State Views - South Carolina
A critical aspect in the battle on Lyme disease is of informing people, physicians and politicians about the seriousness of this illness. It is often misdiagnosed or undiagnosed for lengthy periods of time, leaving devastation in its wake.
Here in South Carolina, we have a compassionate Governor whom we have provided educational medical material to. In reviewing this material, he has made an informed decision to declare May as Lyme Disease Awareness Month. Each year, a citizen of South Carolina must make a request for the proclamation to be declared. Various individuals have made these efforts over many years and addressed two Governors, who very much care about their citizens. The Governor does not advertise or promote Lyme Disease Awareness Month, other than by making the proclamation since there are many proclamations for the month of May. This however, provides the opportunity to the people of South Carolina to bring attention to the disease by their own efforts.
Many ask the mayors of their respective towns and cities to make a similar proclamation. This brings exposure to the public through press and news coverage. It is a further opportunity to write articles and Op-Eds and to do educational activities that promote Lyme disease awareness among individuals. South Carolina efforts are currently at a "grass-roots" level.
As far as the Department of Health and Environmental Control (DHEC) in South Carolina is concerned, they are not. Very little is done on their part to inform the public of the risk of Lyme and tick-borne diseases. Although they have monthly press releases for updating the public on West Nile Virus there is no true "position" paper on Lyme disease. As well, South Carolina DHEC does little to educate the people of this state on the seriousness or true prevalence of Lyme disease. In comparing the 2004 DHEC reported cases with a 2004 survey of physicians, there is a serious disconnect with the statistics in this state. 253 cases of Lyme were reported by physicians responding to this latest survey, while DHEC only had 8 confirmed, five probable and thirteen total cases reported for 2004. Yet somehow there were 22 cases of Lyme reported to the CDC in the same year in South Carolina. The upstate region totaled 42.5% of all Lyme cases reported for 2004 according to the physician survey. This data is consistent with the ILADS position that the actual number of Lyme disease reported cases are under-reported by over a factor of 10.
In the wake of the North Carolina Medical Board's unjust persecution of Dr. Jemsek, a chill ran throughout the Carolinas' physician communities. Patients now find it very difficult to obtain a diagnosis, let alone adequate treatment for a disease that is both highly debilitating and can be fatal. There is no follow-up in this state for chronic Lyme. So, hundreds of patients remain ill from this disease and are left unchecked at either the state or federal level.
In the South Carolina 2005 Annual Report on Reportable Conditions, 11 total cases of Lyme were reported by DHEC (page 10), with precious little information on Lyme contained in this volume of 176 pages. However a shocking truth is revealed if one examines the numbers carefully on a county-by-county basis, these numbers add up to 63 in 2005, as enumerated on page 16. Why is it so difficult for a reportable disease to be correctly reported?
For 2006, 55 cases were reported as confirmed and probable. Interestingly, a mere 22 cases were reported by December of 2007 in the SC CHESS system (Carolina's Health Electronic Surveillance System). However, DHEC EPI Notes Winter 2008 reports that there were 27 cases of Lyme reported from January 1, 2007 to November 30th 2007. The South Carolina DHEC can't really seem to land on a solid number and the totals are suspect, especially when compared to the overall high figure of reported cases of Rocky Mountain spotted fever.
In searching the DHEC database, there is no proper listing of any county being "endemic" for Lyme at all, though many seem to meet the CDC requirements. As well, most curiously, the only year that specifies a death specifically by Lyme is in 2000. Since the year 2001, Lyme mortality by ICD 10 code (A69.2) is lumped into a category spanning ICD 10 codes from A65-A79 and titled as, "OTH. INFECTIONS BY SPIROCHETES CHLAMYDIA OR RICKETTSIA". However, most interestingly, tick-borne spotted fever (A77) is listed separately and not included in the above-noted range in which death by Lyme is appears to be hidden.
Although older documents, the military has even assessed specific SC areas as a higher risk for Lyme disease. Scientific and medical studies conducted in SC show the prevalence of Bb and the higher incidence of infected ticks along the coastal sections of the state. While SC may downplay Lyme disease in our state, the scientific studies clearly acknowledge it.
Many physicians in South Carolina miss the diagnosis of Lyme disease, since they are generally not looking for it. Often people are left with a misdiagnosis or a lack of proper diagnosis altogether. People here are not currently well-educated on the signs and symptoms of Lyme, therefore it is up to those who are informed about the disease to inform those who are not. Within our state, this responsibility rests with the DHEC. Until then, physicians in South Carolina will continue to misdiagnose patients with Lyme and other tick-borne diseases.