Nature-lovers who venture into the woods risk catching tick-borne illnesses.
CNN  — 

After more than three months of shutdowns, mandatory quarantines, self-imposed exile from society and working from home, nature-lovers looking for a well-earned breath of fresh air could face a possible collision course between coronavirus and tick-borne illnesses this summer.

A “perfect storm,” warns Eva Sapi, a University of New Haven biology professor and group director for the Lyme Disease Research Group.

Noting the mild winter on the East Coast, Sapi says, “We do have a bad year for the ticks.”

Hikers, campers and anyone else eager for an escape could “just explode into the outdoors. And there may not be the same thoughtful approach” to preventing exposure, explains Dr. Sorana Segal-Maurer, director of the Dr. James J. Rahal, Jr. Division of Infectious Diseases at NewYork-Presbyterian Queens health care system.

“I’m a little nervous that their guard may be down just a slight bit,” she adds.

Outdoor crowds were so big around Memorial Day weekend, that parks from southern California to North Carolina had to close early after hitting capacity.

Last year, the Centers for Disease Control and Prevention announced a rise in Lyme and other tick-borne diseases, with seven additional germs identified in the US in the last two decades, while the “lone star tick” expanded its footprint beyond the southeast to northern states and the Midwest.

The CDC’s guide to visiting parks and recreational facilities in the Covid-19 era includes avoiding crowded parks, staying home if you’re infected and choosing parks closer to home to limit extra stops that carry added risk of contagion.

But ignoring basic steps that reduce the risk of tick and vector-borne illnesses to focus solely on Covid-19 prevention is just one danger. Another is the possibility of confusing the symptoms if you start feeling sick.

Lyme disease and Covid-19: a tale of similar symptoms

Warning signs for tick-borne illnesses are “very similar to the severity that we’ve seen with Covid-19, which is that fever, the muscle aches, the headaches, the severe fatigue,” says Dr. Segal-Maurer.

She believes a unique difference is that breathing problems are common in coronavirus patients, but not with those infected by tick diseases. Yet even that distinction is up for debate.

“Pulmonary involvement, even to a fatal degree, has been documented in a range of tick-borne infections,” Dr. Steven Phillips of the Bay Area Lyme Foundation tells CNN. “Although serious pulmonary involvement with vector-borne infections is relatively uncommon, non-specific pulmonary complaints, such as shortness of breath, are extremely common.”

The National Park Service, which welcomes more than 300 million people in a normal year, continues its “phased” reopening of lands and services. It launched a “Recreate Responsibly” campaign, reminding visitors not only about social distancing at trails, boat launches and parking lots, but encouraging guests to postpone difficult hikes or new activities, with first responders and others still busy with pandemic response.

Even if you follow the Covid-19 tips, heeding the advice to avoid bites is just as important. Dr. Segal-Maurer describes a “realistic” scenario if you’re on a crammed hiking trail: “You’re all going to be pushing into the vegetation … you’re going to be just a little bit off the path.”

Ticks “hang off the very tip of the blade of grass or the leaf or the vegetation, and they have these little feelers that they … sort of shake out there. So, the second you brush by, they latch on.”

Last month, Pennsylvania Secretary of Health Dr. Rachel Levine announced an increase in emergency room visits over the past several months “related” to tick bites. “Some symptoms of Lyme disease, such as fever, chills and headache, are similar to symptoms of COVID-19,” Dr. Levine said in a statement, reiterating what other experts say.

Head outside – but responsibly

Hikers walking along a paved trail in Utah's Zion National Park, Utah, which had been closed due to the pandemic.

As with coronavirus, the number of reported Lyme disease cases is likely undercounted. While the CDC estimates 30,000 Americans contract Lyme yearly, the federal agency notes recent estimates suggest that the true number may be 10 times higher, around 300,000.

Dr. Segal-Maurer says health care professionals always need to ask patients about their travel and other activities. “You have to cover all your bases… we don’t want to be Covid-blinded.”

Patients, in turn, should also be asking about both possibilities.

And when it comes to guarding yourself from ticks, she says, “You need to use DEET. It’s gotta be 30%. You need to watch where you hike. And then you need to do a body check when you get back inside.”

Dr. Phillips prefers Permethrin, which he says is stronger, but “can only be sprayed on clothes, not skin, and should be allowed to dry overnight before wearing.”

Other tips include putting on hats, light-colored clothing to make ticks easier to spot, placing socks over your pants and choosing long-sleeved shirts to block ticks from getting near your skin.

That, of course, is in addition to wearing a mask to fight coronavirus spread.

Yet even with the extra hassle for a safer summer getaway, Dr. Segal-Mauer encourages people to head outside this summer because she believes “it’s been such a traumatic several months. I think the great outdoors is a very healing place.”