Having done the research myself, it seems to be biofilms that the bacteria create leading to a "dormant" yet still metabolically active state that releases inflammatory byproducts throughout the body.
The recommended course of action seems to be disulfiram to bust those biofilms + antibiotics to finally kill it all off.
In my understanding (from some years back when I was researching this myself), Lyme takes multiple forms, and in some phase in their life cycle are able to hide inside red blood cells. Antibiotics work only for some of the forms.
The recommended course of action seems to be disulfiram to bust those biofilms + antibiotics to finally kill it all off.