US races to replenish storm-ravaged supplies of IV fluids in hospitals

U.S. officials are scrambling to authorize airlifts of IV fluids from overseas manufacturing facilities to ease shortages caused by Hurricane Helen, which has forced hospitals to suspend surgeries as a way to supply rations to the most fragile patients.

Current shortages occurred when floods swept through western North Carolina and damaged a Baxter plant, which is now closed for cleanup. The plant supplies about 60 percent of the fluid in the United States that is used in IVs, for home dialysis and for those who rely on IV nutrition. They include premature babies in intensive care and patients dependent on tube feeding for survival.

With Hurricane Milton hitting Florida, the situation could become even more dire. Tuesday, B. Workers at Brown, the maker of a quarter of the nation's fourth-generation fluids, loaded trucks with medical bags at the company's plant in Daytona Beach and drove them north through the night to what they hoped would be a safer location.

Baxter plant in Marion, NC and B. of Daytona Beach. Brown sites produce about 85 percent of the nation's IV fluid supply. Shortage experts have long pointed out the risks of such over-concentration of critical supplies, citing exposure to disasters now at hand. Even before the latest storm, supplies were tight and reflect a chronic problem of how few companies are willing to produce critical but low-cost and low-profit medical products.

A spokeswoman for the B. Braun site in Florida said the company is working with federal officials and that plant workers will stop work Wednesday and plan to return Friday after the hurricane passes.

A supply crunch caused by flooding at the Baxter plant led hospital customers this week to limit 40 to 60 percent of their normal supplies. The American Hospital Association wrote to President Biden on Monday, asking for help addressing concerns about “substantial shortages of these life-saving and life-supporting products.”

The saline, dextrose and sterile water fluids that the Baxter plant produces have myriad uses in health care: they provide initial hydration before surgery or delivery, and can be mixed with nutrients and drugs, including chemotherapy. They are widely used in life-support infusions for premature babies. Some are crucial for treating sepsis, a life-threatening blood infection.

“When you're coming down with sepsis and especially septic shock, those one-liter bags are the most immediate treatment, and sometimes you're drinking two, if not three, of them in rapid succession,” said Dr. Chris DiRienzo, chief physician executive of the American Hospital Association. “There are so many special populations affected by scarcity, it really affects the entire population.”

Patients who depend on Baxter's fluids for dialysis treatment at home and who depend on IV nutrition to survive have been particularly hard hit by the shortage, doctors and patients said in interviews.

Federal officials and some Baxter staff members worked nights and weekends to minimize the impact of supply disruptions. The Food and Drug Administration is reportedly on track to approve temporary imports of IV, dialysis and liquid nutrition products from several foreign sites.

In North Carolina, crews are working to rebuild a bridge adjacent to the Baxter site to move and deliver truckloads of additional supplies that were not damaged by the storm.

Baxter said in a statement Wednesday that its overseas plants are ramping up production and are expecting FDA approval to export their products. In terms of expected deliveries, the company said it would increase its supply release on Wednesday to 60 percent of normal levels from 40 percent delivered earlier this week. The company's statement said it plans to resume production in phases by the end of this year. Baxter said it is not releasing an estimate of when the plant will be fully operational.

“We will spare no resources — human or financial — to help restart operations and ensure patients and providers have the products they need,” Baxter Chief Executive Jose Almeida said in a statement Wednesday.

For patients like Hannah Hale, 37, who lives in the Dallas area, help can't come soon enough. Ms. Hale learned Monday that her specialty pharmacy could not get enough of the highly concentrated dextrose solution she was relying on to continue giving her IV fluids.

Ms. Hale was sedated by IV fluids for eight years, she said, after extensive surgery for Crohn's disease, a condition in which the immune system attacks the digestive system.

“They're not supposed to dump me just like that,” she said, adding that calls to 14 other pharmacies didn't turn up a backup source. “I have no choice.”

Texas Health, a large health system in North Texas, said it could not comment on patient-specific cases, but that it “proactively implemented IV fluid conservation measures” due to storm-related shortages.

After The New York Times sent questions to Ms. Hale's health care provider, the provider could help her and add some shelf-stable nutrients she had on hand to the saline, a stopgap measure. He said his last bag of standard IV nutrition would only last until Wednesday.

Another big hit is the estimated 100,000 people who infuse fluids, including Baxter's, for home dialysis. These patients need special fluids to clean the blood when their kidneys are not working.

According to William Poirier of the Renal Healthcare Association, the North Carolina plant was among the largest U.S. manufacturers of the fluid for home dialysis.

In the Chicago area, doctors and nurses at Northwestern Medicine are working to provide fluids for about 90 patients undergoing dialysis at home. Dr. Vikram Aggarwal, Medical Director of Home Dialysis Program, said that no new patients can be added now.

“We're triaging; We are trying to risk-stratify,” he said. “One to two more weeks with this deficit, it could be a concern.”

In a letter to health care providers posted Wednesday, Health and Human Services Secretary Javier Becerra said about 400 agency workers are helping communities in the Southwest devastated by Hurricane Helen.

Mr. Becerra said the department has been working with Baxter since Hurricane Helen tore through the area to ensure the safety of the company's workers and address supply shortages.

“My department is committed to mitigating the effects of Hurricane Helen and doing everything we can to prevent further disruptions from Hurricane Milton,” Mr. Becerra's letter said.

If federal officials' plans work out, concerns could be alleviated with more resources.

Top officials at the Department of Health and Human Services and the FDA have had a lot of experience dealing with medical supply shortages in recent years. Deep gaps in adequate supply were evident during the Covid pandemic, when nurses wore garbage bags as protective gear and automotive companies produced ventilators.

In 2023, shortages of cheap chemotherapy drugs cut off supplies in the late spring and early summer, triggering a global scramble for back stocks and new suppliers. Just over a year ago, a tornado tore off parts of the roof of a Pfizer plant in North Carolina, causing yet another shortage of generic drugs.

High-stakes shifts in critical supplies have become the new routine as increasingly powerful and unpredictable storms upend strained medical supply chains. The current IV shortage reminds many hospital workers of a similar outage after Hurricane Maria in 2017, when a Baxter plant in Puerto Rico stopped making IV fluids.

And this episode aligns with experts' list of factors that increase patients' risk of attrition: products are cheaper, giving some suppliers an incentive to make competing products. Given the sterility requirement, the barrier to entry in the field is high. And product concentration adds another risk factor, with 60 percent supplied from a US site.

Tom Cotter, executive director of Healthcare Ready, a nonprofit founded after Hurricane Katrina, said it's unclear whether lawmakers and other officials will learn from the series of crises.

“We haven't seen a really big increase in investment in resilience from government to strengthen our supply chain,” Mr Cotter said.

He added, “Storms are reaching areas where they have never been before. “There is a need to expand the scope of what we perceive to be vulnerabilities in our medical supply chain.”