Saline—that basic mixture of sodium chloride in water many of us encounter in our contact solution—might be the simplest pharmaceutical at any hospital. It might also be one of the most difficult to find these days. In the wake of Hurricane Maria—which decimated Puerto Rico, where much of America’s IV solution is produced—hospitals across the country, including those in the Denver area, are facing severe shortages. Along with many lives and crucial infrastructure, the Category 4 storm’s 155 mph winds damaged the island’s substantial life-science manufacturing industry, including two Baxter International production facilities. Those two factories account for nearly 50 percent of the U.S. small-volume IV-solutions market, including mini bags and tubing. The resulting shortfall—both of the solution and the packaging—has presented a challenge for local hospital pharmacists, who dispense saline for just about everything: hydrating patients before and after surgeries; diluting certain drugs; delivering medications through IV drips; irrigating surgical incisions in the operating room; and operating on organs like the bladder, uterus, and certain joints.
With any critical deficit, when one drug runs out hospitals race to secure an alternative, explains Joshua Schwiesow, pharmacy business manager at Denver Health. “But then the alternative is gone just like the hot toy at Christmas,” he says, adding that saline has very few substitutes. “So everyone scrambles.” That hustle often entails reaching out to wholesalers to find newly available supply channels, mixing alternatives in-house, and training hospital staff about how to conserve saline where possible—along with hoping production at Baxter, whose two plants began operating at pre-hurricane levels in January, can quickly overcome the backlog. Industry experts, however, don’t expect that to happen before fall. If those measures fail, hospitals will likely begin postponing elective surgeries. In the meantime, Schwiesow and other pharmacists across the country will take up another mantle, as amateur meteorologists keeping a weather eye on the Atlantic Ocean: Hurricane season begins this month.
Correction. In the original version of this story, we reported that Baxter’s Puerto Rican factories reopened in January; they actually opened earlier than that but came up to full-scale production in that month. Baxter also does not produce syringes in Puerto Rico. We regret the errors.