ill after COVID. Some after a tick bite. Many never saw a defining moment at all.
And that is the challenge: the Lyme vs Long COVID overlap is so significant that patients often find themselves dismissed, bounced between specialists, or told contradictory stories about their own illness.
Many describe feeling trapped between identities — not knowing whether Lyme disease, Long COVID, or another post-infectious illness explains the sudden unraveling of their health.
What Research Shows About Lyme vs Long COVID
The patterns are not imagined. They are documented.
The study Long-term neurologic outcomes of COVID-19 by Xu, Xie, and Al-Aly demonstrated significantly higher rates of memory problems, slowed thinking, and difficulty concentrating in Long COVID — symptoms that overlap with what I see in many Lyme disease patients.
In my own published research, we compared individuals with a history of Lyme disease to those who later contracted COVID-19 or received the COVID-19 vaccine. The overall symptom burden did not significantly worsen after infection or vaccination, but about one in five who contracted COVID-19 went on to report Long COVID.
That finding alone shows how intertwined Lyme vs Long COVID can be. — Cameron & McWhinney, Antibiotics, 2023
Where Lyme vs Long COVID Symptoms Converge
Brain fog that steals sharpness
Patients from both groups describe the same cognitive struggle: the conversation that slips away, the tasks that suddenly feel too complicated, and the words that disappear mid-sentence. Some call it post-COVID brain fog. Others describe it as part of their Lyme disease journey. But the lived experience can be strikingly similar.
A nervous system that misfires
Dysautonomia ties Lyme vs Long COVID together more than almost anything else. Dizziness, heart palpitations, faintness, and temperature swings may mimic anxiety but are not always driven by emotion. They may arise from the autonomic nervous system losing its stability. For a broader overview of how infection may affect autonomic regulation, see Autonomic Dysfunction in Lyme Disease.
Fatigue that feels like a crash, not tiredness
Both conditions may produce a unique kind of exhaustion: the sudden collapse after a small effort, the days-long setback, and the “wired but tired” state. Patients may learn to fear exertion because even minor activity can push the system into shutdown.
Pain that takes many forms
Headaches, nerve pain, muscle aches, and migrating discomfort may appear in both conditions. Lyme-related pain may move from place to place, while Long COVID pain may be described differently, but both can disrupt daily life with striking similarity.
The Pattern Many Doctors Miss: Cycling Symptoms
One of the strongest clinical clues in Lyme vs Long COVID is the waxing and waning of symptoms.
Patients describe days when they feel nearly normal, followed by sudden crashes of dizziness, exhaustion, pain, or cognitive fog. This fluctuation is often misread as stress or recovery when it may reflect the biology of persistent post-infectious illness.
In each condition, symptom cycling is not a sign of imagination or instability. It may be one of the most important patterns to recognize.
Why the Lyme vs Long COVID Confusion Happens
Most doctors are trained to look for illnesses that follow consistent, predictable patterns. Lyme disease and Long COVID rarely do. Instead, symptoms may rise and fall, move from one system to another, and evolve over months or even years.
Patients may have a normal exam one week and feel incapacitated the next. Their labs may look reassuring even when their day-to-day life is anything but.
Because these illnesses do not always behave the way clinicians expect, many patients hear explanations that never quite fit. They are told they are anxious. They are told it is simply post-viral. They are told it cannot be Lyme without a rash, or Long COVID if their original infection was mild.
None of these assumptions fully match the lived reality of what many patients are experiencing.
And so they land in a kind of diagnostic limbo — sick enough to lose pieces of their life, but not “sick enough” in ways the medical system easily recognizes. The overlap between Lyme vs Long COVID becomes the blind spot where many patients disappear.
Patients Deserve a Better Way to Understand Lyme vs Long COVID
Both Lyme disease and Long COVID — including persistent post-COVID symptoms — may involve post-infectious neuroinflammatory illness. Both can disrupt brain function, autonomic regulation, immune balance, and energy systems.
Patients should not have to choose the “right” label to receive care. They need clinicians who recognize the shared patterns and are willing to look deeper than a single test result.
For a comprehensive overview of the Long COVID and Lyme disease connection — including my peer-reviewed research on 889 patients — see Long COVID and Lyme Disease: What Patients Need to Know.
Frequently Asked Questions
Can Lyme disease and Long COVID cause similar symptoms?
Yes. Lyme disease and Long COVID may both involve brain fog, fatigue, dizziness, palpitations, pain, sleep disruption, and autonomic nervous system symptoms.
How can doctors tell Lyme vs Long COVID apart?
Doctors should review the timing of illness, tick exposure, COVID history, symptom pattern, neurologic findings, autonomic symptoms, laboratory testing, and response to treatment. No single clue is enough by itself.
Can Lyme disease be mistaken for Long COVID?
Yes. Lyme disease may be missed when symptoms begin after a viral illness or when there is no known tick bite or rash. Persistent symptoms should be evaluated in the full clinical context.
Can Long COVID look like Lyme disease?
Yes. Long COVID may cause fatigue, cognitive problems, dizziness, palpitations, pain, and post-exertional crashes that resemble symptoms reported by many Lyme disease patients.
Why do Lyme and Long COVID symptoms come and go?
Both illnesses may involve immune, neurologic, autonomic, and energy-system dysregulation. These systems can fluctuate, leading to symptoms that cycle rather than remain constant.
Clinical Takeaway
Lyme vs Long COVID is not always a simple either-or question. Both illnesses may produce overlapping patterns of fatigue, brain fog, dysautonomia, pain, and symptom cycling.
The key is not to force patients into one label too quickly. The key is to evaluate the full story — exposures, infection history, neurologic symptoms, autonomic findings, symptom timing, and the pattern of relapse or recovery.
Patients with persistent symptoms deserve careful evaluation, not dismissal, when Lyme disease and Long COVID overlap.
Related Articles
These related articles explore the neurologic, autonomic, diagnostic, and post-infectious illness patterns that can help explain why Lyme disease and Long COVID may be confused.
Lyme, Long COVID, or Both? Making Sense of Persistent Symptoms
Is It Long COVID or Lyme Disease?
Neurologic Lyme Disease
Lyme Disease Symptoms Guide
Post-Treatment Lyme Disease Syndrome
References
- Centers for Disease Control and Prevention. Long COVID Basics.
- Cameron DJ, McWhinney SR. Consequences of contracting COVID-19 or taking the COVID-19 vaccine for individuals with a history of Lyme disease. Antibiotics. 2023.
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
I am a 72 yr old married female who had a mild case of Covid in October 2022. We (my husband and I) had taken the Covid-19 vaccinations after the infection. We got along afterwards very well and have had no Covid vaccinations since! I was diagnosed with Parkinson’s Disease in 2012 by a UNC-Ch movements disorder neurologist, Dr Nina Browner, MD. She had me in top shape and ready to do anything I needed to do. Life was good on the farm…until Sept/October, 2023. I was taken to local hospital where every medical test that could be done was done, but labs said I was normal. At this point, I was totally out of it! I lost almost 5 months of my life. I lost my memory, I couldn’t walk, talk, communication was very limited, food was a foreign forkful of mush so I would not eat! I was moved to ECU Health in Greenville where I stayed for 7-9 more days. I saw a hospital neurologist ONCE. He read my chart and saw the PD diagnosis, looked at my husband and said, “she has Parkinson’s”, turned and walked out never to be seen again. I was still incapacitated and had to be cared for by my husband and 2 grown sons while in the hospital. I didn’t communicate, so somebody had to stay with me to make sure my PD meds particularly were given. They sent me home with NO DIAGNOSIS and said I needed home health! I was unloaded by the ambulance EMTs put in my bed and they left! The drs at the local level hospital had already tested for everything imaginable, so they fell into trying to rehab me and get home health involved. My men were caught in something they never thought possible. Hospital said put me in a rehab, my family refused, and hired a wonderful lady to help me for what lay ahead! All of this information was told to me by my husband and sons over the course of almost a year! There’s still things coming out that I’ve never heard before!
I never was offered a Lymes test until February 2024. We had to request it be done. It was a weak positive, but it was the first positive anything I had gotten in the last 6+ months! I started Doxycycline that very day.
I could feel a difference within 3rd day! I was getting better! And without very much help from the medical community I’ve been going to all my adult life! No one will even acknowledge the test. All I have heard repeatedly is “ we don’t have that tick here”! One exception is my PD neurologist, Dr Browner. I wouldn’t have gotten this far without her guidance and caring. I love her!
So much has happened since that day, Feb 28, 2024. There’s not enough time nor paper to put it on.i can tell you that it’s one of the hardest things my family has had to do for me. I praise the Lord for every day He gives me with my family. But “ it ain’t over till the fat lady sings”. I am still fighting and the farther I get, the more I find out there’s not a Dr in eastern NC who even wants to hear about Lymes much less treat you! I’ve been digging thru the internet for years only to find out that there’s help available but it’s far away, expensive and not very reliable nor helpful because distance is a major factor. I have been reading nearly all of Dr Cameron’s posts and blogs and see myself in nearly every one of them. Today, the blog introduced me to the link between COVID and Lymes. Add to that Parkinson’s Disease, that was once believed to be handled, isn’t !! I need help from somebody! I am a shell of who I used to be. My life is much smaller. The brain fog and inability to properly comprehend things, stops me from driving. Memory is horrible and I lose myself in a conversation about midway! I have uninvited relapses and not much ammunition to fight them! This is just the tip of the iceberg, Dr Cameron. I need some help and my husband of 53 yrs and 2 sons (51 &48) need help to at least be comforted that I’m heading in the right direction. Thank you! Benita Wells
I an sorry to hear how tortuous your journey has been. I have Lyme disease patients share similar stories. Keep working on an answer for you and your husband
I’m going through the same thing. I’m not sure if I got reinfected or covid brought my Lyme/babesia back out of remission. My feet hurt, especially my big toes, my thumbs, stiff neck, chills and night sweats. I’m miserable. I have zero energy and my brain fog makes me not wanna do anything or go anywhere because I can’t think or function properly. I live in SC so there’s not much Lyme help here. I wish I could get my old doctor Dr. Richard Horowitz back in NY to help. I had to beg a new Rheumatologist to put me on Doxy. She only gave me 4 weeks when I asked for minimum of 8. But at this point I’ll take anything for relief. And if it helps, I’ll beg for 4 more weeks to hopefully knock it back down. We need the government to get involved and make Lyme and confections covered under insurance. There’s too many of us suffering and dying from this horrible disease. 💚
Yes! This is so true!!! I used to be able to recognize fellow Lyme disease sufferers by the way they walked. I had Lyme for 9 years with no help from anyone but a wise doctor in Wisconsin. Brain fog, vertigo, aches and pains etc… Fortunately I was able to do a good enough imitation of normal to keep working. It was another wise doctor in st. paul who finally cured me in 2020. Thanks also to Dr. Cameron for website information about double vision in Lyme, and my eye doctor here who believed me. (I still have the double vision and residual damage in my left knee.) I hope the existance of long covid will help convince the government and other medical professionals of the reality of Lyme disease.
Covid was just put out here to confuse the diagnosis of tick bourn infections!! So it can still be hid and brushed under the rug! Sorry for all you have been through!
Hi Dr. Cameron,
It’s Gerilynn, one of your first patients that you treated for Lyme. I hope you remember me. Mostly, doing well from my diagnosis of Lyme over 30 years ago. I have managed my symptoms well over the years by exercising, consuming very healthy food, acupuncture, meditation, Tai Chi, weight loss, Yoga, and keeping a positive attitude. Retirement has been wonderful. I have 2 grandchildren which keeps my serotonin at extremely beneficial levels. However, most importantly is your support, expertise and your medical intervention is what will always be the main reason for this healthful journey of wellness. I think so highly of your expertise and respect your compassion and incredible support since we collaborated together. Have a safe and happy holiday. Love, Gerilynn
I don’t forget you. I am 30+ years older. I am happy you reached out.
Thank you Dr. Cameron,
Normal tilt table after 70 days of your meds and care. Before I came to you a Florida neurologist told me it was Parkinson’s. Thank you for being so persistent and knowledgeable and figuring out it was two tick borne diseases as well as Long COVID. People Go see Dr Cameron!!
Lp