Is convalescent plasma the next silver bullet for Covid-19

 Is Convalescent Plasma the next silver bullet for Covid?

Last week I heard on the news that convalescent plasma (CP) had been approved in record time by the FDA as a treatment for Covid-19. This makes a little more sense than rushing through hydroquinone as an unresearched treatment for Covid with it's potential for deadly side effects.

Let me explain what this is exactly:

The use of convalescent plasma (CP) collected from previously infected individuals to passively transfer antibodies in order to protect or treat humans dates back almost 100 years. CP has been used for the treatment of different kinds of viral infectious diseases, especially in times of outbreaks for example polio and pandemics. Other examples of CP use include rabies, hepatitis B, measles, influenza, Ebola and hemorrhagic fevers^.

CP for Covid treatment is thus made from the blood of people who have already had Covid. This requires Covid survivors to be willing to donate their blood.

If you think about it, the logistics and practicality of this would be no easy task assuming that convalescent plasma actually works. It has not been proven.

Why? First of all getting enough regular blood for all the people who need it is hard enough. There is always a shortage.

Although an estimated 38 percent of the U.S. population is eligible to donate blood at any given time, less than 10 percent do so annually. According to studies, the average donor is a college-educated white male, between the ages of 30 and 50, who is married and has an above-average income. This may not necessarily be the profile of the average Covid-19 survivor.

So now we would need to keep tabs on everyone who has had a Covid infection and convince them to donate their blood.

 The donor and the patient must also have compatible blood types. Once plasma is donated, it is screened for other infectious diseases, such as HIV. Then hopefully made available in a timely fashion for the sick person.

The good thing about CP is that over the decades it has been proven to be relatively safe so long as the recipient does not have an allergic reaction (which is basically the same risk as having a blood transfusion). Another good thing is that it will be available a whole lot faster than a vaccine !

At the end of the day this is not a ‘new’ therapy as touted and the availability is currently quite scarce. Once again forget the wonder treatments. The only thing you can really hang your hat on is making sure you don’t get Covid in the first place. Yep, same ole same ole! Wash your hands, use hand sanitizer, wear your mask, stay inside, social distance. Take your vitamin D, zinc, vitamin C and you can add echinacea or elderberry if you like.

Stay well. Please let me know if you have questions.

Do-It-Yourself Covid Testing!

 I want to highlight an article I read today in the Harvard Gazette about a new approach that has not been suggested before. This idea is from Michael Mina a Harvard epidemiologist and expert in disease testing. He is calling for a shift in strategy toward a cheap, daily, do-it-yourself test that he says can be as effective as a vaccine at interrupting coronavirus transmission. He believes it is currently the only viable option for a quick return to a normal life.

Dr. Mina, is an assistant professor of epidemiology at my alma mater the Harvard T.S.Chan School of Public Health. He suggests that this would be a better strategy than closing down the economy and keeping schools closed which is really the only other viable option.

These paper-strip tests (similar to the popular pregnancy tests) have already been developed and their shotgun approach to testing cheap and widespread provides a way back to the workplace, classroom, and other venues.

The strategy, “could put hundreds of millions of tests in the hands of consumers within weeks, at a cost far less than repeated rounds of economic stimulus” Mina said. Several companies have produced these tests which can be produced for less than a dollar. With tests like these, ordinary people can perform their own tests each day or every other day. They are not as accurate as the current diagnostic tests but they are effective at detecting virus when a person is most infectious. If everyone who tests positive stays home, the thought is that the widespread effect would be similar to that of a vaccine because people would stop the transmission chains across the country. If people are concerned about false positives they could then follow up with a formal test with their doctor and stay quarantined meanwhile.

So whats the catch ?

First of all unless the tests are FDA approved and federal government sanctioned, companies are not going to invest and produce these tests in the numbers that would be required to be effective.

The currently available tests take time and are expensive. Which makes them impractical for daily in- home testing. These tests may not be perfect but the nation’s current testing strategy catches less than 3 percent of cases early enough for a person to proactively prevent transmitting the virus. Now if those testing positive stay home, “a cheap, at-home testing regimen has the potential to provide a kind of artificial herd immunity, interrupting enough transmission nationwide to cause the pandemic to stall”

Another catch is one that relates to all fields of prevention: it still requires people to take some level of responsibility and motivation to actually do the test and then follow through if the results are positive.

According to Dr. Mina what’s needed, is the federal government’s financial and organizational clout to both provide resources and get companies working together. Though even a $1 per day test gets expensive, if the federal government provides them free to all Americans, the cost would be far less than recent stimulus efforts. We could get these tests up and running right now unlike the vaccines.

“It will stop the vast majority of transmission and it will cause these outbreaks to disappear in a matter of weeks,” Mina said. “This is something we can actually do at warp speed.”

If you would like to read the full article you can read it here:

https://news.harvard.edu/gazette/story/2020/08/cheap-daily-covid-tests-could-be-akin-to-vaccine/

Its not over yet! The 'state' of the state.

There have been 3600 deaths in Maryland so far with huge differences between the counties. For example: deaths in Howard county 106, PG county 741 and Montgomery county 767.

Presently there are 488 people hospitalized in the state, 117 in ICU.

We were doing so well until the July 4th holiday when people became very lax.

I know you are tired of the restrictions but please don’t quit while we are ahead!

We now have to look forward and figure out how to keep our children safe as people press for a return to the classroom.

Even though things are ‘opening up’ please be cautious and don’t go overboard. Just because you can sit inside in restaurants now doesn’t mean you need to.

Your nails can wait another two weeks, two months if they have to!

The 7 Best Things about Covid-19

“When something bad happens, something good will follow”. That’s one of those old sayings that isn’t particularly useful like “good medicine has to taste bad”. We’ve had a lot of bad this year so I’m sure everyone is ready for some good to follow, so I decided to look for the silver lining. It is after all, a good strategy in life to always try to see some positives even in a bad situation.

So here goes:

1. I think the best thing about Covid-19 is that it is preventable.

We know what causes Covid-19 and we know how to prevent it. Having the will to do what is necessary is a personal decision however.

Imagine how bad things would be if one had no options.

Fortunately this isn’t the plague where you are just a sitting duck. It is not rocket science either. There was a spike in cases and hospitalizations after July 4^th  as expected. At this point, everyone knows what to do. We have no choice but to put life on hold until they do it.

2. The seniors got the memo! The death rate in the elderly is decreasing because they are being more careful. Maybe we should all take a leaf out of their book.

3. You never have to get the flu ever again! As a scientist I am thrilled to see that people finally understand how viruses are spread. Now people are careful about what they touch and are very generous with their use of hand sanitizer. This winter should be like no other. People are already asking me for the flu vaccine. No more chasing folks. I love hearing lay people using all the old epidemiological terms like ‘co-morbidities’, risk factors and infection rates. They sound like pros now.

4. People now understand why organizations like the CDC exist and why disbanding or defunding public health is a bad idea.

People also understand how the health in one country can affect people on the other side of the globe. Yes, the World Health Organization is an important component of a stable planet and the world economy.

5. The racial and socioeconomic disparities in health care are as obvious as a sore on your face. Not just that, people finally realize that we are all interconnected and that it is in everyone’s best interest for even poor people to be healthy.

Disease can spread from the bottom up, even when the rich people hide in the Hamptons they still need ‘essential’ (aka menial) workers.

Maybe universal healthcare for all isn’t such a bad idea after all! Imagine how much money we would have SAVED this year alone not to talk of lives and productivity.

We can no longer pretend healthcare is not political. We hear nothing from our current administration about their plans for providing healthcare to the underserved, only scare tactics about people losing their health insurance. Of course having health insurance requires you to be healthy enough to have a job!

6. Many people have enjoyed working from home. Less gas, less traffic, less pollution, less wear and tear on their bodies. Fewer outfits, less dry cleaning etc! I think that genie is out of the bottle. It behoves us to accommodate this new reality. (By the way have you tried digital medicine yet?)

7. I believe Covid-19 has been a wake up call for a lot of people.

Hopefully we are now more appreciative of what we had and what we are now missing.

These are just some of my thoughts.

Please, at least take the uptick in cases seriously or we could continue this pandemic until the end of the year. It is predicted that at the current rate of increase America will lose another 30,000 people in the next 2 months. A very sobering thought, positives not withstanding.

The Phantom of the Mask, the Myths!

THE SWEDISH MODEL OF 'PREVENTION' :THE RECENT INCREASE IN COVID CASES Do masks work? In a word Yes! But before we get into the myths surrounding the wearing of masks let’s talk about preventive measures in general. Yes, the same ones I have been harping on for 4 months now. The good old social distancing, hand washing, hands off the face and hand sanitizer stuff. How do we know they work? Well, first let’s look at Sweden. Sweden has captured international attention by conducting an unorthodox, open-air experiment. It has allowed the world toexamine what happens in a pandemic when a government does not institute rules. Sweden was the only Scandinavian country that decided not to lockdown or quarantine when the corona virus hit Europe. This is what has happened: Not only have thousands more people died than in neighboring countries, thatimposed lockdowns, but Sweden’s economy did not fare better. Per million people, Sweden has suffered 40 percent more deaths than the United States. Sweden who chose not to lockdown, has 358 deaths per million compared to Norway 44, Finland 53 and Denmark 93 (The US is 267 per million and rising). But Sweden’s grim result showed that a failure to impose social distancing, costs lives, jobs and does not stop the economic consequences of Covid. This disaster is now playing out in the United States, there are states particularly in the South that decided to follow the ‘Swedish model’. Florida for instance currently has 7,000 people in the hospital and has had 4241 deaths and the numbers are rising daily, exponentially. Texas is another state with complete disregard for social distancing. Maryland on the other hand, where masks and social distancing is mandated, continues to have a decline in hospitalizations (Current total 410, ICU 143). Please do not quit while you are ahead! Here we are 4 months in and we are still on high alert, with numbers rising in areas were people insist on being in denial. Who would have thought that because of such lack of political leadership this would still be going on? Even China were it began has pretty much gone back to normal. My neighbor told me a joke the other day: The patient asks the doctor : “Hey Doc how long is this Covid  problem going to last?”  The doctor says:  “I don’t know, I’m not that much into politics!” THE MYTHS OF THE MASK: "Wearing a mask is accepting defeat" : False, it is a sign that you are a responsible citizen. "Wearing a mask implies you are a ‘Liberal’":False, last I checked anyone, of any political persuasion can be infected (and die). Carbon dioxide from exhaling gets trapped under the cloth and can make you sick.  False: this is not true, false science. "Cloth face masks are not effective." False: they create a barrier between your mouth and nose and those around you. This makes it more difficult for the droplets that spread coronavirus through coughs, sneezes and talking to reach other people. Cloth masks are highly effective for the general public. According to the CDC, a cloth face mask needs to have the following in order to be fully effective: ·      Cover both your nose and mouth ·      Fit snugly but comfortably against the sides of the face ·      Be secured with ties or ear loops ·      Have multiple layers of fabric ·      Allow for unrestricted breathing ·      Able to be laundered and machine dried without damage or shape changes "If you've had coronavirus, you don't need a mask". False: If you've had coronavirus before or had an antibody test come up positive, you may believe that you don't need to wear a mask. Unfortunately, at this time, there is no way to know whether having coronavirus once provides immunity from the virus infection again or how long that your immunity might last. This means that you could potentially catch the disease again and spread it to others. Everyone should wear a cloth mask when in public unless they have breathing problems, are under age two, or can't remove the mask without assistance. "You don't need to wear a mask outside". False: At this time, being outside is generally considered safer than being inside. When taking a stroll or participating in other outdoor activities by yourself or with people you live with, a mask isn't required. However, when you find it difficult to maintain at least six feet of distance from people you don't live with – such as passing someone on a sidewalk or eating out at a restaurant – it's important to have your mask on. You should always have your mask on hand when you leave your home. Everyday health in extraordinary times: We are staying open so you can stay healthy! We have special protocols in place in the office to keep you safe and minimal waiting. No walk-ins. Anyone who doesn’t have a mask waits in their car until their appointment. Extra sanitation procedures daily and hand sanitizer for everyone! Come on in! It’s a great time to lose weight especially with our 10% off sale on the Weight Reduction Program. You have plenty of time to focus on your goal (and quit snacking). Other reasons why this is a good time to visit the doctor: Make self care a priority so you can be there for your family and handle your responsibilities better. Schedule that physical exam and pap smear you can never get around to when you are working. Keep your medications up to date and current prescriptions refilled. Pick up your Vitamin C, D and zinc, Echinacea Take off that mole you have been worried about. Get your shots updated. Get a cosmetic consultation. Balance your hormones so you can handle stress. Last but not least manage those co-morbidities that put you at higher risk of Covid-19

"Give me Liberty or Give me Covid!"

People should be careful what they ask for, Covid is no laughing matter. Our numbers in Maryland continue to go down. Todays numbers: 447 in hospital, 160 in ICU and 127 deaths across the state. Unfortunately that is not the situation in most other states. The cavalier attitude that has been rampant is now catching up with them. Even Mike Pence is now seen wearing a mask. Remember when he said “I’m the Vice president I get tested daily so I don’t need a mask!” Things are bad in the South and West and getting worse by the day. I read about a family that got together for a big birthday party and 18 family members got Covid. 9 hospitalized, grandpa fighting for his life on the ventilator. I don’t understand why people cannot learn from what others have experienced as opposed to actually needing to feel the burn themselves. It is truly frustrating that people continue to die needlessly from mishandling and disinformation. The good news is that these will not be my patients. I know you are all wiser than that and will not go crazy just because it is July 4th. There will be many July 4ths to come, missing out on one could keep you alive! Please, it is up to you to make sure that our area does not back track making another compulsory lock down inevitable. I really look forward to the day when I can write about other healthcare issues besides Covid but for now we must all be patient. For those who are interested I made a video on Vitamin D: https://youtu.be/PANxger2_nM And for those who have forgotten what they should be taking at a minimum, here it is again: Vitamin D 4000 units daily Zinc 50 mg daily Elderberry or Echinacea Vitamin C 2000mg We have all these items in stock in the office if you can’t find them. For those at high risk we can give you a short course of antibiotic to keep at home in case you develop the characteristic cough. I am so pleased none of my patients have died. Let’s keep it that way!

Maryland hospitalizations continue their downward trend!

Corona Virus Testing If you are interested in being tested for the corona virus in my office, either by the blood antibody test or the nasal swab please give us a call.

Political Rallies, Beach Parties and other Nonsensical behavior

GOOD NEWS....................sort of! Following up on the good news from last week our numbers in Maryland continue to decline. On June 11th we had 902 people in the hospital and 358 in the ICU. On June 21st we had 608 in the hospital and 230 in the ICU, and today, less than a week later, there are 511 patients in hospital and 209 in ICU. Why in the world would we quit now? Come on Maryland, we cannot do anything about what other states are up to but let’s not quit while we are ahead! Beach parties and indoor dining right now is madness, same thing with indoor cinema. Please don’t shoot me I am only the messenger who brings the truth. Don’t relax, I know its hard but you have to stick with it. Many more are going to die but it doesn’t have to be here because we have followed the rules and science will prevail. I want to make special mention of young adults. Yes, those ‘invincibles’ between the age of 23 and 39 who are the fastest growing segment of corona infected persons. In many places they make up a third of the infected population now. I believe one of the reasons for this is the initial misinformation that it is little more than a flu in young people and they hardly get sick. These young people have clearly not had good public health education. If they did, they would know that they are the key vessels for spreading the virus. People that aren't sick spread the virus the most. When they pass it on to a buddy who takes it home to their grand mother they now become responsible for the death of another human being. If you have a young person in your family or social circle please spell it out for them. It’s not just about how they feel or selfish behavior. For the rest of you avoid these folks like the plague! Just kidding, but you get what I mean. They are not as harmless or healthy as they may look. Especially if they won't wear a mask. I keep hearing slogans like “we are all in this together” but what does that mean if half the people “in it” don’t get it? I personally would love to see the Governors put a tri-state embargo on travel so that all these other non-compliant states couldn't send us more Covid-19 and send us into a second wave and lockdown. (Avoid out-of-towners too!). Anyway, have a plan for yourself and your family. I think it is finally safe to move into phase one. Continue to take your Vitamin C and D and Zinc. Keep washing your hands and wearing your masks. Using ‘common sense’ saves lives! Please stay well.

Update on Covid-19

Testing is available in our office

For anyone who is interested in getting tested for the corona virus, testing is available in our office as well as in the labs: Quest and Labcorp, if you don’t want to go to the testing stations.

It is highly recommended that those who took part in the totally justified demonstrations last week get tested this week, just to err on the side of caution.

Healthcare workers suffer major losses

In the US about 600 frontline healthcare workers died from the corona virus. According to the Kaiser Foundation and The Guardian most of the workers identified as African American or Asian/Pacific Islander. The CDC notes 375 deaths among Healthcare “Professionals” but acknowledges that this is probably an undercount.

Worldwide, according to the International Association of Nurses more than 600 nurses lost their lives to Covid-19 as of June 3rd.

Its not over yet!

Its been a rough 3 months so far and we are almost there. Don’t lose patience.

We in Maryland are lucky to have a Governor who relies on science and commonsense to lead, he has saved many lives with his precise directions.

Please don’t quit while we are ahead.

Our hospitalization numbers and deaths are down even though in 19 states the number of cases are still increasing. Currently Maryland has 902 people in hospital of which 358 are in ICU. Nationally there have now been in excess of 112,000 deaths.

Even though things are ‘opening up’ please be cautious and don’t go overboard. Just because you can sit inside in restaurants now doesn’t mean you need to.

Buyer beware! Your nails can wait another two weeks

Taste and Smell in Covid, not an old wives' tale!

Not an old wives' tale after all!

I had previously mentioned that loss of taste and smell were symptoms of Covid-19 based on clinical observations but a report in the Harvard Gazette this week confirms that these are significant predictors of the disease.

A recent collaborative study between Boston and London in which 2.6 million people used a smartphone app to log their symptoms daily showed that these odd symptoms — loss of smell and taste — was one of the best predictors, and one that scientists said should be including in screening guidelines.

They found that loss of taste and smell were reported by most of those tested, about 65 percent, and that the most predictive group of symptoms was loss of smell and taste, fatigue, persistent cough, and loss of appetite.

Also interesting is that this can occur up to 5 days before the onset of other Covid symptoms like fever.

Show seniors some love. Let's protect them from Covid-19

People in their 80's are 10 times more likely to die from Covid-19 than people in their 50's. Why? No its not just because 'they are old'. They do have a weakened immune system because of age but it can be strengthened by simple measures. Here is my "Senior Script". please follow it for any seniors that you care about. P.S Remember they need quality sleep.
This video discusses my recommendations. Please share with those who take care of and care for the elderly. Please do your part.

https://youtu.be/72YOFkzDeaM

Are we there yet? (AKA: Stop in the name of love!) Can you get Covid twice? Why do seniors die at higher rates with Covid?

Here are three VERY short videos about important topics.

The title may sound a little jovial but it is only an attempt to brighten the dark cloud we are under. Nothing can lift it as fast as taking this whole thing seriously and doing your part. Right now that includes staying home.

54 more Marylanders lost their lives yesterday (RIP). The worst hit counties are Montgomery, PG and Baltimore. Still it doesn't matter where, we are we are all connected, the sooner we realize that the better.

Please take a moment to watch the videos and let me know if you have any suggestions or questions. We can get through this but we are not quite there yet.

Here is the link to one. It is called "Are we there yet?"

. 

This video is about Covid-19 infection rates and whether we are ready to 'open up yet'. The real yardstick to determine that would be aggressive testing. Since we don't have that we have to go by the current numbers.

Are we there yet? Nope!

https://youtu.be/K4yFGMWZr5M

Here is a second link about the elderly and Covid

https://youtu.be/1GhHxMxO5eM

As people get older their immune systems weaken but there are lots of other factors that explain why a person in their 80's is 10 times more likely to die from Covid than someone in their 50's.

So why do the elderly die from Covid and how can we change that? Unfortunately, right now many are like sitting ducks.

Can you get infected twice?

Understand how immunity, whether to a vaccine or an infection works and why you can't be too complacent if you have already been diagnosed with Covid-19

Here's the third link
https://youtu.be/sHY6ZORabDs 

If you prefer to just click on the videos they are below.

Look forward to hearing from you

Love,

Dr. Tuakli

Opening up the schools safely after the Covid lockdown

Buyer beware! Bad news for people taking vitamins!

Four things occurred in the last week which gave me cause to think about vitamins and supplements sold over the counter. First, my office manager told me that the vitamin shelves at Walmart were bare. My first response was “Great, At least people are finally taking their vitamins!” I didn’t think much more about it until one of my patients, called to let me know he is Covid positive. He said he had been following all my recommendations and didn’t feel too bad. “That sounds good” I told him “but now we need to increase your zinc, how much are you taking?” He thought was taking ‘zinc’ from Walmart. But despite his best efforts (bear in mind that he is a nurse) he said he could not see from the label how much zinc was in the product. “But it is citrus flavored” he said, which gave me even more cause for concern. He eventually sent someone to get zinc from my office. My comments regarding the research I did on zinc from Walmart are discussed below. It was also very distressing to hear from him that the geriatric nursing home that he works in Baltimore got its first case of Covid two weeks ago. But now 60 residents there have Covid-19 and 15 staff members are out sick with positive corona virus tests. As I was researching the zinc issue I came across a disturbing article about the findings of the New York Attorney General in 2015. In the New York State attorney general’s office report, they accused GNC, Walgreens, Target, and Walmart of selling “fraudulent and potentially dangerous” supplements. Here are a few more disturbing details from that same report: ·      GNC supplements contained ingredients that were not listed on their labels. Some of which are dangerous allergens for certain people, such as peanuts and soybean. ·      A ginseng supplement from Walgreens turned out to be only rice and garlic. ·      Six supplements from Target tested negative for the main ingredient they claimed, they actually contained beans, rice, peas, and carrots.  ·       At Walmart, the authorities found that it's ginkgo biloba, a Chinese plant         promoted as a memory enhancer, contained little more than powdered radish, houseplants and wheat — despite a claim on the label that the product was wheat- and gluten-free.” “The authorities… found that four out of five of the products did not contain any of the herbs on their labels. The tests showed that pills labeled medicinal herbs often contained little more than cheap fillers like powdered rice, asparagus and houseplants". (Reference: https://well.blogs.nytimes.com/2015/02/03/new-york-attorney-general-targets-supplements-at-major-retailers/) According to a Consumer Reports article - in two years alone – manufacturers selling into the US market “…voluntarily recalled more than 80 bodybuilding supplements that contained synthetic steroids or steroid-like substances, 50 sexual-enhancement products that contained erectile-dysfunction drugs, and 40 weight-loss supplements containing appetite suppressant which has been discontinued in many countries.” (Reference:https://www.consumerreports.org/cro/2012/05/dangerous-     supplements/index.htm) So it appears some of the supplements you are buying are anything but the real thing.  Meanwhile…. Back to zinc. Understand there are different kinds of zinc so they can not be directly compared. Be that as it may: More easily absorbed forms include zinc picolinate, zinc citrate, zinc acetate, and zinc glycinate. Zinc gluconate consistently contains the lowest amount of cadmium levels (many zinc products are contaminated with cadmium which can be harmful if you take high levels). Clearly investigative journalism is not my forte but my interest was piqued so I looked up some zinc products at Walmart, on line. The first thing that caught my eye was the Walmart ‘disclaimer’ “Legal Disclaimer Product packaging and material may contain more and/or different information from the website, including the product description, country of origin, nutrition, ingredient, allergen and other information. Always read labels, warnings, and directions and other information provided with the product before using or consuming a product. For additional information about a product, please contact the manufacturer. Then as far as ingredients are concerned. About This Item: We aim to show you accurate product information. Manufacturers, suppliers and others provide what you see here, and we have not verified it. See our disclaimer (The one I copied above). Interesting… So then I looked at a specific product: Wellness Zinc Lozenges and here is what the label says: Wellness Zinc Lozenges by Source Naturals Inc. 60 Lozenges Wellness Zinc Product .The Wellness Family of products are designed to support the body's defense system when under physical stress. Our zinc lozenges are specially formulated to contain the most active forms of zinc. Zinc is a trace element that plays a significant role in the human body. It is involved in normal cell growth and repair and helps support the body's natural defenses. Natural peach and raspberry flavors leave no zinc aftertaste. Source Naturals wellness Zinc lozenges 23 mg ·      Source Naturals wellness family of products are designed to support the body’s defense system when under physical stress. ·      Source Naturals peach raspberry wellness zinc lozenges are specially formulated to contain the most active forms of zinc. ·      Zinc is a trace element that plays a significant role in the human body. ·      Zinc is involved in normal cell growth and repair and helps support the body’s natural defenses. Sounds great! But then under ingredients it says (I kid you not!) Ingredients: Fructose, natural peach flavor, stearic acid, natural raspberry flavor, and magnesium stearate. I’m sorry, did we forget the zinc part that showed everywhere else on your label? The one that sounded really good for the body! Another product which claimed to have 50 mg of zinc said: “Zinc Lozenges are becoming a huge focus for its support of the immune system. Our Lozenges contain almost TWICE the amount of Zinc than the leading national brand”  bologna! Anyway I hope you get my point. It is often hard to find out where the original source material came from (often China) but do not assume because a supplement has a USA address on it that it was made in the USA. Hello Kirkland, anybody home? The FDA requires all products to have an USA address or phone number listed so people have a contact for questions or complaints. My advice: Choose supplements that are “Made in the USA” exclusively and are manufactured in GMP certified facilities. These have a set of regulations enforced by the US Food & Drug Administration that provide for systems that assure proper design, monitoring and control of manufacturing processes and facilities.”  Quality control is a huge part of those systems. To meet the regulations, every raw material is tested for quality and purity before it is ever used, and every finished product is randomly tested to be sure that each pill, capsule, or other form of the product contains exactly what the label says it contains.  If you decide to opt for a retail store, I recommend small, independent apothecaries that have an excellent reputation with knowledgeable staff. Once you find a good one, it can be a huge relief to be able to trust them. When it comes to what you’re putting in your body, we know now more than ever before that it is worth being vigilant. This is an important step in taking control of your health.