On a recent Sunday evening, a friend — I’ll call him Ron — who lives in northern Nova Scotia discovered a tiny tick embedded in and feasting away on his arm. The area around it was red, but because the tick was so small, he couldn’t identify it, couldn’t tell whether it was a deer (or blacklegged) tick that transmits Lyme disease, or a dog (also called a wood) tick, which doesn’t — although both kinds of ticks can transmit other pathogens.
Ron tries to check regularly for ticks, but he hadn’t noticed this particular tick before and had no idea how long it had been there.
He recalled hearing last year that the provincial government had given pharmacists permission to deal with tick bites, so he called his local pharmacy. Alas, it was closed.
He then called the emergency department of the nearest hospital, but it too was closed. However, someone at the hospital advised him recommended he call 811, the health service number in Nova Scotia.
The person who answered said the 811 nurses were so busy, he would have to wait for up to six hours for a call back.
Ron didn’t want to wait, having also heard that the transmission of Lyme disease from a deer tick begins a couple of days after they began feeding.
He was reluctant to remove it before seeing a healthcare professional who might be able to tell how long it had been feeding. He was also worried that if he mangled the tick while pulling it out, it might make it too difficult to identify when he finally did find a health care professional to look at it.
Ron then called the emergency department at the hospital in Truro, about a 50-minute drive from his home. They told him there was a three-hour wait there, and that they couldn’t offer him any advice over the phone. However, they said there was a pharmacy open in Truro until midnight, where he could go for a consultation.
He drove to the pharmacy.
There he was told he would have to take the tick out himself.
“The pharmacist didn’t seem to know what to do,” Ron said. “She was not inspiring a lot of confidence.”
He decided to head back home, where he and his spouse “dug out” the tick, although they didn’t manage to remove it completely. He washed it and saved the “bits of the tick” in a bag.
In the morning, he drove to Halifax and went to a pharmacy there, where he found a pharmacist who seemed knowledgeable about tick bites and Lyme. She agreed with Ron that it was a deer tick, the kind that transmits Lyme disease.
She told Ron that if the tick hadn’t been in his arm for more than 36 hours, she could give him a single-dose antibiotic, which she did. She advised him to go see his doctor if any symptoms — fever, headache, fatigue, the characteristic red “bulls’-eye” rash – developed.
And so ended Ron’s overnight quest for information and guidance on what to do about a tick bite.
Nova Scotia has a big Lyme problem
Ron’s story is far from unique.
Ticks and tick bites are so prolific in much of Nova Scotia these days that it’s common to read social media posts from people saying they are filling whole jars with ticks they remove from themselves.
In other words, Nova Scotia has a big tick problem. And that means it has a big Lyme disease problem. In fact, the province has by far the highest per capita incidence of Lyme disease in the country.
Lyme disease is a tick-borne disease caused by the bacterium Borrelia burgdorferi, which can be transmitted to humans by the tiny nymphs and adult females of deer ticks, which feed on various mammal and avian hosts, including deer, rodents and ground-foraging birds.
Borrelia is the most common pathogen found in these ticks, but deer ticks and other kinds of ticks can also transmit other pathogens that make people sick.
In 2019, the most recent year for which Canada Health offers Lyme statistics, there were 830 cases of the disease in Nova Scotia, more than ten times the per capita incidence of Lyme in Ontario, which has the second highest rate of the disease in the country.
Related: A plague of ticks, tick-borne diseases, and poli-ticks. Part 1: Tick populations in Nova Scotia are exploding largely because of climate change and the province is Canada’s “hot spot” for Lyme disease. So, how is the province monitoring and managing tick-borne diseases and health risks?
Related: A plague of ticks, tick-borne diseases, and poli-ticks Part 2: What can be done to better manage and minimize the risks of tick-borne diseases in Nova Scotia?
The numbers of Lyme disease cases in Canada have risen dramatically in the past 13 years, since it became a reportable disease. According to Public Health Canada, this is because deer ticks have been moving into new areas in Canada, increasing the incidence of tick-borne diseases in the country, another negative effect of climate change.
Numbers still going up in Nova Scotia
According to Marla MacInnis, spokesperson for Nova Scotia Health and Wellness, since 2007 the department “has had a comprehensive Tick Borne Disease Response Plan.”
In an email, MacInnis said the plan, “is reviewed annually and informed by a group of experts from microbiology, entomology, public health and veterinary medicine.”
The Halifax Examiner also asked for numbers of visits to emergency departments in the province related to tick bites and / or Lyme for 2020 and 2021, or for the past 10 years if the statistics were available.
MacInnis sent numbers for patients with “confirmed or suspected diagnosis of Lyme disease at the end of a Nova Scotia Emergency Department visit,” with the caveat that “some patients, after further investigation and lab results, may not actually be diagnosed with Lyme Disease.”
The table MacInnis provided includes data from only 11 hospitals: St. Martha’s Regional, Aberdeen Hospital, All Saints Springhill Hospital, Colchester East Hants Health Centre, Cumberland Regional Health Care Centre, Cobequid Community Health Centre, Dartmouth General Hospital, Hants Community Hospital, Musquodoboit Valley Memorial, QEII, and Twin Oaks Memorial.
But MacInnis cautioned that, “not all hospitals capture diagnosis consistently,”
That could suggest that the 1,198 positive cases of Lyme in 2021 is an underestimate of actual positive cases in the province.
But even so, that 2021 number of Lyme diagnoses is an increase of 368 cases since 2019, when Nova Scotia had by far the highest incidence of the disease in Canada.
Is the government doing enough tick talk?
The province’s tick-borne disease response plan that MacInnis referenced contains a section on “Public awareness and education,” which states:
Actions taken by the general public play an important role in preventing human cases of Ld [Lyme disease], HGA [Human Granulocytic Anaplasmosis], and other tick borne diseases. Information for the public on the prevention of tick borne diseases is provided; as well as, information on the risks and symptoms of Ld. The DHW PH [Department of Health and Wellness Public Health] website is updated to include new evidence-based information on Ld as it becomes available. The public can receive further information from Public Health in the NSH [Nova Scotia Health]. Press releases, media interviews and social media posts keep the public informed and updated during the spring, summer and fall months (when temperatures are above 4oC) as needed.
This all sounds somwhat encouraging, but just how effectively is the province keeping the public informed and updated on ticks and Lyme?
The Nova Scotia Health and Wellness web page dedicated to Lyme disease offers some very basic information on ticks and Lyme, but no clear guidance on when or exactly where one should seek professional health care.
A little more information is found on the provincial government’s “tick safety” page, including on where to perform tick checks on yourself, and these key messages on how to “reduce your risk:”
- Wear long pants and long sleeves in areas likely to have ticks
- Wear light coloured clothing – its easier to see ticks
- Wear enclosed shoes and tuck your pants into your socks
- Walk on well-travelled paths, avoiding long grass and vegetation
- Apply insect repellents containing DEET or Icaridin to exposed skin and clothes. Follow directions on the package carefully. Permethrin treated clothing repels and kills ticks when they come in contact with it and is now registered for use in Canada for those 16 years of age and older.
The Health and Wellness Lyme page directs readers to a broken link for a video from the federal government, and also to the “most up to date information on the number of Lyme disease cases in Nova Scotia.” [emphasis added]
That link takes them to a report from 2011.
The same web page has a 2019 map showing that the actual risk of Lyme disease in most of the province is now set at “higher,” an odd comparative given that there is risk everywhere in Nova Scotia, and only one county, Guysborough, with a “moderate” risk, and three counties in Cape Breton with a “lower” risk.
The risks are certainly higher than they were just two years earlier than that, when the risk of Lyme disease was “higher” in only six counties.
There is no mention on the Nova Scotia Health and Wellness Lyme page that the number of Lyme cases per population in the province is much higher than it is anywhere else in Canada.
Lyme Disease Awareness Month came – and went
Ron’s dilemma of what to do about a tick bite happened in May, which was officially “Lyme Disease Awareness Month.”
Nova Scotians could be excused for not being aware of that.
There was a small ceremony in Halifax at which Mayor Mike Savage and Progressive Conservative MLA Steve Craig, standing in for Premier Tim Houston, unfurled a brand new Lyme flag,
Donna Lugar, founder of the Nova Scotia Lyme Support Group, told the Examiner that Steve Craig delivered the province’s proclamation that May was Lyme Disease Awareness Month. That evening, both Province House and City Hall were lit in lime green to mark the occasion.
But, Lugar said, that was about all there was.
While Lugar tweeted prolifically all month long with the hashtag #LymeDiseaseAwarenessMonth, providing crucial information on prevention and treatment of Lyme and other tick-borne diseases, the provincial government did nothing more to raise public awareness on Lyme disease after that initial ceremonial proclamation on May 3.
“There wasn’t even a press release,” Lugar told the Halifax Examiner.
Before the last provincial election in August 2021, the Nova Scotia Lyme Advocacy / Activist Group wrote to political parties to ask what they would do to address Lyme disease in the province.
The Progressive Conservative (PC) Party replied that in 2019, while opposition leader, Tim Houston had introduced the Lyme Disease Strategy Act, and pledged that should they win the election, they would implement it in their first year.
“Lyme disease is an issue that is personally important to Tim Houston and he remains committed to fighting against Lyme disease,” said the letter, signed by Tara Miller, campaign co-chair of the PC Party of Nova Scotia.
So far, the Lyme Disease Strategy Act has not been implemented, Lugar said.
Lugar’s advocacy group also asked the PC Party if it would support the “establishment of a collaborative care clinic in Nova Scotia for the diagnosis and treatment of ALL stages of tick-borne illnesses?”
Upon forming the government and implementing the Lyme disease strategy, we will ensure this is considered.
So far, that doesn’t seem to have happened either.
The Examiner asked Marla MacInnis what the government was doing to raise public awareness of the risks of ticks and tick-borne diseases in Nova Scotia, if it had put up any public notices at provincial borders, the Stanfield International Airport, in ports, or public parks to warn Nova Scotians of the risks, or what they should do if they find a tick on themselves.
MacInnis replied that the province is “promoting tick safety and awareness across social media all summer and into the fall and is currently working to have signs shared with parks and across the province.”
Advice from an expert
In the summer of 2021, before the provincial election that brought Houston’s Progressive Conservatives to power, Iain Rankin’s Liberal government authorized pharmacists in the province to assess for Lyme disease, as the Examiner reported. They could also prescribe an antibiotic treatment – a single dose of doxycycline – provided the tick bite was from a blacklegged tick, the tick was removed in the previous 72 hours, and it was attached for at least 36 hours.
But of course not everyone can tell a deer tick from a dog tick, especially not when they are in the minute lymph stage. And once bitten, many people – like Ron – don’t know how long the tick has been attached, and are unsure of just where to get help.
The Halifax Examiner contacted Vett Lloyd, professor of biology at Mount Allison University and principal researcher at the Lloyd Tick Lab that she founded at the university, to find out what advice she has for anyone who finds a tick embedded on themselves.
Lloyd, herself a Lyme survivor, said that if you find a tick on yourself, you need to get it out safely. (Canada Health has a useful site on ticks and Lyme, a pamphlet on Lyme prevention, and a good video on how to remove an embedded tick.)
“The dangerous part of the tick is in the body, in the salivary glands,” said Lloyd. “That’s where the bacteria are. Ticks don’t actually have heads; they just have a mouth. So the salivary glands are in the body. So as long as you get the body off, that’s the important part.”
Lloyd said there is no need to worry too much about “mangling” the tick while removing it, although that can make it more difficult to get a good photo to send to the E-tick service to find out what kind of tick it is.
However, Lloyd explained, a mangled tick is no problem for people checking ticks for pathogens, as they do in the Lloyd Tick Lab in Sackville, New Brunswick, which is now working together with the tick- and Lyme-testing Geneticks lab.
“We don’t need the full tick for testing,” she said. “Because our first step in testing is to kill it and grind it up.”
Once you’ve removed the tick, Lloyd advised, “Do your best with the photography. Do not throw it away because you’re going to need that for proving to people that you had a tick on you.”
Lloyd cautioned that it is wise to keep the tick (or the remains of it) in a plastic bag in the freezer with a date on it, in case symptoms of illness develop later and you want to have it tested.
In Nova Scotia, she said, you can approach a pharmacist, something that is not yet possible in New Brunswick where Lloyd lives. “Depending on what tick it was, and how long it was feeding on you, they should give you either a single dose or a 10-day treatment of antibiotics.”
Lloyd said the single prophylactic dose is for cases when the ticks were discovered and removed 24 hours after they started feeding, but noted that Nova Scotia seems to have “two conflicting policies” on timing, which doesn’t help clarify things for someone with a tick bite, who may not even know how long the tick has been on them. Lloyd explained:
One policy says that the tick can’t transmit anything for 36 hours, which is contradicted by quite a bit of scientific literature. The other says that the prophylactic dose works best within the first 24 hours. And how well it works wears off until about 72 hours, at which point it’s not recommended.
This is what happens when policy is made by people who are less familiar with the scientific literature and are going for a simple answer, which is not necessarily what nature provides. And there’s also a certain amount of just dogma circulating, which isn’t helpful.
Lloyd is critical of the traditional “wait-and-see” approach that does not involve any prophylactic antibiotics, saying:
This strikes me as just bizarre and very much contrary to any other aspect of our health care system, which recognizes that prevention is good, and saves illness, suffering, and a lot of money. And for some reason, tick-borne disease has a history of just being trivialized … as if it’s not serious, and an attitude of “We can deal with it if you get sick.” Certainly the increasing evidence is that Lyme is serious, and the longer it goes, the harder it is to deal with it. Which is the whole idea behind the preventative treatment.
Lloyd acknowledged there is a “heritage view” among some medical professionals that chronic Lyme disease doesn’t exist, which is an “obstacle” for people who are suffering from the disease even after being treated.
“Denying a real problem doesn’t help people get better. Ignoring science does not help people get better,” Lloyd said.
Lloyd believes there is need for more awareness of Lyme, both prevention and treatments. But, she said, “Prevention is not going to work 100% of the time. Ever. There are so many ticks, particularly this year, that there are going to be tick-human encounters.”
Lloyd said she hears from many people in Nova Scotia every day struggling with access to treatment at pharmacies, and she also has sympathy for the pharmacists who are trying to cope with the new program.
Quebec leading the way
On May 25, at a Cabinet scrum, the Halifax Examiner’s Jennifer Henderson asked Mental Health Minister Brian Comer, who was standing in for Health and Wellness Minister Michelle Thompson, if the government had any plans to establish a lab in Nova Scotia to identify ticks.
There is a lot of awareness and worries about the prevalence increase of ticks in the province but there are no immediate plans to expand our lab capacity in this way right now. There are some good resources that help. An identification service etick.ca … I was on the site myself this week, there is also an app available for mobile phones. There is also significant work being done by pharmacists. Nova Scotians can walk in and get an assessment. Pharmacists can prescribe antibiotics, so I suggest people who have worries or concerns utilize those services.
Contrast this with how the province of Quebec is handling the plague of ticks and the diseases they bring.
The incidence of Lyme disease in Quebec is more than 14 times lower than it is in Nova Scotia — just 5.9 cases per 100,000 people compared with 85.6 in this province — but Lyme Disease Awareness Month brought a huge advance for those concerned with tick-borne diseases in Quebec.
On May 19, Quebec minister of health Christian Dubé announced that the province was opening 15 new clinics specialized in “long-COVID and Lyme” in a $20.5 million three-year pilot project.
The network will include five referral centres, including one for coordination, and 10 satellites, and while treatment and care will be at the centre of the project, research to better understand long-COVID and Lyme will also be included. The Quebec government announcement noted that the two diseases can both have a range of persistent symptoms, which can be numerous and incapacitating.
Asked for her reaction on the new long-COVID and Lyme disease clinics in Quebec, Vett Lloyd exclaimed, “Great!”
“I’m thrilled that Quebec has started to take action, and I very much hope that’s a model that other provinces will follow,” she said.
But, Lloyd added, “Like it or not, I think Nova Scotia should be taking the lead here because you have so many ticks and your tick-to-human ratio is the highest in the country.’
‘Here we’re just trying to ignore them’
According to Donna Lugar, not only is Nova Scotia not taking the lead in addressing Lyme, the opposite is happening.
Lugar is part of the informal Nova Scotia Lyme Advocacy Group that works to raise awareness of the disease and the need to educate both the public and medical professionals on its prevention and treatment.
In December last year, the group wrote to Health and Wellness minister Michelle Thompson, with requests for action on Lyme. They received no reply.
In February, the advocacy group made a presentation to the entire PC caucus, including the premier and health minister, with several asks, including a provincial tick collaborative care centre in Nova Scotia, like the one in Manitoba that deals with “possible late Lyme and/or other emerging tick borne diseases.”
As Lugar recalled it, Premier Houston said their asks were not insurmountable.
“But we’ve had no updates since then,” Lugar told the Examiner.
“There’s less information, there’s less awareness, it’s gotten worse,” she said. “Why are we not taking this more seriously?”
“In the northeastern United States, in the high-tick areas like Connecticut, there are billboards, there are signs. There’s awareness that the ticks are there and you need to take precautions,” said Lugar.
“Here, we’re just trying to ignore them.”
With files from Jennifer Henderson.