A shortage of saline was already an issue in US hospitals. Now the country is teetering on "the brink of a significant public health crisis," per a letter earlier this month from the American Hospital Association to Congress. It all comes down to a problem with the bags that hold the salty solution, as a trio of manufacturers face various issues and the industry faces a DOJ criminal probe for possible price-fixing and collusion. Per Bloomberg, the FDA is on the case of a major manufacturer, B. Braun Medical, for reportedly "leaky and moldy" IV bags, while another bag-maker, ICU Medical, struggles to meet demand. But it's the largest supplier of the bags, Baxter International, that had power to its Puerto Rico plants knocked out by Hurricane Maria. Per NPR, all three of its factories there were temporarily down after the storm; the company tells Bloomberg one site is still not up and running.
Per FDA stats, Puerto Rico churns out $40 billion in pharma supplies for the rest of the US via its 100-plus drug and medical device makers. "I can't believe that one plant in only one place makes so much of a critical product that every hospital needs to function," says a University of Utah Health drug expert. One of the Baxter factories in particular is in a "very remote" location on top of a mountain with limited road access making it harder to bring things back to normal, per NPR. For now, stopgap measures include makers rationing out bags they're able to make, as well as importing bags from overseas, and hospitals cutting down on the number of patients who get a saline solution bag. "I find it shocking that in the richest country in the world we run out of fundamental, basic supplies," an oncology nurse says.