By July, he started feeling off and had unusual aches and pains, and even though he hadn’t clocked a specific bite, he started to suspect he had contracted Lyme disease.

Blood work confirmed the diagnosis. By then the 33-year-old was struggling to walk without losing his breath. His doctor sent him for an electrocardiogram to check for heart issues.

Before he made it home from the test, he got a call to turn around and head straight to the ER. He had a relatively rare complication of Lyme called Lyme carditis, which interferes with the functioning of the heart. Left untreated, it could be fatal.

He was admitted to the cardiology unit at Kingston General Hospital and stayed 11 days, wondering what this would mean for his active life.

Richardson is one of a growing number of Ontarians diagnosed with Lyme disease, an infection spread through the bite of an infected blacklegged tick. Ontario, which reports more cases than almost any other province, has already recorded 515 cases this year.

As climate change drives the rapid expansion of blacklegged ticks into new parts of Ontario, researchers say the province is at a pivotal moment in its response to Lyme disease. Efforts are underway to improve testing, expand surveillance, raise awareness of prevention measures and develop a human vaccine. But researchers and patients say significant gaps remain in early diagnosis, physician education and access to care for people experiencing persistent symptoms.

While Lyme can be treated successfully when caught early, delayed diagnosis can leave some patients with debilitating symptoms that persist for months or years. 

Though it took him nearly eight months to return to normal, Richardson believes he was incredibly lucky. He attributes that to the attentiveness of his family doctor, his care at Kingston General under a leading specialist in Lyme-related cardiac issues, and being so healthy to begin with.

 “They said it was only a matter of time, if it wasn’t properly treated it was death.”

Lyme disease was first discovered in Lyme, Conn., in the mid-‘70s. Yale researchers Dr. Allen Steere and Dr. Stephen Malawista identified a cluster of arthritis cases in children in the area and noted that many patients also had developed a bullseye rash, which they connected to tick bites. Later research identified the cause as Borrelia burgdorferi, a bacterium transmitted by infected blacklegged ticks.

By 1989, ticks carrying Lyme disease were found in Canada, in southern Ontario. In 2009, Lyme became a priority of the federal government and provinces and territories for monitoring and control efforts as a nationally notifiable disease due to ticks’ northward migration.

Between 2009 and 2025, provincial public health units reported 35,138 human cases of Lyme disease across Canada, likely an underrepresentation. Reported cases per year have risen dramatically, from fewer than 200 in 2009 to 7,105 in the most recent data.

“Over the past decade, we’ve really seen almost an exponential increase in the incidence of Lyme disease,” said Manisha Kulkarni, professor in the School of Epidemiology and Public Health at the University of Ottawa and, until recently, scientific director for the Canadian Lyme Disease Research Network, which wrapped up in March when its supporting research grant ended from the Canadian Institutes of Health Research.

Ontario has seen nearly half of cases in Canada since 2009. It had the second-highest incidence rate of Lyme in 2024 (after Nova Scotia) with 14.67 cases per 100,000 people.

Kulkarni said warming temperatures caused by climate change increase the rate of development of ticks and allow them to survive where they previously could not. Ticks can expand into new regions.

Some of these regions are more densely populated with higher potential for human exposure, like mixed urban-rural settings around Toronto and Ottawa. She said research suggests fragmented forests and suburban development can create suitable habitats for wildlife species that support tick populations, making neighbourhoods bordering woodlands higher risk.

“As more risk areas expand into highly populated areas, we’re only going to see a growing trajectory of Lyme disease incidents,” said Kulkarni. “Unfortunately, that’s going to be coupled with the emergence of additional tick-borne disease risks in those areas as well, given that the blacklegged tick can transmit multiple pathogens.”

Tick bites can also spread Anaplasmosis, Babesiosis and Powassan virus, which can present with flu-like symptoms and progress to very serious complications if untreated. In 2023, these, too, became reportable as diseases of public health significance in Ontario.

An infected tick usually needs to be attached for 24 hours to spread Lyme. Symptoms typically start three to 30 days after a bite. A rash is a common sign of Lyme and can be in the shape of a bullseye or bruise. Other symptoms include fever, chills, headache, muscle aches and joint pain, fatigue, swollen lymph nodes, spasms, numbness or tingling and facial paralysis.

If untreated, the disease can progress to more serious issues including problems with the heart, liver and joints, including arthritis, and neurological problems. Symptoms from untreated Lyme disease can have significant health impacts and last for years.

Josephine Kozlowski, 34, believes her symptoms started about two years before she was diagnosed. She lives in downtown Toronto, and though she spends time at the occasional cottage and Trinity Bellwoods Park in the summer, she never goes hiking or camping. “I’m not an outdoorsy gal,” she said. She has never seen a tick in person.

When she started feeling unwell in 2023, Lyme disease couldn’t have been further from her mind.

She initially felt fatigued and had strange nerve sensations up and down her arms, fingers and hands, followed by night sweats. She had a new job, and fighting brain fog as she tried to get up to speed made her realize something was not right. She saw her family doctor, who, she said, took her health more seriously than she did.

When her doctor ordered blood work, including a Lyme test, she waited a month before going in. A few days after the test, she found out directly from Public Health Ontario that she had Lyme.

She was prescribed a three-week course of antibiotics by her family doctor. But she was bed-bound for months, sometimes sleeping 16 hours a day. She lost 20 pounds and had to take a medical leave from her new job. Lyme is more responsive to treatment the earlier it is discovered, and studies have shown that those not treated early are at higher risk for long-term symptoms.

“I was so sick,” she said, “I wasn’t eating. I wasn’t communicating. I wasn’t really holding a conversation. I wasn’t socializing. I wasn’t working.”

She has gotten somewhat better and returned to work, but has developed nausea, migraines she never had before, and the fatigue has stayed. It has made it hard to live the life she was living.

Kozlowski belongs to a large and growing group of Lyme sufferers who report experiencing symptoms after treatment. These longer-lasting symptoms, which the Centers for Disease Control and Prevention in the U.S. refer to as Post-Treatment Lyme Disease Syndrome (PTLDS), are less understood than acute Lyme symptoms and challenging to manage.

Andrea Forget, a spokesperson for the Public Health Agency of Canada, said in an emailed statement that the agency recognizes some people may experience prolonged or recurring symptoms following treatment but does not use the PTLDS terminology used in the U.S. She said the agency refers to these experiences as “persistent symptoms following Lyme disease treatment.” Forget said long-term symptoms after Lyme treatment are an area of ongoing study.

Ontario has been tackling the spread of Lyme disease from several directions. In 2023, it adopted a new form of testing called modified two-tier testing.

It’s an approach that was approved by the U.S. Food and Drug Administration and is recommended by the Centers for Disease Control and Prevention. In 2021, Nova Scotia brought it in.

Public Health Ontario says the testing is better at early detection, gives results faster, reduces human interpretation errors and is easier for labs to process at scale.

PHO is conducting surveillance of the disease and of tick populations. Ontario’s Vector-Borne Disease tool updates Lyme counts weekly, and shows where cases are appearing.

PHO works with health units to actively look for ticks and collect data from ticks submitted by the public. This data is shared with the ministry and health units to help them understand trends and educate health-care providers and the public.

PHO also works with eTick (etick.ca) to identify ticks from submitted pictures, and they conduct active tick surveillance, also called tick dragging, in conjunction with health units to find blacklegged ticks and test them for pathogens. By early July, eTick had logged more than 3,378 reports of blacklegged ticks across Ontario this year.

PHO said blacklegged ticks are most commonly found in wooded areas of southern Ontario, along the north shores of Lake Erie, Lake Ontario and the St. Lawrence River. Southeastern Ontario, including Kingston, Frontenac Park and Thousand Islands National Park, is considered the provincial hot spot for Lyme. Over the past few years, populations have also been found in Haliburton, Kawartha, Muskoka, Thunder Bay and northwestern Ontario. 

The majority of the GTA has been considered a risk area for blacklegged ticks since 2019, meaning the area shows evidence that blacklegged ticks are reproducing and maintaining local populations.

Public Health Ontario encourages people to enjoy the outdoors this summer while remaining vigilant. “Stay on the trails, do your personal protection, and be aware that ticks are out in the environment,” said Curtis Russell, senior program specialist with the Enteric, Zoonotic and Vector-Borne Diseases Unit .

Russell suggests people wear light-coloured clothing, tuck all clothing in and use repellent when outdoors. He advises performing a tick check after coming out of an environment where ticks might be present, having a bath or shower, and washing and drying clothes on high heat.

He said people should be aware that ticks appear in different life stages throughout the year. Adult ticks, about the size of a sesame seed, are most common in spring and fall, while smaller nymph ticks, about the size of a poppyseed and much easier to miss, are more active in summer.

For people who do find a tick on them, Ontario has added another route to quick assessment and preventive treatment. In January 2023, the scope of practice for Ontario pharmacists was expanded to include the ability to assess and prescribe medications for various minor ailments. As part of this, pharmacists were empowered to assess a patient’s risk of Lyme disease after a tick bite and to prescribe post-exposure prophylaxis antibiotics. However, a Lyme test needs to be ordered by a doctor.

This treatment is different from the antibiotic treatment given after someone has a suspected case. Instead it’s a one-time dose of doxycycline used to prevent the bacteria from establishing an infection. In the right circumstances, the prophylaxis can be fairly effective in preventing Lyme disease, but patients who feel unwell after taking it should see a doctor.

While preventive antibiotics can reduce the risk after a tick bite, the pharmaceutical industry is working on something that could protect people before they’re ever bitten.

It’s a development many outdoors people are also keeping a close eye on. Though there is a Lyme vaccine for dogs, a vaccine for humans has not been available in Canada since 2002.

Pfizer Inc. and Valneva SE have been developing a Lyme vaccine, which the companies say is the one furthest along in the clinical development timeline. Trials took place in North America and Europe, including sites in Nova Scotia and Ontario.

In March, the companies shared results from the Phase 3 VALOR “Vaccine Against Lyme for Outdoor Recreationists” clinical trial. They reported that it demonstrated more than 70 per cent efficacy in preventing Lyme in people five and up.

While the results suggested the treatment was effective, it fell short of the study’s own bar for statistical confidence, meaning how sure researchers are that a result reflects reality and not just chance — leaving the path to approval uncertain. Pfizer did not comment on its timeline for applying for approval in Canada or when Canadians could expect this vaccine to be available.

A previous vaccine, LYMERix, was sold here but was discontinued by the manufacturer in 2002 in the U.S. and Canada due to insufficient demand. The vaccine was also facing a class-action lawsuit alleging it caused adverse health effects and that the manufacturer concealed evidence about its potential risks.

As warming temperatures expand the habitat of disease-carrying ticks, experts say Canada is approaching a pivotal moment in its response.

“We’re really sitting at a critical tipping point for tick-borne diseases,” said Kulkarni. “The rate of increased numbers of cases over the last 10 years I think should be a really strong signal to the importance of keeping attention and increased investment in this area.”

Both Christian Richardson and Josephine Kozlowski believe that despite their suffering, they were lucky. They had family doctors, something that an estimated 1.5 million Ontario adults lack. And they felt their doctors played a key role in advocating for them.

Other patients haven’t had the same support. Laura Dalrymple was living in transitional housing in Waterloo when she found a tick on her leg in June 2025. She didn’t know a lot about Lyme disease before getting bitten and wishes she had acted sooner. She was treated for Lyme at a walk-in clinic four days after the bite and continues to experience fatigue, dizziness, fainting, difficulty breathing, memory lapses and vertigo, and has struggled to get follow-up care.

“Up until the point where I got bitten I was perfectly healthy,” said Dalrymple. “It’s pretty much completely debilitated and took most of the energy away from me.”

Jake Lavoie lives in Kingston, a hot spot. “A lot of people either aren’t aware or they just choose not to be aware but it’s everywhere,” he said.

He believes he was bitten while golfing last July. After going to the hospital twice for serious swelling in his knees, he suggested to his doctor that they test him for Lyme. Despite the influx of cases in the region, Lavoie said it appeared not to be on the doctor’s radar. Nearly a year later, despite treatment, he is still struggling with symptoms, and he has sought alternative treatments out of pocket, including herbs and more antibiotics from a naturopath.

“I would like more research into treatment for chronic Lyme sufferers,” he said. He believes more help is needed for people with long-term symptoms.

Kulkarni would like to see more emphasis on the detection, early diagnosis and treatment and the expansion of information and decision-making tools for practitioners. She also urges more training and support to manage late-stage Lyme disease that may not have received early diagnosis and treatment, and post-treatment Lyme disease.

“We can do more to make sure that those risks are really being taken seriously.”