[CanLyme Note: Dr. Strang’s response below to CanLyme director Rob Murray’s letter from January 2019 (below) demonstrates an alarming lack of the very principle of scientific due diligence that they accuse Lloyd and Hawkins of. In the weeks that it took to respond, no one seems to have bothered to check to see if the Lloyd and Hawkins 2018 paper is actually published in a peer-reviewed journal. It is an easily verified fact that the journal is peer-reviewed – check it yourself right here https://www.mdpi.com/journal/healthcare. Or is Strang calling the editor and entire editorial board liars? We note that the Canadian member of the editorial board is not only an associate professor at the University of Alberta, but also a provincial government director for Alberta Health. It has been more than 6 months since the paper was published, so the government of Nova Scotia has had plenty of time to ask its experts to evaluate the science. The most honest and direct way to evaluate a scientific claim is to examine the facts and logic that support it. Why doesn’t Strang do that? Is it because the journal has an international board of editors, rather than the parochial North American echo chamber of experts that Dr. Strang prefers to consult? It is time for the government of Nova Scotia to evaluate the science, rather than engage in slander. The fact that Strang chose to present a demonstrably false statement about the journal in which Lloyd and Hawkins published is a strong indication that he was unable to find any scientific basis for countering their article, and he has just provided another example of the sloppy science that demonstrates what Lloyd and Hawkins have just called our attention to.]
February 15, 2019
Please see below the response to your January 29th email to Minister Delorey. The Minister has asked Dr. Strang to respond on his behalf.
“Dear Mr. Murray:
Thank you for your email dated January 29, 2019, regarding Lyme disease (Ld) to the Honourable, Randy Delorey, Minister of Health and Wellness. I have been asked by the Minister to respond to your request.
As you are aware, Ld is an established disease in Nova Scotia and is emerging in other parts of Canada. The increase in the range and size of tick populations in Canada is a result of climate change. The Department of Health and Wellness (DHW) has had a comprehensive Tick-Borne Disease Response Plan since 2007. This plan is reviewed and updated annually by a group of experts in fields such as, microbiology, entomology, public health and veterinary medicine. The plan encompasses multiple tick-borne diseases, including Ld, Human Granulocytic Anaplasmosis, Babesiosis and Powassan virus.
Elements of the Response Plan include human and tick surveillance, public awareness and education, and a communication strategy. Nova Scotia performs active tick surveillance to monitor the spread of blacklegged ticks, identify the presence of the bacteria causing Ld and other potential emerging pathogens.
The main purpose of infectious disease surveillance is to monitor for trends, emerging or changing disease patterns and early identification of outbreaks rather than identifying every case of a specific disease. All cases of lab-confirmed Ld are reported to Public Health and are included in our human surveillance data. The human surveillance also includes early Ld cases that are diagnosed on clinical assessment alone, however, we are aware that there is a degree of under-reporting of such cases. The Lloyd and Hawkins article that you reference was not published in a credible journal and it is uncertain as to whether it was peer-reviewed. Therefore, the paper’s results intended to inform the degree of under-reporting cannot yet be taken as valid.
DHW provides regular evidence-based recommendations and information to health care practitioners in the province via multiple avenues. Surveillance, diagnosis, treatment and prevention of Ld are all addressed in the information provided to health care providers. This information includes a “Statement for Managing Lyme Disease in Nova Scotia” document, developed by the provincial Infectious Disease Expert Group. The approach outlined in this document is based on current scientific evidence and is consistent with national and international evidence-based guidelines. In addition, the Nova Scotia Infectious Disease experts are readily available to assist family physicians with diagnosis and treatment of Ld and complex Ld situations.
The plan’s communication strategy includes providing Nova Scotians with consistent, current and reliable information about tick borne diseases. Prevention messaging for the public is distributed through multiple channels; such as, social media, websites, and signage. The tick check basics poster was developed and distributed to provincial parks in 2018. The poster can be downloaded here: https://novascotia.ca/ticksafety/poster.pdf. Information regarding Ld is also available on the DHW website at https://novascotia.ca/dhw/CDPC/lymp.asp and https://novascotia.ca/ticksafety/.
Public health and school awareness campaigns are ongoing throughout the province. Specifically, within the western region of Nova Scotia, letters were distributed to schools, daycares, and the municipalities regarding tick borne diseases, including Ld. There was collaboration with a local municipality to support their enhanced communication campaign.
Robert Strang MD, MHSc, FRCPC
Chief Medical Officer of Health””
“Hello Minister Delorey:
I have used the conclusions drawn from the paper by Dr. Vett Lloyd and Dr. Ralph Hawkins [Under-Detection of Lyme Disease in Canada, Lloyd VK, Hawkins R, Healthcare 2018, 6(4), 125; doi:10.3390/healthcare6040125 https://www.mdpi.com/2227-9032/6/4/125/htm] and those from the CDC 2013 press release [https://www.cdc.gov/media/releases/2013/p0819-lyme-disease.html] to update and revise the Nova Scotia Lyme disease rates compared to other diseases as reported by PHAC and the Notifiable Diseases in Nova Scotia 2017 Surveillance Report: https://novascotia.ca/dhw/populationhealth/documents/Annual-Notifiable-Disease-Surveillance-Report-2017.pdf. Both the Lloyd/Hawkins paper and the 2013 CDC press release report 90% under-reporting of Lyme. Borrelia seldom travel alone yet there is little mention of the co-infections and other tick-borne diseases [TBD’s].
Please see the attached pdf file and note the striking number of Lyme cases in the western zone [health district No. 1] compared to all other diseases. It would be difficult to convince residents that this disease is rare and only a minor nuisance. It is too bad that physicians don’t feel confident in diagnosing Lyme and TBD cases clinically and are not aware of the variability of presentations at various stages of these diseases. Certainly better tests would help. Infectious disease doctors claim to know how to treat these complex infections but in many cases they don’t. This is the plague of the 21st century and if it were any other disease than Lyme this would be declared as emergency situation and an epidemic. We haven’t seen the Tick-Borne Disease Response Plan put into action and even if it were will it be enough to stem the tide? https://novascotia.ca/dhw/cdpc/documents/Tick-Borne-Disease-Response-Plan.pdf
No matter how big the problem becomes there is almost no funding of basic science on ticks and TBD’s. What little federal money there was was given to a group of status quo researchers most of whom are employed by PHAC or provincial public health departments. The research will be used to confirm old ideas.
There is still little in the way of visible signage or media announcements that you could be badly injured or killed from a tick bite. We need a much more robust program involving communities and schools.”