COVID-19 vs. Tick-Borne Diseases: How to Tell the Difference

An infectious disease expert explains that these diseases may have a few symptoms in common, but one key contrast is that COVID can cause respiratory symptoms.

Close up photo of a tick

Tick season is upon us, and although the threat of tick bites is expected every summer as people spend more time hiking, walking, or picnicking in grassy areas, symptoms normally attributed to a tick-borne disease — like fever, fatigue, and muscle aches — might be confused with COVID-19.

On top of that, as states ease restrictions, people who haven’t had the chance to escape the city might flock to parks and hiking trails after being stuck indoors, potentially causing a surge in tick exposure, says Dr. Sorana Segal-Maurer, director of the Dr. James J. Rahal, Jr. Division of Infectious Diseases at NewYork-Presbyterian Queens and professor of clinical medicine at Weill Cornell Medicine.

However, understanding the signs and symptoms of both COVID-19 and common tick-borne diseases can help you tell the difference between these infections. Dr. Segal-Maurer spoke with Health Matters about these differences, the effect the pandemic might have on people this tick season, and how to keep you and your loved ones tick-free when enjoying time outdoors.

How would someone know if they have symptoms of a tick-borne disease rather than COVID-19?
Most tick-borne diseases common to the Northeast — Lyme disease, anaplasmosis, babesiosis, and Powassan virus, all carried by the blacklegged tick — have some similarities to COVID-19. They can present with fever, fatigue, and muscle aches. But the cross-symptoms really end there. With COVID, the symptoms can very quickly progress into a respiratory problem. Tick-borne diseases don’t have a respiratory component. You’ll feel lousy, you’ll have fever and aches, but you won’t have a cough, you won’t have pneumonia.

Tick bites also might leave distinct physical marks. In the case of Lyme disease, some people will develop a very particular rash that looks like a target, and in the case of anaplasmosis and babesiosis, you may see what we call petechiae, which look like a rash with little red scattered dots. These aren’t typical with COVID.

If someone has recovered from COVID, are they more susceptible to serious illness if they get a tick-borne disease?
Unfortunately, we don’t know because COVID is relatively new. For instance, COVID-19 can cause an inflammatory overreaction in the body called a cytokine storm, when your body basically presses the panic button in response to the virus and your immune system goes into overdrive. In people who’ve had a cytokine storm, they seem to have something that’s called hypercoagulable syndrome, which means they form blood clots everywhere.

We don’t know how people who’ve had serious cases of COVID will react to some other infection in the future. Does COVID scar your immune system? Does it cause you to be more susceptible to more serious complications? The good news is, most people don’t develop a cytokine storm, but I think it’s too new and too soon to know whether someone who has recovered from either a serious or even mild case of COVID is more susceptible to an infection from a tick-borne pathogen.

Has the COVID-19 pandemic impacted tick season in New York and surrounding areas?
Normally with such a mild winter like we had this year, people would already be up and about hiking and enjoying the great outdoors. But what’s hard to predict this year is the effect of the orders to stay home due to COVID-19. We might not have the usual exposures this time of year because people were not out in droves in March, April, and May. Now that recreational areas have opened and people are going out to places where they might brush up against ticks, it’s possible there could be a big influx in cases.

Another factor that could contribute to an increase in tick-borne illnesses is the fact there has been very limited automotive traffic and air traffic over the last few months, and wildlife has migrated to relatively suburban and urban areas. This includes coyotes, rabbits, squirrels, hawks, and owls, and they could be bringing pests, including ticks. So although you may not be out on a trail in the great outdoors, you might be in your backyard or at a local park and be bitten by a tick.

Dr. Sorana Segal-Maurer debunks COVID-19 myths

Dr. Sorana Segal-Maurer

What precautions can people take to avoid being bitten?
Wear light-colored clothing so ticks are easier to see, and socks over pants and long-sleeved shirts to prevent ticks from getting near your skin. And don’t forget hats.

A concentration of DEET of up to 30% has proved effective either due to its smell or its ability to camouflage us when the ticks are putting out their feelers. The other thing that’s been studied is eucalyptus oil for those wishing to avoid DEET. Pre-treatment of clothing with permethrin is also very effective, but you have to be careful about its use around cats. If you treat dogs with permethrin, cats need to be kept away from them.

When you’re outside, stay on paths. Once you brush against foliage, you’re putting yourself at risk.

Who’s most at risk for getting tick bites?
Kids are at risk because they might veer off walking paths and run through foliage without realizing it, as are pets because they’re always face-down smelling all these fabulous things outdoors. Hikers are at risk, as is anybody who is active outdoors.

What should you do if you’ve been in an area with ticks?
Immediately do a tick check when you get indoors. You can put your clothing into a hot dryer for at least 20 minutes. Water doesn’t kill ticks, but heat does. And then, of course, do a body check. Ticks like to go anywhere it’s warm and protected, like under your arms, between your legs, around private parts, the back of your knees, your neck, in your hair, or behind your ears.

If you find a tick on your body, should you remove it? What is the best way to do it?
Yes. Once they attach, they’re very difficult to pull out. There are a number of talked-about remedies that do not work and can be dangerous, like using petroleum jelly to “smother the tick” or “burning it off,” which just serves to cause a nasty burn. There’s really no way of doing it other than making sure you have a very sharp pair of tweezers. Not blunt tweezers, because if you squeeze the tick, you increase the potential to infect yourself. Try to pull it out from the mouth straight out, not twisting. That’s very important.

When you’re disposing of it, either flush it down the toilet or drop it in rubbing alcohol in case you end up with a rash and want to bring it in for identification.

After removing the tick, what are the next steps?
Call your healthcare provider. If it’s been attached for more than 24–48 hours and you can reasonably see it (it is engorged and larger than the size of a poppy seed or grain of sand), it has probably fed. In general, it’s one dose of doxycycline as a preemptive treatment. If you don’t know that you’ve been bitten and now have symptoms, you have to get a full course of treatment, which will be determined based on your diagnosis.

You can also reach a provider using telehealth. Because of COVID-19, we’ve increased our telehealth resources, expanding access to all primary and specialty care. If you think you’ve been bitten by a tick, you can consult with doctor via a video visit, show the doctor your rash, or even show them the tick, and they can put you on a doxycycline preventive regimen and call it into your pharmacy, all without you having to go into a doctor’s office.

Anything else people should be aware of?
Blacklegged ticks can be infected with multiple diseases. If you’re diagnosed with Lyme, get treated for it but be vigilant if you have additional symptoms or you don’t feel like you have returned to your baseline. Make sure your healthcare provider looks for all the other infections that we see with these tick-borne illnesses. Because COVID is still a risk, people should wear face masks in public places, wash their hands when they get home, and practice social distancing.

Sorana Segal-Maurer, M.D., is a professor of clinical medicine at Weill Cornell Medicine and director of the Dr. James J. Rahal, Jr. Division of Infectious Diseases at NewYork-Presbyterian Queens.