Perspective: Risks for Lyme disease patients during a COVID-19 pandemic
Hundreds of thousands of people contract Lyme disease every year. Some of them remain chronically ill. What are the risks for Lyme disease patients during a COVID-19 pandemic?
There are reports that the COVID-19 virus can be more severe in individuals with a co-morbidity. In fact, a recent study found that out of 1,590 cases in China, 1 in 4 patients had at least one co-morbidity. 
The most common co-morbidity was hypertension and other cardiovascular diseases. There were a few cases of cerebrovascular diseases, diabetes, hepatitis B infections, chronic obstructive pulmonary disease, chronic kidney diseases, malignancy, and immunodeficiency.
Co-morbidity, which refers to the presence of more than one disorder in the same person, can impact the outcome of a disease.
Lyme disease could be considered a co-morbid condition. Post-Treatment Lyme Disease Syndrome (PTLDS) is a complication of Lyme disease, whereby patients continue to suffer from pain, fatigue, cognitive impairment, and poor function. These patients often have weakened immune systems.Risks for Lyme disease patients during a COVID-19 pandemic. Click To Tweet
The risks for Lyme disease patients during the COVID-19 pandemic needs to be discussed.
Meanwhile, the risks to patients with other conditions, including Rheumatoid arthritis, an autoimmune disease, have been discussed. Doctors have been concerned with the risk of infection in these patients “because of an overall impairment of immune system typical of autoimmune diseases combined with the iatrogenic effect generated by corticosteroids and immunosuppressive drugs,” Favalli writes in the article “COVID-19 infection and rheumatoid arthritis: Faraway, so close!” 
Disease-modifying anti-rheumatic drugs (DMARDs) are used in rheumatoid arthritis patients to slow down disease progression.
(None of the 1,590 cases of COVID-19 cases in China had rheumatoid arthritis.)
Monti and colleagues described 8 patients with Lyme arthritis who developed COVID-19.  Although they were receiving treatment with DMARDs, the medications were temporarily stopped while they recovered from the COVID-19 virus.
All of the 8 patients were treated with antibiotics. Five of them were on previous treatment with hydroxychloroquine. One was admitted and treated with antibiotics, antiviral medications, and hydroxychloroquine.
Fortunately, none of the 8 patients developed severe respiratory complications or died.
The risk for cancer patients during a COVID-19 pandemic has also been discussed. “Several classes of cancer treatment, including chemotherapy and immunotherapy, can suppress immune systems and make patients more susceptible to COVID-19 infection,” writes Extance. 
Out of the 1,590 cases of COVID-19 studied in China, 18 patients had cancer. “Early published reports from China on the outcomes of patients with cancer infected with COVID-19 indicated a 3.5 times higher risk of needing mechanical ventilation or ICU admission or dying compared with patients without cancer,” writes Liang and colleagues. 
It’s been stressful for Lyme disease patients and their families until we know more about their risks of COVID-19.
Fortunately, the antibiotics used to treat Lyme disease do not have an iatrogenic effect, as seen with corticosteroids and immunosuppressive drugs.
For now, it is important to continue universal precaution, to eat right, and avoid stress. Be careful to avoid another tick bite. And make sure you continue to receive treatment for your Lyme disease.
- Guan WJ, Liang WH, Zhao Y, et al. Comorbidity and its impact on 1590 patients with Covid-19 in China: A Nationwide Analysis. Eur Respir J. 2020.
- Favalli EG, Ingegnoli F, De Lucia O, Cincinelli G, Cimaz R, Caporali R. COVID-19 infection and rheumatoid arthritis: Faraway, so close! Autoimmun Rev. 2020:102523.
- Monti S, Balduzzi S, Delvino P, Bellis E, Quadrelli VS, Montecucco C. Clinical course of COVID-19 in a series of patients with chronic arthritis treated with immunosuppressive targeted therapies. Ann Rheum Dis. 2020.
- Extance A. Covid-19 and long term conditions: what if you have cancer, diabetes, or chronic kidney disease? BMJ. 2020;368:m1174.
- Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21(3):335-337.
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