In the midst of what health officials say is shaping up to be the worst flu season in nearly a decade, three of the region’s largest hospital systems are struggling to provide intravenous (IV) bags for incoming patients.
The bags, which are used to administer fluids and medications, have been in short supply since Hurricane Maria’s devastation of Puerto Rico in September, according to the U.S. Food and Drug Administration. The storm not only knocked out the island’s electrical grid but also damaged a number of manufacturing facilities responsible for the production of IV bags.
“If we can’t support patients coming in emergency rooms who have the flu, more people are going to die,” Deborah Pasko, director of medication safety and quality at the American Society of Health System Pharmacists, told the Associated Press. “I see it as a crisis.”
The shortage comes amid a spike in flu cases, both in South Carolina and nationwide. This year’s flu season is particularly intense due to a mutation of the virus that made the original iteration of the flu vaccine less effective, according to the Centers for Disease Control and Prevention.
The S.C. Department of Health and Environmental Control reports that the flu is widespread throughout the state, with more than 81,000 confirmed cases since October. Greenville County currently leads the state, with more than 3,000 cases of the flu reported last week.
The flu season lasts from October to May, but usually picks up during the winter months, according to the CDC. Those at highest risk include people 65 and older, people with chronic medical conditions such as asthma or heart disease, pregnant women, and young children.
Symptoms of the flu include a sudden onset of fever, dry cough, sore throat, headache, muscle aches, fatigue, and nasal congestion, according to the CDC. Most people recover in a few days to two weeks, but some develop pneumonia and other complications that require hospitalization.
[infogram id=”ef2c38ef-eb27-4f11-8df7-c39fe969e321″ prefix=”6iO” format=”interactive” title=”South Carolina Flu Rates 2012 to 2017″]
Officials at hospitals across the Upstate emphasized that the national shortage of IV bags has not yet affected their ability to treat patients, but has in some cases changed the treatment methods.
The Greenville Health System, for instance, has limited the use of IV bags at its eight inpatient hospitals since November, according to John Pearson, director of pharmacy services. “We have been closely monitoring the situation to ensure that we proactively take the necessary steps to minimize our patients from being impacted,” he said.
GHS typically uses more than 10,000 small-volume IV bags a month to administer antibiotics and other medications, according to Pearson. But to conserve resources, the health system is requiring nurses and physicians at all inpatient hospitals to deliver medications into a patient’s bloodstream via syringe or administer oral medications when they can.
Spartanburg Regional Healthcare System, which owns and operates Pelham Medical Center in Greer, has managed the shortage since October through the use of oral medications, continuous drug infusions, and alternative fluid options, according to Dr. David Church, vice president of oncology and support services.
Anderson-based AnMed Health has adapted to the ongoing shortage by switching patients to oral therapies when possible, stopping IV therapies when patients no longer need them, directly injecting medications rather than delivering them via IV whenever possible, and identifying alternative suppliers, according to spokesperson Kari Lutz.
“We have begun to see our inventory levels return to normal in recent days, and are hopeful that we are nearing the end of the shortage,” she said.
Bon Secours St. Francis Health System, which operates a number of inpatient hospitals and outpatient facilities throughout the Upstate, did not respond to multiple interview requests before time of publication.
The Food and Drug Administration expects the shortage of IV bags to improve in the coming months as more and more manufacturing facilities are restored to full capacity and connected to Puerto Rico’s power grid.
Numerous pharmaceutical companies, including Baxter International Inc. and B. Braun Medical Inc., have already resumed production, according to the FDA. But they must first clear their backlog of orders.
In the meantime, the FDA is working with pharmaceutical companies to extend the expiration dates on critical drugs and temporarily permit the import of IV products from facilities outside the United States. Baxter, for instance, has been shipping IV bags from its facilities in Ireland, Australia, Canada, Mexico, Brazil, England, and Italy since October.
Others, however, are calling on the federal government to develop a more comprehensive strategy to prevent future shortages.
In November, the American Hospital Association and five other trade groups addressed a letter to the House Energy and Commerce Committee, arguing that the production of medications and supplies is too dependent on manufacturing facilities in Puerto Rico.
“Congress should examine how the pharmaceutical industry communicates information about what drugs are manufactured at which plants and where those plants are located. To date, no state or federal law requires that this information be disclosed,” the letter reads.
“This lack of transparency puts health care systems at a significant disadvantage when trying to take a proactive approach to handling a potential drug shortage. The current system results in a reactive approach, which is usually short-notice and has a rapid downstream effect, leaving hospitals at a loss to meet patient needs.”