I met Maaike, twenty-four, at a Lyme disease event in Amsterdam, where she was every inch a vibrant young woman, with blue eyes, long dark-blond hair, and red lipstick. She was thrilled to be interviewed and insisted that she remove her jacket for a photograph, showing wrists prettied with bracelets and a fringe of black lace at the shoulders of her sleeveless shirt. The only inconsistency in this picture of vitality was the blue air mattress on which she was propped, and where, suddenly, her left leg began to spasm, a neurological manifestation of the Lyme pathogen’s wrath. The smile faded, replaced by a mixture of fear and embarrassment, as she clasped her thigh until the tremor passed. A wedding postponed, Maaike and her fiancé were pooling money for a visit to a Belgian specialist that had filled her with hope. “When I ask my doctor about Lyme disease, he gets very angry,” she said unprompted. “‘Not everybody has Lyme disease,’ he says.”
When utility workers in the Netherlands fix cables buried beneath weeds or landscapers prune bushes, they will have far more protection against ticks than Maaike Boere did, sparing some from her disability and pain. A standard for permethrin-impregnated clothing will soon be proposed for adoption across the European Union. In the United States, Lyme disease adds $712 million to $1.3 billion to national health costs every year, according to a Johns Hopkins study. That’s an estimated $3,000 per patient. Now consider the unmeasured cost of lost earnings and disability payments. Forty percent of patients who report they have chronic Lyme disease were unable to work, according to a study of 3,000 patients by Lymedisease.org and Carnegie Mellon University.
Maaike, for one, had not worked in nearly two years in a land generous for its social welfare but unable and unwilling to provide care for late-stage Lyme disease. A day after meeting Maaike, a Dutch man, who I met on a bike trail where I was flagging for ticks, told me that after he was bitten by a tick, his two physician brothers had a suggestion: Go for tests to Germany. In that country, diagnostics are used for potential tick-borne illness other than the often-unreliable two-tiered testing. Of course, you must be able to pay for them.
The Dutch clothing regulation brings me back to Tom Mather’s chip-away-at-the-problem philosophy. The Netherlands’ effort to protect workers represents one salvo against ticks, preventing infection, reducing human misery, and educating workers, who then bring the message home. A savvy scientist in Holland named Sip van Wieren tried a different tack. He treated sheep with an insecticide and let them loose in forest patches and small campsites, which are a hugely popular destination for the Dutch. Van Wieren then watched as the sheep collected ticks by the handful in their furry fleece—“sheep mopping,” he called it—reducing populations by 70 percent. With sheep a ubiquitous fixture on the flat Dutch landscape, the experiment employed available resources to great effect.
Van Wieren’s sheep, Mather’s shoe treatments, Gaff’s robots—they are each one strike against tick-borne disease. We need more. Warn and empower citizens at every drugstore checkout. Tell parents their kids are potential meals for ticks. Tell schools. Combine the efforts of a thousand advocacy groups into a coordinated strategy. Employ and subsidize tactics known to work. Moreover, and for the long-term health of the planet, recognize our role in creating this epidemic and the forces that propel it.
Silver Bullet?
In April of 2017, a Yale University ecological economist named Eli Fenichel calculated a different cost of Lyme disease. Call it the fear factor, akin to my new vow to avoid walking in my beloved meadow. Fenichel and three other researchers devised a way to correlate the incidence of Lyme disease and the duration of tick season with the amount of time people spent on outdoor activities, as recorded in the American Time Use Survey. In high-Lyme states in the Northeast and Midwest of the United States, it turned out, people went on fewer hikes in the woods or strolls in the park than people in other parts of the country, the disparity pronounced in tick season but not at other times.
In all, residents of Lyme-ridden areas lost more than nine hours a year in outdoor time. That lost experience, Fenichel and colleagues concluded, was worth $2.8 billion to $5 billion a year—one billion missed forays into the natural world multiplied by the $2.74 to $4.91 travel cost of each. This, of course, did not capture the intrinsic value of breathing forest air. But it was one way to “monetize well-being,” as he put it, and for a simple reason. “If there were a silver bullet to get rid of Lyme disease,” Fenichel told me from his office at Yale, “we should be willing to pay three to five billion dollars for that silver bullet as a society.” And so, the paper asked, “How much would people be willing to pay for a Lyme Disease free world?”
David Whitman sells the two-step tick protection technology that I rejected as too costly. For sixteen years, his company, Connecticut Tick Control, has applied the product along the fringes of sporting fields and playgrounds at seven schools in western Connecticut. I was happy to hear this, the vision of unprotected children in my own community so clear. He agreed the cost was high; another school district he had long serviced had recently cut the protection from its budget. “There are municipalities who say we need to protect the kids while they are in our care,” he told me. “There’s no silver bullet. There’s no cheap way out.”
For too long, however, the cheap way has long been the chosen way. We, as a society, have done little to mount an effort against ticks, and some have paid the price. A tick-bite on a grassy preschool playground in Kansas City, Kansas, ended the teaching career of Kathy White in 1998, when she was fifty-three-years old. Active in the Lyme Association of Greater Kansas City, White hands out Lyme disease information kits at schools—our chief method of fighting this epidemic—where nurses have reported using the packets’ special tweezers to remove ticks from students. White and a small army of people who learned of Lyme the hard way are chipping away at the problem. They cannot wait for science to solve this. Although it would be nice.
In 2016, an MIT researcher named Kevin Esvelt had the idea to tweak the DNA of mice in a way that would make them immune to invasion by Borrelia burgdorferi. Ticks would bite, the idea proposed, but the pathogen would not infect the mice, which are the single biggest, though not only, source of the Lyme disease bug in nature. These genetically altered mice would no longer nourish and sustain the Lyme pathogen, breaking the cycle of circulation—tick to mouse and vice versa. This would involve years of work, of course. First, identify mice that make the best Lyme antibodies after vaccination. Then, implant the bit of DNA that ramps up this prized resistance into the eggs of female mice, insuring it will pass to roughly half of their progeny. The altered mice would be released first onto an uninhabited island off of Cape Cod, Massachusetts, then onto Lyme-riddled Nantucket and Martha’s Vineyard islands, where the power of ticks to transmit Borrelia burgdorferi would hopefully be defused.
“Sculpting Evolution” is the name of the MIT project of which this is part, and Esvelt is aware of its considerable implications for the natural world and the need for transparency and community support. As he told local residents at a public meeting in July 2016, “Life finds a way.” He is determined to avoid unforeseen consequences, in particular if and when the idea is applied toward a mainland fix that is more sweeping and permanent. On the offshore islands, the mice would be altered using DNA from other mice. But to assure success in the wider world, DNA from other species would have to be introduced to assure all mice, not just half, received the mutation. In so doing, the DNA of mice would be forever changed.
Beyond this, Esvelt’s technologically alluring fix has two other significant hitches. As with human Lyme disease vaccines, it would still allow ticks to proliferate, bite, and, most significantly, deliver other pathogens besides the vanquished Lyme bug. To address that, the MIT group may try another tack, altering DNA in mice in a way that targets tick saliva like European antitick vaccine. Feeding would be blocked or the tick killed. Esvelt’s island experiments would likely run into the low tens of millions, he said. The cost will be far greater for
trials in the wider world. “Are there enough Lyme cases here,” he asked, “to make that worth it?”
Quarantines and Cattle
So what is the value of avoiding tick-borne infection? Consider the Texas-Mexico border. There, an army of agricultural experts is dedicated to the task of stopping cattle ticks from moving north of the Rio Grande and into prime ranchlands of Texas longhorn cattle. The surveillance program is meant to wipe out cattle fever, also called bovine babesiosis. It is aggressive and expensive. Nearly two million acres of land were under permanent and emergency quarantine as of mid-2017, as the ticks crept farther north on the heels of a warming climate. Under the program, cattle are regularly rounded up, sometimes by helicopter, inspected, vaccinated, and periodically dipped into treatment baths for six to nine months. Deer are fed corn laced with a tick-killing chemical or treated to a dousing of permethrin at special feeding stations. This is all done, free of charge to ranchers, to protect not one but two lucrative industries: beef production and hunting on growing preserves populated with game that also spreads the tick. These efforts have been successful. In the meantime, blacklegged and lone star ticks also move north. They run rampant. They inflict damage. But the response is anemic and inconsequential. And these ticks, unlike their counterparts on cattle, harm people. Many, many people.
We are left, then, with a pandemic against which we chip away. Homeowners scatter cotton balls soaked in permethrin so that passing mice may use them to line their nests and be made tick-free. New York State adopts a law to develop a curriculum on Lyme disease prevention, though schools don’t have to teach it. Facebook posts remind us to check for ticks. Conservation groups hold classes on garden plants that deter ticks. Lyme groups hand out pamphlets, demand change, and share news stories, like one I read recently of a two-year-old girl named Kenley who died in Indiana days after a tick infected her with Rocky Mountain spotted fever. This is all something.
Aginar Mafra Neto, a chemical ecologist, is testing his own idea, putting tick pheromones and pesticides into tiny black dollops that he spreads on vegetation; ticks lured to what looks a lot like tick excrement face death or debility. Several scientists told me the idea had potential. Said its inventor, in a refrain I’d heard before: “For ticks, there’s no funding.” If Ixodes ticks were agricultural pests, there would be money, he said.
But perhaps this picture is not as bleak as it sounds. For some projects, there is money, except that it is not coming from the government. In 2016, the Cary Institute of Ecosystem Studies in New York State began a $5 million, five-year experiment to bring down Lyme rates in twenty-four neighborhoods with a one-two punch. Properties are treated with a fungicide that kills ticks, while mice are invited into feeding stations for a coating of insecticide. The funding was among $40 million distributed by the Steven & Alexandra Cohen Foundation of Stamford, Connecticut, which, with other nonprofit organizations, has stepped into the Lyme disease void left by the National Institutes of Health and the CDC. Another nonprofit group that is funding significant research, the Bay Area Lyme Foundation in Silicon Valley, California, computed the US government’s research support based on the number of afflicted people. For every HIV/AIDS case, the NIH distributed $57,960 in 2015. The per capita West Nile Virus allotment was $7,050. Lyme disease research grants amounted to $133 for each and every case.
For every way out of the mess of tick-borne disease, there are obstacles and drawbacks. It will cause other problems. It will do half the job. It will cost too much. We are fighting an eight-legged menace that emerged in the early part of the Cretaceous period, about 145 million years ago or just after the Jurassic period. It has had a lot of time to evolve. And Borrelia burgdorferi, its chief but not sole cargo, has been around for a good portion of that time, taking equal advantage of the benefits of natural selection. It is marvelously adept at changing, chameleon-like, to fool the immune system into thinking it is no longer there. It persists. What is new in the long history of ticks and Borrelia burgdorferi are the conditions of the twenty-first century that have made their lives good: the cut-up forests; the profusion of small animals on which ticks feed and in which the pathogen lives; the paucity of animal predators; and the endless, inviting landscape on which to settle, a frontier made possible by a warmer, less challenging world.
If this first epidemic in the era of climate change is to be controlled, three things must occur. First, the pain of tens, maybe hundreds, of thousands of long-term tick-borne disease sufferers must be recognized. Why solve a problem that has barely been acknowledged? Second, health issues must be addressed, including the need for better tests and treatment trials, and an acceptance that the problem is tick-borne disease, not only Lyme disease. Finally, an organized, coordinated effort must be made to tackle the problem of ticks in the environment and the harm they do. Others can suggest how climate change, with its potential to alter life as we know it, should be addressed.
Without this commitment, we will live in a world in which nature is feared or, for the unschooled, dangerous. While mosquito-borne illnesses come in cycles, ticks are constant and forever. There is no waxing or waning, no sign they will collapse or die off. They only grow in number and place and pathogens.
Children should be able to run in a field, their hands brushing the tops of a row of summer grasses. Their mothers should tell them to play outside in the belief it is good for them. Hikers who go to one place should not return to another with a disease that is unrecognized, unaccepted, and even scorned. Lives and careers should be saved from disability and ruin. At the same time, patients should be able to turn to medicine and doctors for help. They should not have to devise a plan, when the wrong tick bites, that relies on their resources, ingenuity, connections, and faith. Parents should not fear losing their children to tick-induced physical or mental illness. They should not fear child welfare authorities who question their Lyme disease choices.
Finally, let’s stop calling this Lyme disease. Call it Borreliosis, perhaps, when it’s early and clear cut. Label it Tick Infection Syndrome, maybe, when it’s not. Then let’s admit the obvious. This is an epidemic. It is global and dangerous. It is spreading to new places on earth and affecting places in the human body, the brain for one, in ways that are not fully understood. History teaches us that medicine sometimes clings fiercely to convictions that are ultimately proven wrong. Lyme disease is one such time. Believe this, because ticks are out there. Whether we live in a city, a suburb, or an exurb; in a small town in a valley or a chalet at the top of a high mountain, we all have some occasion—let’s hope so, at least—to commune with meadows, trees, sand dunes, and trails. Right now, many of these places in too many countries are havens for tiny, almost invisible, eight-legged creatures waiting for the next meal. On balance, they have power far greater than our own.
Selected References
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Ang, C.W., D.W. Notermans, M. Hommes, et al. “Large Differences between Test Strategies for the Detection of Anti-Borrelia Antibodies Are Revealed by Comparing Eight ELISAs and Five Immunoblots.” European Journal of Clinical Microbiology & Infectious Diseases 30, no. 8 (2011): 1027–32.
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Barbieri, A.M., José M. Venzal, A. Marcili, et al. “Borrelia Burgdorferi Sensu Lato Infecting Ticks of the Ixodes Ricinus Complex in Uruguay: First Report for the Southern Hemisphere.” Vector-Borne and Zoonotic Diseases (Larchmont, N.Y.) 13, no. 3 (2013): 147–53.
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Barrett, A.W., and S.E. Little. “Vector-Borne Infections in Tornado- Displaced and Owner-Relinquished Dogs in Oklahoma, USA.” Vector-Borne and Zoonotic Diseases (Larchmont, N.Y.) 16, no. 6 (2016): 428–30.
Barrett, A.W., B.H. Noden, J.M. Gruntmeir, et al. “County Scale Distribution of Amblyomma Americanum (Ixodida: Ixodidae) in Oklahoma: Addressing Local Deficits in Tick Maps Based on Passive Reporting.” Journal of Medical Entomology 52, no. 2 (2015): 269–73.
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