The flu is on a tear, and a shortage of IV fluid bags tied to a hurricane in Puerto Rico three months ago is forcing hospitals in the Kansas City area to get creative in treating it.
Ongoing power outages following Hurricane Maria have crimped production at a plant that manufactures about half of the small IV bags in the United States.
Across the country, hospital officials, pharmacists and other staff have been devising alternatives and workarounds, training doctors and nurses on new procedures and options, and hitting the phones to try to secure fluid bags from secondary suppliers.
“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 Kansas City and nationwide.
The Kansas City Health Department reported 655 laboratory-confirmed cases of influenza in the week leading up to New Year’s Day, as compared to 456 the week before and 293 the week before that.
“We’re seeing the rapid influx,” health department spokesman Bill Snook said. “Flu is here.”
Reports of flu-like symptoms are much higher than lab-confirmed cases.
The Missouri Department of Health and Senior Services reports that flu is now widespread throughout the state, with almost 31,000 suspected cases since the season began. The Kansas City area is experiencing its worst early flu season since 2014-2015, while the St. Louis area and the southeast side of the state are reporting rates that outstrip even that year.
HCA Midwest Health said flu cases at its six hospitals in the Kansas City area were up 34 percent in December 2017 as compared to December 2016. The chain then treated 245 cases of flu in the first five days of 2018, compared to 150 in the first five days of 2017.
Lougene Marsh, the director of the Johnson County Department of Health and Environment, said a preliminary review of death certificates and cremation permits by the county coroner “indicate an increase in the number of flu and pneumonia related deaths for this time of year.” That’s comparable to what the Centers for Disease Control and Prevention is seeing nationally.
“The best way to protect yourself from the flu and its complications is to get a flu shot and wash your hands frequently,” Marsh said.
The flu vaccine is believed to be less effective against this year’s dominant strain than in years past, but health officials say it’s still providing some protection and is worth getting.
Sporadic shortages of Tamiflu, a prescription antiviral used to treat flu symptoms, have been reported in some areas. The CDC says “most manufacturers have stated they have sufficient product on hand to meet projected demand for the 2017-2018 flu season” but advises patients to call their pharmacies in advance to make sure it’s in stock.
Officials at hospitals in and around Kansas City emphasized that the national shortage of IV bags has not yet hampered their ability to treat patients, but has in some cases changed the treatment methods.
Lester McCrae, the pharmacy purchasing coordinator for the University of Kansas Health System, said he has switched back and forth between different saline formulas, depending on what’s most readily available.
“There has been some shuffling,” McCrae said.
Joel Hennenfent, the assistant director of pharmacy at Truman Medical Center, said his hospital has used more small glass vials to mix medications and then inject them directly into veins, or “push” them, rather than add them to IV fluids and infuse them into patients with a slow drip.
“Other alternatives are using oral fluids in patients who can tolerate those and making sure they have all the clinical support they need,” Hennenfent said. “I don’t think our patients have noticed any difference in their care. I think that’s what’s important.”
Susie Law, the vice president of clinical operations for HCA Midwest, said it has coped with the IV bag shortage by tracking all potential sources of supply and using alternative fluid options when needed. Law said patients are receiving the care they need, but the supply chain issues are real.
“The recovery from Hurricane Maria has been slow and other IV fluid manufacturers not impacted directly by the storm have received a significant increase in requests and orders for product, causing their supply to deplete due to rising demand,” Law said.
Most flu cases can be treated with rest and fluids and don’t require hospitalization. But some cause breathing problems, including pneumonia, and can be fatal. Children, the elderly and people with weakened immune systems are particularly vulnerable.
Officials from Shawnee Mission Health said they are also treating a lot of flu this year, but they’ve been able to handle it, and from their perspective the IV bag shortage appears to be getting better than it was a few weeks ago.
But officials from St. Luke’s Health System and Olathe Health said they aren’t expecting the problem to go away in the next few months.
“We are well aware supply shortages will continue to be a challenge,” Olathe Health spokesman Mike Jensen said. “However, we have adjusted effectively and are well prepared for flu season.”
McCrae and Hennenfert both said the IV bag shortage is a symptom of much more widespread problems within the United States’ medical supply chain.
Too many medications and supplies are heavily dependent on a few manufacturers, or even just a few manufacturing facilities, they said. If just one closes due to a natural disaster, or something more mundane like a negative inspection by the U.S. Food and Drug Administration, it can force health care providers to improvise.
“It’s something we’re definitely used to doing, unfortunately,” McCrae said. “Shortages have been going on forever and they’ve gotten really bad throughout the last 10 years. They get worse every year.”
Hennenfert said IV bags are one of 183 shortages the American Society of Health System Pharmacists is currently tracking on a website that also offers workarounds pharmacists can use when they can’t get a certain product.
The group is working with the FDA on solutions to shore up the supply chain, but in the mean time McCrae said the nation’s health care system is vulnerable.
“With the way things are going now, this would definitely be a horrible time for a pandemic,” McCrae said.
This article includes information from the Associated Press.