Lyme Disease Season Is Here. These Are Tips on How to Avoid It. - The New York Times

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As if we all needed another health concern, Lyme disease season has arrived.

A walk in the woods might be an appealing way to relieve stress from the coronavirus lockdown, but it comes with an underappreciated risk: Ticks that carry Lyme and other illnesses.

Some of the basic symptoms of a Lyme infection — fever, malaise, fatigue — can resemble Covid-19. That’s a worry nobody needs. In addition, contracting a serious illness like Lyme could put you at greater risk from Covid.

“We already know people with underlying conditions are more vulnerable for complications with coronavirus,” said Shannon L. Delaney, a neuropsychiatrist and director of child and adolescent evaluation at Columbia University’s Lyme and Tick-Borne Diseases Research Center. “Certainly, people with tick-borne illness fall into that category.”

Fortunately, you don’t have to skip that walk in the forest. Understanding Lyme disease can help you to minimize your risk.

Where? Lyme disease is most prevalent on the Eastern Seaboard of the United States, from Virginia to Maine, and from the western reaches of New York and Pennsylvania to the East Coast and into Atlantic Canada. It’s also found in the Upper Midwest, primarily in Wisconsin and Minnesota. But its range is expanding. “Now it’s spreading into Michigan, Illinois, Iowa, and the southern part of Midwestern Canada as well,” said Richard S. Ostfeld, a disease ecologist and tick specialist at the Cary Institute of Ecosystem Studies.

Cases are also found in states outside these hot spots, including in California, Texas and Florida, but numbers there remain comparatively low.

Ticks like the woods. “They tend to be much more scarce on lawns, although they do exist,” Dr. Ostfeld said. Ticks tend to live in shady forests with leaf litter, and in the type of shrubby barberry or honeysuckle thickets that tend to cover the understory of woods near neighborhoods and roads.

“They are extremely abundant in small forest patches of a couple acres or less,” Dr. Ostfeld said. “Large expanses of continuous forest tend to harbor fewer ticks than little fragments of forests in suburbia or an agricultural landscape.” That’s because these patches tend to have higher concentrations of disease-carrying mice, because of a lack of predators. “Owls, foxes, bobcats, weasels, are doing us a favor,” Dr. Ostfeld said, but fragmented woods tend to have too few of them to keep mice populations in check.

Based on surveys of acorns, which provide food for mice, Dr. Ostfeld said he expected 2020 to be “an average or slightly below average year for ticks.” The acorn signal for next year, though, is very clear: “Last fall was a huge acorn year. So we would expect 2021 to be a really bad Lyme year.”

Dr. Ostfeld added that it’s something of a myth that deer are the main carriers of Lyme disease. The so-called “deer tick” was misnamed when it was first discovered, he said. “We learned it was only a northern population of the black-legged tick,” which attaches itself to at least 50 different species of mammals including mice and chipmunks, and is the species of tick that most commonly transmits disease to humans.

Deer can carry Lyme, but in reality, the main culprits in terms of disease transmission are white-footed mice. Newly hatched ticks attach to the mice and other small rodents, acquiring the bacteria from their first blood meal, and passing it on to other mammals, including humans, the following year.

An adult and nymph tick. Quick removal of ticks from clothing and skin is crucial.Credit...Jean-Christophe Verhaegen/Agence France-Presse — Getty Images

When? Is it above 45 degrees Fahrenheit, or roughly 7 Celsius? If so, ticks will be out. Climate change, by the way, is making the onset of Lyme season earlier each year, and making the season last longer.

What to wear? Basically, long sleeves and long pants. Dr. Delaney recommends tucking your pants into your socks so ticks can’t crawl up your legs. Wearing light colored clothing is a good idea, so dark ticks show up easily.

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She also recommends you spray your clothes, shoes, and socks with the insecticide permethrin, which kills ticks on contact.

Permethrin shouldn’t be sprayed on skin. Instead, treat exposed skin with DEET or a chemical called IR3535, which she says is more commonly used in Europe, and has an excellent safety record. If you are taking bags out for outdoor sports, like tennis, spray your bags too.

Where to hike? Stay on the path. Stepping off the trail puts you directly into the leaves and brushy area that ticks love. “That’s where ticks hang out. You’ll increase your risk of tick bites,” says Brian A. Fallon, a psychiatrist and the director of the Lyme and Tick-Borne Diseases Research Center at Columbia University.

When you get home: Inspect your clothes and body for ticks. If you find one on your skin, remove it immediately and consult your doctor. She might put you on prophylactic antibiotics to prevent a Lyme infection.

The Coronavirus Outbreak

• Frequently Asked Questions and Advice

  Updated May 27, 2020

  • What are the symptoms of coronavirus?

    Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

  • How can I protect myself while flying?

    If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

  • How many people have lost their jobs due to coronavirus in the U.S.?

    Over 38 million people have filed for unemployment since March. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

  • Is ‘Covid toe’ a symptom of the disease?

    There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.

  • Can I go to the park?

    Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.

  • How do I take my temperature?

    Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.

  • Should I wear a mask?

    The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

  • What should I do if I feel sick?

    If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

  • How do I get tested?

    If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.

  • How can I help?

    Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.

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Quick removal is important. The bacteria that causes Lyme disease, by far the most common tick-borne illness in North America, is believed to transmit after the tick has been attached for at least 24 hours (though other tick-borne diseases can transmit much faster). The Centers for Disease Control and Prevention has instructions for removing ticks.

You should save the tick, because you can (and should) send it to a commercial lab for analysis. It’s helpful to understand which, if any, of the many tick-borne illnesses you were exposed to if you develop symptoms later. In Connecticut, the state runs a lab that will analyze your tick free of charge.

Giving your clothes a spin in the dryer after that hike is a good idea, too, even if you don’t spot any ticks. A bit more than 10 minutes should be enough to kill any unnoticed hangers-on.

Lyme symptoms can show up any time between two days and three weeks after a bite. Fever, fatigue and malaise are hallmark Lyme symptoms, and are also among the symptoms of a coronavirus infection. “But the one major difference is presentation of respiratory symptoms,” Dr. Delaney said. That means if you’re coughing, it’s probably not Lyme.

It’s crucial to tell your doctor about any recent hikes or outdoor activity. The sooner you get treated for tick-borne illness, the better the outcome tends to be.

“If we’re changing our behaviors in terms of outdoor exposure, we need to think about this,” Dr. Delaney said. “Make sure you bring that up with your doctor. These tick-borne illnesses should be on your radar.”

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