Ticks are out!

Anyone who has been out enjoying Vermont's wildlife areas in the past few weeks has likely noticed a tick or two. Ticks are very active in early spring. They have been dormant all winter, and they are hungry. And when they bite, they can transmit diseases, like Lyme disease and anaplasmosis.

In the midst of the COVID-19 outbreak, we'd like to share what is the same and what's different about fighting tick-borne illnesses this year.

What's the same?

Every year, we share many of the same basic tips:

The most important thing you can do is to avoid getting bitten by a tick in the first place. Avoid wooded and bushy areas and those with tall grass or leaf litter. (If you enjoy hiking, walk in the center of the trail.) Use a repellent that contains 20 percent or more DEET, picaridin, or IR3535 on exposed skin, and follow the directions on the package. You can also treat your clothing with permethrin, which both repels and kills ticks. It is very effective against tick bites and poses no threat to humans. It is often marketed for “clothing and gear.” One treatment, following to the directions on the package, can last up to six washings.
Your next line of defense is to keep those ticks that found you from biting you. Change clothes when you come inside. Wash them in hot water and tumble dry. If possible, bathe or shower within 2 hours of coming indoors, as well. Conduct a thorough tick check. Deer tick nymphs look as small as a poppy seed on your skin. They can hide in and behind ears, under arms, in the groin, and behind the knees. Check yourself, have a family member check your back and other areas that are difficult to see, and check your children carefully.
If you find a tick on your skin, remove it immediately. In most cases, you have at least 24 hours to find and remove a feeding tick before it transmits and infection. Use pointy tweezers or an aftermarket tick removal device. Grab the tick as close to the skin as possible, and pull it straight upwards. Do not use any lubricants or hot objects. Mouthparts remaining in your skin does not increase the chances of infection. They will come out on their own. Disinfect the area with alcohol or other disinfectant. Identify the tick using online resources, if possible. Then flush it down the sink or toilet.
Know the symptoms. Not all ticks are infected, so being bitten does not guarantee that you will get a tick-borne illness. Conversely, many of those who receive a tick-borne illness diagnosis don’t recall having been bitten. It's important to know the symptoms and watch for them. Symptoms of Lyme and anaplasmosis are similar. They include flu-like symptoms, like fever and fatigue; head, neck, and joint aches; and enlarged lymph nodes. Usually the symptoms come on suddenly. Only about 25 percent of people who are diagnosed with Lyme disease get the characteristic "bull's eye" rash.
If you do notice symptoms, call your doctor right away. Symptoms treated early are less likely to make any long-term impact.

What's different?

Your healthcare provider will likely see you via a telemedicine visit. (See this handy guide to telemedicine.) Because both COVID-19 and tick-borne disease come with a fever, it may be slightly more difficult for your healthcare provider to diagnose both of them right now. Your provider may have you describe the onset of your symptoms to help determine which illness you are more likely to have. COVID-19 symptoms come on slowly, while tick-borne illness symptoms generally come on quickly. And it would be an impressive feat of bad luck, but there is a chance you could have both COVID-19 and a tick-borne disease.

Your provider may choose to treat you for tick-borne disease or have you tested for tick-borne illness or both. As always, the test for tick-borne illnesses requires a blood draw at a lab. SVMC's lab is open and safe. You will be asked to complete a respiratory check-in at the door and may be asked to wear a mask.

By following your doctor’s instructions and taking any prescriptions as directed, you will very likely feel better within just a few days. Once you are feeling better, resume all of your tick-bite prevention efforts. Having had a tick-borne illness once does not protect you from being infected again!

Donna Barron, RN, is the infection preventionist at Southwestern Vermont Medical Center.