Lyme in The Time of COVID: A Reminder to Heed The “Normal” Risks This Season

by Heather Kopsco, Nohra Mateus-Pinilla | May 3, 2021 | Recreation, Research

Two people are walking along a trail in a green spring woodland. A tan medium sized dog trots ahead of the two people.

Photo by Chris Lutke.

A black, white, and gray graphic including four maps of Illinois indicating in which counties of Illinois the American dog tick, backlegged tick, lone star tick, and gulf coast tick have been reported. — **Figure 1: County-presence of ticks of medical significance in Illinois (as of Feb. 2021)**. From top L to bottom R, American dog tick (*Dermacentor variabilis*), blacklegged tick (*Ixodes scapularis*), Lone star tick (*Amblyomma americanum*), and Gulf Coast tick (*Amblyomma maculatum*). Corrected June 2021: The previous version of this figure erroneously labeled Piatt County as having a report of a Gulf Coast tick. To date we do not have records of the Gulf coast tick in Piatt County. Map credit: I-TICK

When the pandemic closures began in March 2020, non-essential places and outdoor recreational areas were shuttered to prevent the spread of a poorly understood, and deadly virus. Hiking trails, nearby parking areas and park entrances all closed. Since then, we have learned a lot about how the virus that causes COVID-19 behaves. We now know that being outdoors in large open spaces is low risk, especially if you are fully vaccinated.

The importance of time spent outdoors to our physical and mental wellbeing was never before so apparent. In the past year, research echoed that we need exposure to nature to feel happy, calm, and frankly, human. Studies on adolescents found that outdoor play and exposure to green spaces during the pandemic were associated with better mental health (Jackson et al. 2021) and physical activity protected against negative mental health impacts (Wright et al. 2021). Outdoor activity organizations and experts were compelled to issue recommendations to keep these spaces open, arguing that physical activity and green spaces may even protect against health conditions such as heart disease that increase the likelihood of worse outcomes from COVID infection (Slater et al. 2020).

A graphic indicating a new tick invading from the south into Illinois. It is called the Gulf Coast tick, and it is brown with tan markings on its back. — **Figure 2: The new tick in town.** The Gulf Coast tick is invading from the south. Documentation of its occurrence in Illinois start after 2008 (Gillman et al. 2019; Philips et al. 2020). This tick can be infected with a bacteria (*Rickettsia parkeri)*, that causes a disease similar to Rocky Mountain Spotted Fever (Paddock 2004). It looks similar to the American dog tick, but has needle-like mouthparts, and a more angular pattern on its back.

During 2020 we saw how barriers to medical care resulting from the pandemic led to delays in diagnosis of more “typical” illnesses, such as tick-borne diseases (Novak 2021). While it would make sense that diagnoses would be faster given a heighten sensitivity and awareness of flu-like symptoms, the reliance on telemedicine may have prevented adequate triaging of and examination of patients. One case report described a man presenting with symptoms that initially appeared to be a COVID infection (Novak 2021). Lacking a rash at the time, he was not assessed for Lyme disease after a negative COVID test. As a rash and more symptoms, such as blurred vision and meningitis, finally developed he tested positive for Lyme disease. This man’s delayed diagnosis led to significant neurologic symptoms that thankfully subsided, but only after months.

Where the Wild Ticks Are

A graphic comparing the three most commonly encountered ticks in Illinois including the Blacklegged tick, the Lone Star tick, and the Dog tick. — **Figure 3: The three most commonly encountered ticks in Illinois shown to scale.** Adult-stage ticks are roughly the size of a sesame seed. Nymphs closely resemble a poppy seed. Larvae, even smaller, will generally come in groups. Image credit: **CDC**

As we enter our second warm season alongside COVID, remember that time in nature can be our medicine, but to also prepare for “normal” risks. Here in Illinois, a growing threat to humans and our furry adventure companions lurking along those greening trails are several types of ticks (Figure 1) (Gilliam et al. 2020); all of which may transmit various diseases to you or a pet.

Despite the old adage to “wear a hat to keep away ticks,” ticks do not fall from the trees. They either crawl up from the leaf litter or are waiting on knee-high vegetation to latch onto their next meal as it passes by. Ticks need blood to grow to their next life stage. After feeding they will drop to the ground to digest and grow into their next life stage. (Figure 3).

There are three main ticks of medical importance in Illinois (Figure 3) and a new tick is quickly establishing in several counties (Figure 2). Each tick is unique in the sense that its stages are active at different times of the year, in different habitats and each can carry different diseases (Table 1). The best defense is a good offense. Get to know your ticks and then make a plan to prevent bites this season.

A table listing the type of tick and what life stage one might encounter in the outdoors during different parts of the year. The table also includes the habitat and the commonly transmitted germs. — **Table 1.** A brief guide to the most commonly encountered ticks of Illinois including their seasonality, habitat and commonly vectored pathogens. *Rarely encountered by humans in this life stage. They feed almost exclusively on small to medium-sized wildlife species such as mice, voles, raccoons, skunks, etc. Here is a quick guide to avoiding tick bites.

How to Avoid Tick Bites:

1. Prepare

Choose clothing friendly repellent-products with 0.5 percent permethrin. Applying this odorless, stainless spray to fabric (including shoes) provides a highly effective tick-barrier for up to 4 weeks (even with launderings).
Treat exposed skin with an EPA-approved repellent, ideally containing 20-30 percent DEET, picaridin, or LipoDEET lotion. Find a repellent that is right for you and your family at the EPA’s repellent finder: https://www.epa.gov/insect-repellents/find-repellent-right-you
Pets need protection, too! Ask your veterinarian about an effective tick bite preventative and use it all year long.
Keep a sealable container and pair of fine-tipped tweezers on hand for any ticks that may have gotten past your initial defenses. For tiny larvae? Keep a lint roller on hand.
Download the TickApp, a free smartphone app that allows you to send a photograph of your tick to scientists who will identify it and provide relevant information to you – for free.

2. Check

Make it habit. Conduct a tick-check after venturing off a trail, before getting back in the car, and when you’ve returned home.
Throw clothes into a dryer on high for 10-15 minutes BEFORE washing. The dry heat will kill loose ticks.
Showering soon after getting back helps dislodge or spot ticks hiding in hard to see places, such as armpits, groin, neck, behind knees and ears, or at the hairline (particularly on children).
Check your pets, too! Pay attention to bellies, face, paws and tail.

You Found a Tick! Now What??

Don’t panic.
Do not apply oils or substances to “suffocate” the tick before removal. This causes it to regurgitate saliva (and potentially germs) into the skin.
Use your pointy tweezers to gently, but firmly, grasp the tick as close to the skin as possible, and pull slowly straight up. Place the tick in a sealable container, label it with the date and location where you think you picked it up and put it in the freezer in case you need it for testing or confirmation of tick species.
Wash the bite site with soap and water, monitor for any rashes and flu-like symptoms. Consult your doctor if you’re concerned.
Report your tick to TickApp, and visit https://vetmed.illinois.edu/i-tick/ for more information about ticks, and to participate in the I-TICK statewide monitoring program.

Happy (and healthy) trails!

For more information:

I-TICK program https://vetmed.illinois.edu/i-tick/

CDC Tick page https://www.cdc.gov/ticks

An infographic describing how to avoid ticks while being outdoors. Tips included in the graphic are check for ticks frequently, dry clothes, then wash clothes, save and report any ticks, treat gear with permethrin (0.5%) before going out, use EPA-approved repellent on exposed skin, and protect your dog.

References

Jackson S.B., Stevenson K.T., Larson L.R., Peterson M.N. and Seekamp E. Outdoor Activity Participation Improves Adolescents’ Mental Health and Well-Being during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health. 2021; 18(5):2506. https://doi.org/10.3390/ijerph18052506

Novak, C. B., Scheeler, V. M., and Aucott, J. N. (2021). Lyme Disease in the Era of COVID-19: A Delayed Diagnosis and Risk for Complications. Case Reports in Infectious Diseases, 2021, 6699536. https://doi.org/10.1155/2021/6699536

Gilliam, B., Gronemeyer, P., Chakraborty, S., Winata, F., Lyons, L. A., Miller-Hunt, C., Tuten, H. C., Debosik, S., Freeman, D., O’Hara-Ruiz, M. and Mateus-Pinilla, N. (2020). Impact of Unexplored Data Sources on the Historical Distribution of Three Vector Tick Species in Illinois. Journal of Medical Entomology, 57(3), 872–883. https://doi.org/10.1093/jme/tjz235

Paddock, C. D., Sumner, J. W., Comer, J. A., Zaki, S. R., Goldsmith, C. S., Goddard, J., McLellan S. L. F., Tamminga, C. L. and Ohl, C. A. (2004). Rickettsia parkeri: A newly recognized cause of spotted fever rickettsiosis in the United States. Clin. Infect. Dis. 38:805-811

Phillips, V. C., Zieman, E. A., Kim, C.-H., Stone, C. M., Tuten, H. C. and Jiménez F.A. (2020). Documentation of the Expansion of the Gulf Coast Tick (Amblyomma maculatum) and Rickettsia parkeri: First Report in Illinois. The Journal of Parasitology, 106(1), 9–13. https://www.ncbi.nlm.nih.gov/pubmed/31958375

Slater, S. J., Christiana, R. W. and Gustat, J. (2020). Recommendations for Keeping Parks and Green Space Accessible for Mental and Physical Health During COVID-19 and Other Pandemics. Preventing Chronic Disease, 17, E59. https://doi.org/10.5888/pcd17.200204

Wright, L. J., Williams, S. E. and Veldhuijzen van Zanten, J. J. C. S. (2021). Physical Activity Protects Against the Negative Impact of Coronavirus Fear on Adolescent Mental Health and Well-Being During the COVID-19 Pandemic. Frontiers in Psychology, 12, 737. https://doi.org/10.3389/fpsyg.2021.580511

Dr. Heather Kopsco is a postdoctoral research associate and disease ecologist at the College of Veterinary Medicine where she investigates questions at the intersection of tick ecology and human and animal disease prevention, a path that emerged from her own experience with tick-borne illness. Beyond research she spends her time hiking, getting distracted by birds, and wrangling a 3.5 yr. old, two rescued pit-bull type dogs, and an ever-growing collection of houseplants.

Veterinary Epidemiologist Dr. Nohra Mateus-Pinilla from the Illinois Natural History Survey at the University of Illinois works to understand variables that impact disease transmission to populations in natural and captive systems. Her goal is to build on the best available evidence to base interventions and practices that minimize exposure and spread of infectious diseases on animals and people. Her interest in ticks and their occurrence and distribution in natural areas dates back to 2005 with a study of the deer tick in an east-central Illinois natural area. Although she has experienced Lyme disease and treatment, she still enjoys remote camping and canoeing and remains active in the world of tick-related research.