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Hurricane María devastated Puerto Rico. Then it caused a blast effect in hospitals on the mainland.

While Puerto Rico is slowly recovering from the destruction of Hurricane Maria in September, hospitals on the continent are grappling with some of the side effects of that destruction. They are struggling with the shortage of intravenous fluids that directly link the damage caused by the hurricane.

Baxter, a leading manufacturer of intravenous fluids and bags, has three factories in Puerto Rico. In an email, a Baxter spokesman said that 10 weeks after the hurricane hit the island, one of its factories in Puerto Rico is still powered by a diesel generator. The other two factories are back in the power grid, but the power is intermittent. Severe damage to roads and bridges is also slowing recovery.

IV fluids such as saline and dextrose are the blood of hospitals. They are needed to administer medications and rehydrate patients. Hospital pharmacies use smaller IV bags to mix medications. But they have become scarce, especially since the hurricane, so pharmacists have relied on larger bags. Now those larger bags are running out too.

On November 22, physicians at Massachusetts General Hospital in Boston received an email urging them to conserve intravenous fluids as much as possible:

"Like some of you, we know that almost all hospitals in The entire country reports a significant shortage of intravenous fluids, although the shortage of intravenous fluids has been intermittent since 2014, the impact of Hurricane Maria in Puerto Rico this fall has exacerbated the situation, given the significant manufacture of medical products. industry on the island that suffered damage Although the initial impact of the shortage of manufactures was limited mainly to the shortage of small volume bags, there have now been side effects that have led to a shortage of "regular" IV liquid bags as the Health systems have had to change their use for these products. "

Email continues, "Now we have reached the point where scarcity is a possible operational concern.

Chris Fortier, chief pharmacy operator at Massachusetts General Hospital, says conservation is key to dealing with shortages.

"Where can we conserve, we will conserve. Let's make sure we're reserving our products for patients for whom we need them, and when we can use other alternatives that are as effective as the product in an IV fluid, let's do that, "he says.

Some substitutions include injecting medications with a syringe when possible, and assess whether a patient can take medication in a pill form, or rehydrate orally.

The FDA is temporarily allowing the importation of IV saline products from Baxter's factories in other countries, but not it is clear how much relief it will provide.

"Every day is a kind of moving target," says Fortier. "Some days we hope to get a product and we do not. Some days we hope to get many products and only get a few. "

In the pharmacy department of Deborah Heart and Lung Center, a small specialized hospital a mile from Fort Dix in New Jersey, there are lots of boxes labeled" Baxter " Deb Sadowski, the hospital's pharmacy director, says that the boxes, filled with small bags of IV fluid, would usually remain in the hospital's central supply, but that she is "hoarding" in the pharmacy department so that The nurses on the hospital floor can often use a larger bag, for example, to rehydrate a patient, while the pharmacy needs smaller bags to mix medications, he says. 19659003] "It's like stealing Peter to pay Paul, as they say," says Sadowski. "Everything goes for the same good cause … making sure we have what the patient needs."

FDA, there has been a shortage of intravenous fluids intermittently since 2014 for a variety of reasons, but nothing like this. In November, the American Hospital Association sent a letter to Congress declaring that the US health system. UU He was "on the verge of a major public health crisis."

"I think he's about to reach critical mass in the next week or two," Sadowski says. "There is simply no more to have and you can only go so far with your conservation methods, we are all doing everything we can do."

Pharmacists are also concerned that the effects of Hurricane Maria do not stop with intravenous fluids. Puerto Rico produces more pharmaceutical products for the continent than any of the 50 states and more than any foreign country, according to an economic analysis by the FDA published in November. Anti-cancer drugs and anti-HIV drugs are among the products manufactured on the island still devastated.

Fortier says it is difficult to prepare for a potential shortage because the FDA does not require companies to disclose where their drugs are made.

"There are other plants in Puerto Rico that manufacture drugs, and those products are scarce, we do not know," says Fortier.

Hospitals say that patient care is not compromised, but they do not expect the shortage to disappear until at least next year.

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