Avoiding Lyme Disease as Americans Get Outdoors this Summer

June 17, 2020|4:37 p.m.| ASTHO Staff

As states begin relaxing stay at home orders and implementing phased processes of reopening public establishments and parks, more Americans are enjoying the outdoors. In order to maintain recommend distance from others, many people are likely to spend time in public or state parks. While these activities may help to prevent the spread of COVID-19, it does increase individuals’ exposure to Lyme disease, one of the most common vector-borne diseases in the United States.

Lyme disease, caused by the Borrelia burgdorferi bacterium and transmitted through the bite of an infected tick, has been a nationally notifiable disease since 1991--health agencies report approximately 30,000 Lyme disease cases to CDC each year. That number may only be the tip of the iceberg, however, since additional studies of disease diagnoses estimate that approximately 300,000 cases occur annually. The recommended treatment regimen for Lyme disease is two to four weeks of antibiotics. However, this depends on a variety of factors such as age and medical history—approximately ten percent of patients experience post-treatment symptoms including fatigue, muscle pain, poor memory, and decreased concentration. Lyme disease treatment and post-treatment symptoms cost our healthcare system from $700 million to over $1 billion annually.

During the current state legislative session, ASTHO identified approximately 100 proposed bills related to Lyme disease. Legislative approaches to address Lyme disease, including educational campaigns for practitioners and the public, diagnosis and treatment guidelines, and insurance coverage for treatment and long-term antibiotic therapy, continue to be emerging trends in state policies. Below is an overview of state activities related to the prevention and treatment of Lyme disease.

Physician & Public Awareness
New York is considering several bills that would increase Lyme disease infection, prevention, and treatment awareness among specific at-risk populations. S5873 would direct the Commissioner of Agriculture and Markets—in consultation with the Commissioner of Health—to develop and conduct a public awareness campaign regarding Lyme disease and other tick-borne diseases, recognition of symptoms, available treatments, and preventative measures. Information will be tailored toward farmers and farm workers, since they spend a significant portion of their work outdoors, which puts them are particular risk for Lyme disease. The bill passed the state Senate and is currently in the assembly. S6702 would require the Department of Health, in consultation with the Department of Environmental Conservation, to develop a Lyme and tick-born infection awareness and prevention program for children’s summer camps. The bill also requires the Commissioner of Health to promulgate rules and regulations for tick removal guidelines and procedures for parental notification.

Massachusetts proposed a bill that would establish a special commission to study the feasibility and best practices for a statewide education and awareness program to prevent the contraction of Lyme disease and tick-borne illnesses. The commission would be required to submit recommendations as well as draft legislation.

Diagnosis and Treatment
New York introduced companion bills (A8640 and S6657) directing the Commissioner of Health to establish a standard protocol for the diagnosis and treatment of Lyme disease and other tick-borne diseases. The protocol would require written notification to each patient relating to symptoms, risk factors, diagnosis, and other information related to the disease. In addition, the bills require physicians to review medical records of patients diagnosed with neurological and neuropsychiatric disorders or other musculoskeletal pain syndromes of unexplained origins and consider whether the patient has suffered or is suffering from Lyme disease and/or additional tick-borne diseases.

Treatment Coverage
This session, New Jersey is considering companion bills (S214 and A897) that would require health insurance to cover Lyme disease if it’s deemed medically necessary by a physician. In New York, a proposed bill A2968 would direct the state Health Care Quality and Cost Containment Commission to study and report the impact of health insurance coverage for Lyme disease treatment. Recognizing the unique geographical spread of Lyme disease—as well as the disproportionate patient impacts of Lyme disease in the state—legislators in New York also introduced S1295, which would direct the superintendent of financial services to study the relationship between patient access to care and treatment of Lyme disease and health insurance coverage.

Numerous clinical trials have examined the potential benefits of long-term antibiotic use to treat Lyme disease. Results of this research show no benefit, and actually found long-term antibiotic treatment is associated with serious complications, including increased antibiotic resistance and healthcare costs. However, some advocacy groups and physicians continue to advocate for long-term treatment and several states have proposed policies to cover these treatments.

New Hampshire introduced a bill requiring insurers to provide coverage for long-term antibiotic therapy for tick-borne illnesses when determined to be medically necessary and ordered by a licensed infectious disease physician. The bill language states that the Department of Health and Human Services acknowledges that coverage of long-term antibiotic therapy will result in increased use, but also recognizes that this treatment has been associated with serious complications, including antimicrobial resistant infections. The bill passed the state House in March and is currently in the Senate.

New York is considering companion bills (A178 and S426) that would require health insurers to provide coverage for long term medical care for Lyme disease and other tick-borne related pathogens including intravenous antibiotic therapy, oral antibiotic therapy, or any other treatment recommended by a licensed physician. New York also introduced similar bills (S4186 and A2767) that would require health insurers to cover all costs of no less than 30 days of intravenous antibiotic therapy, 60 days of oral antibiotic therapy, or both, to treat Lyme disease and other tick-borne related pathogens.

State and territorial health agencies can help reduce the burden of Lyme disease and protect the public’s health by strengthening partnerships with a variety of stakeholders to coordinate enhanced Lyme disease surveillance, prevention, and response activities—as well as support effective, evidence-based research and regulations. As individuals take advantage of warmer weather and have more freedom to move around outdoors, it is important to inform the public about preventing Lyme disease and increasing access to effective treatment if exposed. ASTHO will continue to track legislative activity on this important public health issue.

Leah Silva is the director of state health policy at ASTHO.