Lyme – the Ebola of the developed world

You might think: that is nonsense! Ebola is caused by a virus, not bacteria like Lyme. Ebola is highly contagious, and often leads to death quickly. Lyme occurs ‘here’ in temperate regions, while Ebola primarily happens ‘there’ in the tropics and is not our problem, unless it is momentarily broadcast on TV.

However, the two have many similarities as well (1): both are zoonotic diseases, they are initially transmitted from animals to humans. And both present a serious and growing problem that is extremely expensive and that politicians, for various reasons, are eager to sweep under the carpet, although this is a more complicated affair for Ebola. The causes of both diseases also show many similarities, though the so-called Lyme experts in the Netherlands and the US will not tell you this: disturbed ecology, modern agriculture, climate change, hosts who, through poison and stress, have become more vulnerable to diseases that have existed for millions of years and have only become a serious problem a relatively short time ago. Several international organizations such as the WHO have indicated this for some time now, but the message fails to get through to the medical and political sectors. Clinicians and politicians still believe that Lyme is an isolated problem caused by deer, ‘new nature’, being too economical with pesticides and above all ‘the Internet’ (some opinions about the causes of Ebola are just as bizarre, even among so-called experts).

The traditional approach – developing antibody tests, vaccines and medicines – costs a lot of time and money and often consists of Band-Aid solutions. When it comes to such increasingly emerging zoonotic diseases, prevention and containment – e.g. by counteracting the causes and by quickly and accurately tracking the pathogen using DNA / RNA technology – would be more effective and cheaper. Unfortunately, commercial, political and sometimes military interests exist which ensure that, in practice, the best approach is usually not followed.

Both Ebola and Lyme face problems with diagnostics, which you rarely hear about in public. A false-negative Lyme test? It would not disturb any expert. Falsely negative tested Lyme patients mostly remain invisible and slowly decline in silence; ‘It is in your head’, problem solved! False-positives on the other hand are something that has kept experts busy for years: imagine someone receiving antibiotics for something that in retrospect was not Lyme at all! Even if a Lyme test fails to detect over half of the cases, there is no problem as long as there are not too many false-positives.

You rarely hear about problems with Ebola diagnostics. But what do you think happens when someone in Central Africa with fever symptoms (malaria?) is tested for Ebola? Tests are never 100% reliable. In this case, a false-positive test means a near-death sentence, since such a person goes into quarantine together with actual Ebola patients. Consequently, there is no news afterwards, as false-positive often automatically turns into true positive. When a patient fortunately happens to work for a Western organization, they might be cared for (and retested) in their own country. False-positive then becomes negative, meaning ‘the treatment has worked exceptionally well!’. A false-negative test in Africa means there might be much more patients in a few weeks, but panic prevention and the economy are sometimes more important. In short, the authorities do not like to talk about it, but the reliability of Ebola tests leaves much to be desired and this is costing lives. Recently, there has also been growing attention for the problem that some Ebola patients still carry the virus with them long after ‘being cured’ and potentially infecting other people (persistent infection? now where have we heard that before …).

There is one area in which Africa is far ahead of the Ebola of the developed world. While patients here are still sent on their way with Medieval antibody tests for Lyme disease (imagine this somewhere in Central Africa: “please come back in about 4-8 weeks, the test is not reliable before then” or “the test result is positive: this was a past infection, treatment is superfluous!”), Africa increasingly uses the more modern PCR technique, which unfortunately is not always reliable either. This has to do with local circumstances that make Ebola diagnostics many times more difficult than Lyme diagnostics in the developed world.

Another difference: with Ebola the urgent need for action has been recognized. At the end of May, the famous Pasteur Institute will organize the first international Ebola conference (2), in order to rapidly improve diagnostics and treatment of Ebola. One of the conference participants is US physician / researcher Sin Hang Lee, who has previously developed a PCR-sequencing test for Borrelia (3). He believes he can use the same techniques to improve Ebola diagnostics (4) and proposes to set up local labs in Africa (instead of transporting the patient’s blood sample for three days by canoe, truck, helicopter, airplane etc. to a lab somewhere in an African capital, the US or Europe). The tests would not only be more reliable and cheaper, but the results would also be known much quicker, which is extremely important for Ebola, every delay can be fatal. Furthermore, the sequencing can yield a wealth of scientific information that provides further insight into the disease. The costs of local labs are limited, and the technique is so robust and simple that local staff would only require a short training to be able to do all the work – making Africa no longer dependent on Western organizations (which can sometimes have other interests at heart). There is still a long way to go before Ebola diagnostics and treatment are optimal, but where there is a will there is a way.

Is not it odd that the so-called developed world is helping Africa control Ebola, while our own Ebola variant is getting completely out of control due to policy failures? Are slowly declining Lyme patients not spectacular enough to force clinicians and politicians into action? Perhaps Africa will soon be able to help us …

(1)Ebola, Dengue fever, Lyme disease: The growing economic cost of infectious diseases

(2)1st International Conference on Targeting Ebola

(3)Nieuwe Borrelia PCR tests

(4)Bring Sanger Sequencing to the Site of Ebola Outbreak (PDF presentation)

Original publication : may 2015

Update march 2017: after the Ebola conference several parties were very impressed with Mr. Lee’s Ebola DNA testing proposal, but due to lack of commercial and political interest (i.e. not enough profit to be made) it isn’t pursued. That again sounds pretty similar to the situation with Lyme diagnostics …

Aangepast: 27 maart 2017