CDC blasted for removing public data on tests for coronavirus


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Lawmaker blasts CDC for removing public data on number of Americans tested for virus

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The Centers for Disease Control and Prevention has abruptly stopped disclosing the number of Americans tested for the novel coronavirus, a move one lawmaker has called “unacceptable.”

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In recent days, the agency has posted statistics to its website detailing the impact of the virus as it spread across the United States. Figures include a breakdown of confirmed and presumed patients and the total number of deaths, cases and tests administered.

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But as Rep. Mark Pocan (D-Wis.) noted Monday, one of those numbers suddenly vanished from the site.

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“Americans are dying,” Pocan wrote in a letter to CDC director Robert R. Redfield. “We deserve to know how many people have been tested.”.His letter cited comments made Sunday by Scott Gottlieb, the former commissioner of the Food and Drug Administration, who said there could be “hundreds or low thousands” of coronavirus cases in the U.S.

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Given this possibility, Pocan said, “knowing that CDC testing is keeping pace with the likely number of cases is imperative to maintaining public trust.”

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The material on this site is for informational purposes only.
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It is not legal for me to provide medical advice without an examination.

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It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

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U.S. badly bungled coronavirus testing


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Quoting March 1, 2020, from Science:

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As of Friday, South Korea had tested 65,000 people for the coronavirus; the U.S. had tested only 459, per Science Magazine. China can reportedly conduct up to 1.6 million tests a week. Although the World Health Organization has sent testing kits to 57 other countries, the U.S. decided to make its own.

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.There have also been problems with the tests themselves. On Feb. 12, the FDA announced that health labs across the country were having problems validating the CDC’s diagnostic test, Science reports in an in-depth account of what went wrong with the tests.

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The FDA announced yesterday that public health labs can create their own diagnostic test. Scott Becker, the CEO of the Association of Public Health Laboratories, told Science that he expects that public health labs will be able to do 10,000 tests a day by the end of the week.

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From Common Dreams, February 27, 2020:

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“Mike Pence literally does not believe in science,” tweeted Ocasio-Cortez, a New York Democrat. “It is utterly irresponsible to put him in charge of U.S. coronavirus response as the world sits on the cusp of a pandemic. This decision could cost people their lives. Pence’s past decisions already have.”

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Ocasio-Cortez pointed to Pence’s tenure as Indiana governor, where he she said his “science denial contributed to one of the worst HIV outbreaks in Indiana’s history.”

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“He is not a medical doctor. He is not a health expert,” Ocasio-Cortez wrote. “He is not qualified nor positioned in any way to protect our public health.”

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Gregg Gonsalves—a Yale epidemiologist who co-authored a 2018 paper connecting Pence’s policy decisions as governor to the 2014 HIV outbreak in Scott County, Indiana—denounced the president’s decision to allow Pence to coordinate the administration’s coronavirus response.

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“Over 200 people were infected with HIV in an outbreak, met with ignorance, bumbling, incompetence, and ideological intransigence. Two hundred needlessly infected, now on medication for life at great costs to themselves and the state,” Gonsalves tweeted Thursday morning. “Now Donald Trump has put Mike Pence in charge of coronavirus.”

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“It’s like putting an arsonist in charge of the fire department, a bank robber in charge of the U.S. Mint,” Gonsalves added. “Donald Trump made the choice of putting someone absolutely not up to the task to this crucial position. It endangers us all. This isn’t a Republican or Democratic issue—we have the potential for coronavirus outbreak in the U.S. and we needed to rise above the partisan fray.”

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The material on this site is for informational purposes only.
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It is not legal for me to provide medical advice without an examination.

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It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

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Welcome to my Weblog on Pain Management!

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Medical Library


This page at the National Library of Medicine or Medical Librarymay be useful to you, allowing you to search for the explanation of Medical Conditions, Medications, Procedures, Tests, and general questions.

Other active links – click to open

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Other  organizations include American College of Emergency Physicians, National Hospice and Palliative Care Organization, Family Caregiver Alliance, American Bar Association Commission on Law & Aging.

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Vitamin D – A Steroid Hormone, Anti-inflammatory


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The Sunshine Vitamin Controversy

What should normal values  be for calcium homeostasis?

My attention was drawn to Vitamin D several years ago when a review appeared in the journal Neurology, published by the Academy of Neurology, that linked low levels of Vitamin D to Multiple Sclerosis.  The article was unusual for its length and the breadth of research cited over several decades.  More recently, a Johns Hopkins article published “the most conclusive evidence to date” that Low Vitamin D Levels Pose Large Threat to Health.

New publications on Vitamin D seem to appear every week with the focus on levels of 25-hydroxyvitamin D, also written as 25(OH)D. Its half life in serum is ~ 10 days to 3 weeks.

The biologically active form 1,25-dihydroxyvitamin D, written as 1,25(OH)D²,  is made in the kidneys and has a much shorter serum half-life of ~ 4-6 hours, thus making it less useful as a serum marker for measuring.

Sources & Metabolism: Vitamin D is a fat soluble vitamin that’s absorbed in the small intestine from  foods such as egg yolks, fatty fish, fish liver oils, fortified milk, margarine, and cereals.  Bile salts are required for absorption.  Sunlight stimulates the skin to synthesize vitamin D, but exposure of hands and face as little as 15 minutes may not be sufficient and it is not as effective for everyone.  It won’t work in winter months, it won’t work for the aged, for those who have pigmented skin, and it won’t work for those who cover their skin.

Vitamin D Metabolism - click to enlarge

Vitamin D Metabolism

The Controversy –  How Do We Determine Normal Values?

Surprisingly, in a well designed multicenter study of healthy young Hawaiians in their 20’s who were exposed to at least 29 hours of sun per week, 51% were found to have vitamin D deficiency using the usual cut off of 30 ng/ml for normal.  This study from 2007 found the mean concentration of 31.6 ng/ml, and the highest of 62 ng/ml.  It raises the question whether

“it seems prudent to use this value [60 ng/ml] as an upper limit when prescribing vitamin D supplementation,”

rather than the generally published normal range of 30 to 80 ng/ml or even 100 ng/ml quoted in some labs.  This study is important in discussing the controversial question of what normal values should be for calcium homeostasis and reviews several possible explanations for inadequate production of D3 including genetic differences.

They note the highest reported values in “Nebraska outdoor workers… were between 81 and 84 ng/ml” but the assay system differed compared to theirs and results in a higher value.   Reviewing this study that was published in the Journal of Clinical Endocrinology & Metabolism has allowed me just now to readjust my own patient practice.

Laboratory Testing:  results can differ from one laboratory to another.  My hospital sends specimens to ARUP for testing, whereas Quest has acknowledged errors in laboratory testing and problems with standardization as reported by the New York Times here.

Function:  It is important for absorption of calcium and phosphorous from the small intestine, for bone health, osteoporosis, risk of falls, certain cancers(colon, breast, prostate), and possibly 6 to 7 years of longevity.  Deficiency of vitamin D is associated with suboptimal health and possibly increased pain; it is linked to infections, gum disease, hypertension, diabetes, coronary disease, neurological diseases such as Multiple Sclerosis, Parkinson’s Disease, dementia and Alzheimer’s Disease though it may not be causal. Its receptor is found all over the body including the brain.

I recommend this review by one of the best web resources at Memorial Sloan Kettering Cancer Center Herbs & Botanicals.

They quote a reference showing it reduces postmenopausal weight gain and “In adults with impaired fasting blood glucose, giving calcium and vitamin D reduced increases in plasma glucose and insulin resistance….”

It is the only vitamin that is a steroid hormone, and my interest increased on learning that it functions as an anti-inflammatory.  But as I tested blood levels for 25(OH) vitamin D and parathyroid hormone (PTH), I discovered more than 90% of my patients had vitamin D deficiency and a few had hyperparathyroidism.  There are four parathyroid glands next to the thyroid, and for some reason doctors have rarely tested their hormone levels.

***Persons with hyperparathyroidism should NOT take calcium or vitamin D.

It may lead to kidney stones and bone pain:  stones, bones and groans.***

Evidence for Optimizing Vitamin D Concentrations

On the other hand, if vitamin D is low, there is some evidence that replacement with vitamin D3 so that blood levels are in the high normal range, may help pain.  That is, it may raise the pain threshold and possibly have other benefits for health and longevity. It is desirable to avoid toxic levels of D as it causes hypercalcemia with depression, drowsiness, weakness, headache, polydipsia,  bone loss, and metastatic calcifications of many organs, soft tissues and blood vessels.  The generally quoted range of normal for 25(OH) vitamin D is 30 to 80, that varies with the lab.

great-western-divide-wp1

Doesn’t that photo of the Great Western Divide make you want to get outside into the sun?

Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes was reviewed by Heike Bischoff-Ferrari et al, in 2006,  though it has been superseded by much additional work since then.

To quote from their article:

This review summarizes the evidence for optimal serum  25(OH)D concentrations. The endpoint selection for this review was based the strongest evidence to date—ie, that from RCTs [randomized controlled trials], consistent evidence from prospective and cross-sectional epidemiologic studies, and strong mechanistic evidence or dose response relations.  BMD [bone mineral density], fracture prevention, lower-extremity function, falls, oral health, and colorectal cancer met these criteria. Weaker evidence exists of a beneficial effect of vitamin D on other diseases, including multiple sclerosis (15), tuberculosis (16), insulin resistance (17, 18), cancers other than colorectal (19 –22), osteoarthritis (23, 24), and hypertension (25–27), but these diseases are not considered here.

They did not review pain studies.  I would add that “weaker” evidence merely means that it must be confirmed by more studies, not that it excludes those conditions.  There is an epidemic of vitamin D deficiency in the country, and the incidence is very high in pain clinics as reported in several studies.

A new multi-center epidemiology study  “Demographic Differences and Trends of Vitamin D Insufficiency in the US Population, 1988-2004”  by Ginde, et al, in 2006,  “demonstrate a marked decrease in serum 25(OH)D levels from the 1988-1994 to the 2001-2004 NHANES data collections.”  And like others before them, they point out:

“Current recommendations for vitamin D supplementation are inadequate to address the growing epidemic of vitamin D insufficiency.”

Summary:

Make sure your doctor checks both your 25(OH)Vitamin D and parathyroid hormone level (PTH) – not thyroid – to determine if you have hyperparathyroidism or if you have normal or low vitamin D.  That will determine if you need replacement or if you should stop using calcium and D as it will cause kidney stones and calcium deposits on your bones leading to pain.

If vitamin D levels are low it may result in increased physical pain and may cause or aggravate many medical conditions.

If PTH levels are high indicating hyperparathyroidism it will cause new painful conditions.

Intake does vary with the patient, the season, the age, but the recommended daily allowance may perhaps be double what it is now.  It is unclear when the federal government will adjust that dosage.   As always, your physician’s recommendation will be based upon blood levels of 25(OH)D and PTH.

Do not make changes in your dosage without careful evaluation.

Could this possibly be one of the most important areas of research this century?

The material on this site is for informational purposes only, and

is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

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