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Published on July 21, 2020

Is it COVID-19 or Lyme Disease?


Remember Lyme disease?

As we venture out of our homes, it’s easy to forget there are still threats besides COVID-19 lurking on the Cape. If you start to feel sick, it might not be the pandemic, but another scourge: Lyme disease, brought to you courtesy of black-legged ticks. The two diseases can share some common symptoms, such as fever, body aches and fatigue.

Barnstable County averaged 175 reported cases of Lyme annually between 2000 and 2015, according to the U.S. Centers for Disease Control (CDC), peaking in 2012 with almost 300 cases. In 2018, there were 6,395 confirmed cases across the six New England states, according to the CDC, and more than 23,558 across the country. The CDC considers another 10,108 cases from that year to be “probable.” While that might seem miniscule in the face of COVID-19 numbers, many cases of Lyme go officially unreported or are too mild to cause symptoms, according to the CDC and Patrick J. Cahill MD, an infectious disease expert at Cape Cod Healthcare. And there are other infectious diseases passed by ticks, including babesiosis, anaplasmosis, tularemia and Powassan.

While the Barnstable County Department of Health and Environment says June, July and August are the most common months for a Lyme diagnosis, ticks don’t take much time off, said Dr. Cahill.

“Ticks are out there and they’re active as long as it is above freezing,” he said. “It’s always tick season on Cape Cod.”

Lyme Symptoms

Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of infected blacklegged ticks (also known as deer ticks) -- usually when they are pinhead-size nymphs, the stage of a tick’s two-year life that comes after the larvae and before adulthood. Usually, the tick must be attached for 36 to 48 hours to transmit Lyme, the county health department says, but because the nymphs are so tiny they often go unnoticed. And, while Lyme is known for its signature erythema migrans, or bullseye rash, that symptom might not show up for a month, or not at all.

According to Dr. Cahill, Lyme disease symptoms generally have three stages:

First Stage:

“The early or first stage is typically the bullseye rash, which appears typically where the tick would bite you,” he said.

The rash is actually the disease’s bacterial spirochetes proliferating and burrowing under the skin. Patients may have multiple bullseye rashes, although that doesn't mean there are multiple bites, Dr. Cahill said.

“I’ve seen anywhere from one to 30 or 40 bullseyes on people, but typically it’s just a single bullseye rash, often in a not-very-accessible area. People miss that a lot -- and not everyone gets the bullseye anyway.”

As with COVID, there’s currently no vaccine for Lyme. Patients diagnosed in the first stage, however, usually respond to a course of doxycycline, a type of antibiotic, he said.

Second Stage:

Lyme’s second stage may include flu-like symptoms such as fever, body or joint aches, headache or neurologic deficits like Bell’s palsy that causes one side of the face to droop, Dr. Cahill said. If it’s not treated, Lyme can then progress to symptoms such as Lyme carditis, or heart block, meaning your heart’s electrical circuits fail to conduct signals properly. That can require cardiac intervention such as a pacemaker, or even treatment in the intensive care unit, he said.

Third Stage:

Patients with late-stage Lyme may also suffer swelling and pain in a single joint, such as the knee. There are also less common neurologic manifestations that may occur such as painful or painless nerve dysfunction.

“That can be months or even years after Lyme disease has occurred and usually represents a localized infection at that point, but it’s basically because the Lyme does affect every organ system,” he said.

How Lyme Differs From COVID-19

Unlike COVID, Lyme does not usually affect the pulmonary system or cause shortness of breath, Dr. Cahill said. “The tick-borne diseases aren’t going to give you a sore throat or shortness of breath or cough.” Nor are they contagious from person-to-person, he said.

Avoiding Lyme disease

How can you avoid Lyme in the greater world this summer?

Here are tips from Dr. Cahill and other health officials:

  • Do a tick check on yourself and any children in your family whenever you’ve been outside. “You don’t have to be in the middle of the deep woods to get a tick bite,” Dr. Cahill said. “A lot of people get them just from their yards while gardening. Wood piles can harbor ticks.”
  • Before going outside apply insect repellent that contains DEET (N,N-diethyl-meta-toluamide). Dr. Cahill said it does “a fair job” of keeping ticks away. The CDC and the U.S. Environmental Protection Agency say DEET products are safe for children and women who are pregnant or lactating if they are used with precautions. You can apply permethrin, another over-the-counter repellent, to your clothing and shoes.
  • Run your outdoor clothes through the dryer for 20 minutes to kill any ticks.
  • If you do find a tick embedded in your skin, use pointed tweezers to remove it by grasping it around the head and pulling straight up. Apply a bit of Neosporin to help dissolve any leftover pieces of beak.
  • Next, save the tick in a sealed plastic bag and send it for testing! Go to to see how to mail it to University of Massachusetts testing labs. While the test costs $50, you’ll be helping to track and help find treatments for Lyme and other diseases.