are a lot of cases that aren’t being counted by the health
According to the CDC, there were 90 reported cases
of Lyme in California in 2016. But a study co-authored
by Stricker in the International Journal of General
Medicine shows that in that same year, there were
46,000 insurance claims related to Lyme disease
in the state.
So which is it? Do we have zero Lyme in Marin? Or
are there a fair number of cases here, and throughout California, as anecdotal evidence suggests? “Both
are true, unfortunately,” says Matt Willis, M.D., the
county’s public health officer. “Your friends are not
lying. But they have been probably been diagnosed
by methods that do not count as an official case in the
eyes of the California Department of Public Health
or the CDC.
The honest response is that there’s a lot we’re learning about Lyme disease,” adds Willis, who suffered
from the disease himself in 2000, while at medical
school in Boston. (He found out quickly and treated it
Lyme is statistically one of the fastest-growing infectious diseases among the populace in the United States,
and the CDC estimates that around 300,000 Americans
suffer from it each year. There were a record number
of tick-borne diseases reported in the country in 2017,
including Lyme, babesiosis and Rocky Mountain spotted
fever. And a number of experts are concerned that as the
planet grows warmer, tick populations may increase too.
In California, the tick that carries Lyme is the
western black-legged tick, which lives on host creatures
like deer, rodents, and small animals such as gray squirrels. Ticks feed on blood, and because they cannot jump
or fly, they wait at the ends of grass or foliage, latching on
to clothing or skin as humans and other creatures pass
by. In order to transmit diseases, ticks typically need to
be attached to the skin for 36 to 48 hours.
Fortunately, Marin’s ticks have a low infection
rate. According to Kelly Liebman, scientific programs
manager at the Marin/Sonoma Mosquito and Vector
Control District, about 2 percent of adult ticks and
4 percent of nymphs — young ticks, which can be as
small as poppy seeds — are infected with Lyme. Adult
ticks are most active from the first fall rains into the
spring, and nymphs are most active in the spring into
the summer months.
Unfortunately, it can be difficult to tell if you’ve
been infected. The CDC estimates that only 70 percent
of people with Lyme develop the telltale “bull’s-eye”
rash, and even that can vary by geographic region. The
two-tiered blood test for Lyme, the ELISA and Western
blot test, misses up to 60 percent of acute Lyme cases,
yet it’s the only form of testing the CDC considers
valid. “The testing is antiquated and not very accurate,
unfortunately,” Stricker says.
This may change. A company in Palo Alto, IGeneX
Laboratories, has developed much more sensitive test-
ing for Lyme and is now trying to get FDA approval.
Efforts to create a Lyme vaccine are also underway.
But for now, Lyme remains difficult to diagnose — and
can be just as tough to treat. If it’s detected within the first
30 days after a tick bite, a simple course of antibiotics usu-
ally cures the infection. But for people who go undiagnosed
for months or years, it can be much more challenging,
resulting in “late-stage” or “post-treatment Lyme disease.”
That was the case for Lucas Valley resident Lia
Gaertner, 46, who was infected twice in a 10-year
period — once on the East Coast, while earning a
graduate degree in ethnobotany at Cornell, and again
in Mendocino, where the incidence rate is higher than
in Marin because it’s wetter there and farther north.
Gaertner suffered baffling symptoms such as rapid
heartbeat and heart palpitations, anemia, and night
sweats. “I had 10 years of not being able to sleep at night
because of the intense heart palpitations,” she says.
Like Stein, Gaertner visited countless doctors. It
was only in 2008 — 10 years after her first infection
— that a colleague of her husband (who is a doctor)
correctly diagnosed her. Gaertner tested positive for
Lyme, and other tests indicated that she also had the
tick-borne disease Babesia. Co-infections are common
in Lyme sufferers and were a problem for Stein, too.
Gaertner, who’s now on the Bay Area Lyme
Foundation’s advisory board, underwent a gruel-
ing course of treatment, which included at least six
months of antibiotics and fistfuls of natural remedies.
Sometimes she swallowed as many as 80 pills, sup-
plements, herbs and tinctures a day. It worked. Five
years after her diagnosis, in 2013, she competed in
the Tough Mudder race in Tahoe. A year later she ran
As Gaertner and Stein’s stories illustrate, Lyme
can be devastating if not intercepted early. But there’s
also good news: Matt Willis says a number of events
have to occur for someone to become infected in
Marin. You need to be bitten specifically by a western
black-legged tick (not just any tick). It has to be one of
the 2 to 4 percent of ticks that is infected. And it has to
embed in your skin for at least 24 hours. “If I have one
lingering concern around this, it’s that people have an
exaggerated sense of the risk and that it may prevent
them from engaging in the healthiest behavior, which
is getting physical activity outdoors,” Willis says. “But
it’s all about exposure. And there are things we can do
to prevent being bitten by a tick.” m
When heading outdoors,
apply an EPA-registered
insect repellent to your skin,
such as DEE T, picaridin or
oil of lemon eucalyptus (the
latter two are DEE T-free
Treat boots, clothing and
camping gear with products
containing 0.5 percent per-
methrin, which repels ticks.
Wear light-colored clothing
(to make it easier to spot
ticks) when outdoors, as well
as long pants, long sleeves
and long socks.
Stay on trails, and avoid con-
tact with nymph habitat such
as leaf litter, logs, blades of
grass and tree trunks.
Shower soon after being
outdoors. According to the
CDC, showering within two
hours of coming indoors has
been shown to reduce the
risk of Lyme disease.
Check your body and cloth-
ing for ticks upon returning
from potentially tick-infested
areas, including your own
backyard. Use a hand-held or
full-length mirror to view all
parts of your body.
Run clothing through a dryer
on high heat for at least 10
minutes to kill any ticks after
you come indoors.
If you are bitten by a tick,
says Dr. Willis, use fine-
nosed tweezers to reach
in and try to grab the
embedded tick head. Apply
steady, gentle traction
backwards to remove it.
Dogs can get tick-borne
diseases too, so be sure to
put flea-and-tick repellent
on them. When walking dogs,
keep them on leash so they
don’t stray into tick-rich
environments, and do a tick
check when you’re finished.