By otakuyassine3@gmail.com 
Hospitals across the country are struggling to conserve and stretch their supplies of IV fluids in the wake of a shortage brought on by Hurricane Helene, in some cases giving patients Gatorade instead of IVs and warning the issue could lead to delays in elective medical procedures in the near future.
A Baxter facility in North Carolina that produces more than half the nation’s IV solutions was forced to close after Helene, while Hurricane Milton is now bearing down on Florida, where a plant owned by B. Braun, the nation’s second-largest supplier of IV solutions, is located in its projected path.
The episode is the latest in a series of weather disruptions that demonstrate just how fragile the nation’s medical supply chain is. Several medical manufacturing plants in the southeastern U.S. and Puerto Rico have been damaged by tornadoes and hurricanes in recent years.
“Our members are already reporting substantial shortages of these lifesaving and life-supporting products,” the American Hospital Association said in a letter sent to President Joe Biden on Monday, asking the administration to invoke the Defense Production Act to expand production.
The U.S. Department of Health and Human Services (HHS) on Wednesday released a letter saying it was coordinating a U.S. government-wide approach to address disruptions, including having the Food and Drug Administration consider options to increase supply, including granting shelf-life extensions for existing products and temporarily allowing the importation of IV fluids from foreign manufacturers. The Administration for Strategic Preparedness and Response “has identified the possibility of Hurricane Milton further disrupting an already fragile market,” the letter said.
The HHS letter urged hospitals to compound, or mix their own fluids, as one way to temporarily ease the shortage. It also said that Baxter had ended a shipment hold it had placed last week, was resuming up to 60% of its shipments of fluids to hospitals and dialysis providers, and was scaling up production at its other facilities with hopes of increasing allocations.
The situation has left patients who rely on fluids for at-home peritoneal dialysis and IV-nutrition worried about what they will do when their personal medical supplies run out. Providers who oversee care said they were triaging supplies to make sure the sickest patients were cared for and said they were concerned what they would do if supplies tightened further in coming weeks.
The recently flooded Baxter facility in North Cove, North Carolina, about 35 miles east of Asheville, provides more than 60% of the nation’s IV solutions, irrigation fluids, and peritoneal solutions for dialysis. The HHS letter noted that many of these IV fluids were in short supply before the recent spate of hurricanes — an issue many analysts attribute to weak interest among manufacturers in providing low-cost medical supplies.
In an update Wednesday, Baxter said it hoped to get its North Cove plant back up and running by the end of the year but also hoped to provide normal levels of supplies sooner by importing products from its other facilities, including those overseas if that is approved by the FDA. Officials said the facility had not sustained any structural damage and that a temporary bridge to replace one that had been washed out by flooding was being constructed so that supplies could be shipped out.
Baxter officials took the unusual step of adding that they had seen a large amount of misinformation about supply issues that was frightening patients. “We are disheartened to see blatant speculation fueling patient and customer concerns,” the letter said.
On Wednesday, the nation’s second largest supplier of IV solutions, B. Braun, closed its facility in Daytona Beach before Hurricane Milton hit, with officials saying they hoped to reopen on Friday and ramp up production. Workers there spent Tuesday loading IV bags onto trucks so they could be driven to a safe location out of Milton’s path, said Alli Longenhagen, director of corporate communications for the country. The company was also increasing production at its plant in Irvine, Calif., she said.
Hospitals around the country are closely watching the situation. Mass General Brigham warned in an internal email to employees last week that it had only received 40% of its usual IV supply from Baxter, and the Florida Hospital Association is sending regular situation updates to member hospitals. At Keck Medicine of USC in Los Angeles, officials said they had adequate supplies but were “proactively implementing conservation strategies” because of the dynamic nature of the situation. Cleveland hospitals also reported all patients who needed IVs were receiving them and that medical procedures were continuing, but that they were actively monitoring the situation.
A handful of hospitals, including Alina Health in Minnesota, reported they were temporarily rescheduling some non-emergency procedures. Hospitals Main Line Health, a hospital chain in Philadelphia, were giving less critically ill patients Gatorade and other electrolyte solutions to drink in lieu of hanging IV bags, hospital officials told the Philadelphia Inquirer. Other hospitals in the city were conserving supplies by giving some patients medicine orally instead of via IV drips. A number of hospitals that did not have Baxter as their main supplier said they were nonetheless monitoring their supplies, especially given the possibility of Hurricane Milton creating more shortages.
The U.S. is no stranger to disruptions in the medical supply chain due to natural disasters. In July, 2023, a tornado tore the roof of a Pfizer pharmaceutical plant in North Carolina that produced a quarter of the nation’s sterile injectable drugs, but the company was able to resume production about 10 weeks later. In 2017, Hurricane Maria knocked out three Baxter IV-bag producing plants in Puerto Rico, leading to hospital shortages, temporary rationing, and some resellers marking IV bags up by 600%.
Because of these issues, the American Society of Health-System Pharmacists has a standard set of recommendations for how hospitals, clinics, and dialysis providers can conserve fluids, from not “pre-spiking” IV bags before surgery in case they are needed, using smaller volume bags when they will suffice, and leaving IV bags hanging for longer durations, as long as infection control and monitoring is in place.
With drug and supply shortages of all types on the increase, Congress last year held four hearings on the issue. Erin Fox, associate chief pharmacy officer at the University of Utah, has tracked shortages for two decades and said she thinks Congressional action is needed. She sees no quick fixes to the longstanding problem of too few manufacturers producing drugs — or being able to pick up the slack when one plant suddenly goes offline due to a weather event or, in the case of last year’s chemotherapy drug shortage, is closed because of quality control issues.
Congresswoman Debbie Dingell of Michigan is among those urging HHS leaders to strengthen the supply chain. She wrote in a letter to the agency: “This supply chain disruption is a grave reminder of the interconnection of our government and society.”
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