Did the COVID-19 pandemic mask an alarming rise of tick-borne diseases in Rappahannock County?
In recent years, experts have gained a better understanding of the various illnesses caused by the parasitic bloodsuckers skulking in local grasses. But local residents and experts believe misdiagnoses and under-reported cases of tick diseases paint a skewed image of a health issue that is endemic in Virginia.
“Prior to COVID, one of the number one tested conditions in our whole health district … was Lyme disease,” said Rappahannock-Rapidan Health District Epidemiologist Daniel Ferrell, whose coverage area includes Rappahannock, Culpeper, Fauquier, Madison and Orange.
Since 2017, there have been nine recorded cases of Rocky Mountain spotted fever and 29 recorded cases of Lyme disease in the county, while the Rappahannock-Rapidan Health District as a whole has seen six cases of Anaplasmosis, 48 cases of Ehrlichiosis, 116 cases of Rocky Mountain spotted fever and 373 cases of Lyme disease in the past five years, said Ferrell.
However, due to under-reported cases – an issue specialists say was exacerbated by the pandemic – along with the Center for Disease Control and Prevention’s (CDC) strict guidelines on case confirmation, Ferrell and other observers say case numbers are a vast misrepresentation of the magnitude of diseases caused by ticks. Additionally, the rise in related conditions like Alpha-gal Syndrome, a red meat allergy generated from tick bites, has raised further concern among residents in tick-infested areas. Victims can’t eat beef, pork, venison and in some cases dairy products.
“So many of the local epidemiologists were so busy dealing with COVID, that a lot of tick-borne disease cases probably went unreported,” said Dr. David Gaines, Public Health Entomologist for the Virginia Department of Health (VDH).
Dr. John McCue of Mountainside Medicine near Washington said health insurance claims provide a more accurate figure for Lyme disease, the most common tick-borne disease in Rappahannock and Virginia.
“A lot of times doctors will treat patients and not do testing,” said McCue. “But you can tell from insurance claims that [Lyme disease] is actually quite common.”
While the CDC reports more than 30,000 confirmed cases of Lyme disease each year nationwide, insurance claims suggest the actual number may be around 476,000, said McCue.
From spring through fall, McCue said he treats one or two patients for Lyme disease out of the roughly 25 that he sees on a daily basis. He’s seen a few cases of the other tick-borne diseases over the years but said those are much less common. Every tick-borne illness is treated with antibiotics, sometimes administered through an IV in serious cases.
With an array of symptoms that can vary from patient to patient, Lyme disease has previously often been misdiagnosed.
According to the CDC, early symptoms of Lyme disease include fever, chills, headaches, fatigue, muscle and joint aches and a bullseye rash, also known as erythema migrans. However, the bullseye rash does not always occur in patients infected with Lyme disease and does not always indicate a Lyme disease infection.
If left untreated for days or months, Lyme disease symptoms can include migraines, facial palsy, arthritis, heart palpitations, dizziness, shortness of breath, nerve pain, and inflammation of the brain and spinal cord.
Rappahannock resident Megan Smith said she was misdiagnosed five times while suffering from Lyme disease in 2007. With the absence of a bullseye rash and several diagnostic tests showing negative results for Lyme disease, Smith said she received false diagnoses which included fibromyalgia, multiple sclerosis and chronic fatigue syndrome.
Dr. McCue also noted that Lyme disease was often misdiagnosed as fibromyalgia in previous years.
After Smith found a doctor who recognized her condition as Lyme disease, she began researching and reporting on the inaccuracy of testing and underreporting of Lyme disease cases.
Her articles, published in 2012 and 2013 in the Rappahannock News and Washington Post, detailed how cases of Lyme disease were being egregiously underreported by doctors in the area. Smith said she believes both case reports and testing have improved in the decade since.
In Rappahannock County, the main culprits to look out for are the blacklegged tick (deer tick), which carries Lyme disease and Anaplasmosis; the Lone Star tick, known to cause Ehrlichiosis, Rocky Mountain spotted fever and Alpha-gal Syndrome; and the American dog tick, carrying Rocky Mountain spotted fever.
While the blacklegged tick can carry Lyme disease at all life stages, it is more common in adult ticks. However, McCue noted, ticks in their nymph stage cause roughly 75% of Lyme disease cases, as they are harder to detect on the body. The blacklegged tick requires an attachment period of 36 to 48 hours before Lyme disease can be transmitted, according to the CDC.
Elevation is a determining factor of habitats for the various species.
“Lone Star ticks are a southern tick species and they’re not really found very much above 1,600 feet of elevation,” said Gaines. “Once you get above 1,600 feet of elevation, blacklegged ticks predominate.”
Both of those species are known to feed from deer, and a rise in deer population would invariably lead to a rise in tick-borne illnesses.
“Wherever deer are abundant, either one of those tick species will be abundant, depending on elevation,” said Gaines. “Rappahannock County … on the edge of higher elevation, is going to have more blacklegged ticks than counties that are of lower elevation.”
He said suburban forests are hotspot areas for the two most common disease-carrying tick species since deer hunting is not permitted in suburban areas.
Gaines spends much time in tick abundant habitat. He says spraying clothing with permethrin, and waiting for it to dry before getting dressed, is the best-known preventive method. Permethrin can be found in camping or outdoor supply stores.
While a precise rise in tick-borne diseases can’t be confirmed by the numbers, many believe that illnesses caused by ticks are becoming more prevalent.
Doctors and epidemiologists have cited several factors that could lead to an increase in cases, which include increased awareness in recent years, a rise in deer population, mild winters and more people retreating to wilderness areas for recreation following the onset of the pandemic.
COVID clouded the extent of Lyme disease since 2020, but as the pandemic wanes, experts anticipate reported Lyme disease cases to be back on the rise.
“The numbers will start to increase again,” said Ferrell.
A recent effort by the VDH, to gain a better understanding of tick ecology in Virginia, allows people to mail in a tick found on their person to the department to identify the species. For more information visit www.vdh.virginia.gov/environmental-epidemiology/virginia-tick-survey.
The initiative, said Ferrell, will help further determine the geographical distribution of ticks in Virginia and identify high risk localities. Nonetheless, he advises anyone who spends time in grassy areas to remain cautious, practice preventive methods and always check for ticks afterwards.
Next week: Also on the rise thanks to the Lone Star tick, and difficult to treat: Alpha-Gal Syndrome.
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