Re: How “long covid” is shedding light on postviral syndromes
Chronic medical conditions like M.E., Fibromyalgia, Chronic Lyme Disease/PTLDS and long COVID all share similar symptoms as your article suggests, but the implication that Lyme disease fits into the same category from an etiological point-of-view, and is not a persistent infection, nor immunological in nature requires elucidation.
Although there has been a long ongoing debate on the nature of persistent symptoms in Lyme disease, recent published research from Johns Hopkins University, the University of New Haven and Stamford University have all implicated biofilm/'persister' forms of Borrelia as one of the reasons why symptoms persist in this chronically ill population. Clinical studies on dapsone combination therapy as well as disulfiram as ‘persister’ drug regimens have been shown to have benefit in relieving symptoms in the CLD/PTLDS population, and the published medical literature has found up to 16 reasons why symptoms may persist. A review of the literature reveals that long COVID and chronic Lyme disease share certain etiological overlaps based on published literature, including possible persistent infection, reactivation of infection (EBV, HHV6), autoimmunity and immune dysfunction, POTS/dysautonomia, and mitochondrial dysfunction.
In the United States, 87% of our health care costs and 70% of our deaths are due to chronic disease, and chronic infections and environmental toxins are not regularly considered in the work-up. In the case of COVID, disadvantaged populations exposed to high levels of pollution fared poorly during the pandemic due to higher levels of free radical/oxidative stress, and with chronic Lyme disease, environmental toxicity including heavy metals and mold toxins also may have a negative impact. Considering that 14.5% of the global population has now been diagnosed with Lyme disease, with climate change and environmental pollution a significant health risk, perhaps it is time to evaluate the 16 point MSIDS model as a potential diagnostic map to evaluate the high societal burden of chronic fatiguing, musculoskeletal illnesses with neuropsychiatric symptoms, which are responsible in large part for high levels of chronic disability and rising health care costs across the globe.
Dr Richard Horowitz
Medical director, Hudson Valley Healing Arts Center, Board certified internal medicine
Member NYS DOH Tick-borne Disease Working Group 2021-2022
Member HHS Tick-borne Disease Working Group 2017-2019
Co-chair HHS Other Tick-borne Diseases and Co-infections subcommittee 2017-2019
Member, HHS Babesia and Other Tick-borne Pathogens 2019-2020
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2. Horowitz, R.I.; Freeman, P.R. Efficacy of Double-Dose Dapsone Combination Therapy in the Treatment of Chronic Lyme Disease/Post-Treatment Lyme Disease Syndrome (PTLDS) and Associated Co-infections: A Report of Three Cases and Retrospective Chart Review. Antibiotics 2020, 9, 725. https://doi.org/10.3390/antibiotics9110725
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Competing interests: No competing interests