A nationwide shortage of IV fluid and dialysis products has significantly worsened due to damage at a Marion, McDowell County manufacturing facility caused by Hurricane Helene with no immediate end in sight.

According to a press release on the company’s website, heavy rain and storm surges triggered a levee breach, which allowed water to permeate Baxter International’s North Cove facility, prompting it to close. Bridges accessing the site were also damaged.

With its international headquarters in Illinois, the North Cove site is the company’s largest manufacturing facility, with over 2,500 employees. The site primarily manufactures intravenous and peritoneal dialysis solutions and is the largest manufacturer of the solutions in the United States.

The American Hospital Association (AHA) said the plant produces 60% of the nation’s supply of IV solutions, or 1.5 million bags per day. 

The group has asked the Department of Health and Human Services (HHS) to declare a public health emergency to allow waivers of Medicare and Medicaid rules and wants the Food and Drug Administration (FDA) to declare a national shortage of IV solutions, which would extend solutions’ expiration dates and speed approval processes for finding international manufacturers.

North Carolina Republican Congressman Greg Murphy, NC_03, also concurred with the AHA about declaring an emergency.

AHA also wants the Biden administration to leverage the Defense Production Act, which could allow other companies to produce the fluids and bags more quickly. 

In a letter to healthcare officials Wednesday, HHS Secretary Xavier Becerra noted that there are currently shortages of normal saline IV fluids, normal saline irrigation fluid, sterile water irrigation, and dextrose 5% IV fluids that pre-date Hurricane Helene and the hurricane-related supply disruption at the Baxter facility will likely lead to further constraints for IV fluids.

Hospitals across the country, like UNC Health, are closely monitoring the national shortage of IV fluids and are taking steps to help alleviate the impact.

“Many hospitals in North Carolina and across the country are having to postpone and reschedule non-emergency surgeries and procedures that require specific fluids,” Alan Wolf, director of News and Media Relations for UNC Health told Carolina Journal in an emailed statement Thursday.  “UNC Health is employing conservation efforts, seeking alternative products and working to ensure that urgent patient care is not affected. We are postponing some elective, non-emergent surgeries starting this week until the situation is resolved.”

He said their clinical teams will work with any affected patients to reschedule their procedures. While they understand this is concerning for their patients who had planned on having surgery to help with a medical condition, Wolf said they are doing everything within their control to get these cases rescheduled as soon as possible.

The Daily Mail reported that Dr Paul Biddinger, Mass General’s chief preparedness and continuity officer, told reporters the hospital system is implementing conservation measures to save its supply of IV fluids, including giving patients Gatorade and plain water instead of IVs to rehydrate them.

Becerra said, however, that compounding of drugs on the U.S. Food & Drug Administration (FDA) shortage list can be done in accordance with current requirements to help alleviate shortages. But, in the coming weeks, supply may continue to be constrained.

Baxter said in a press release Wednesday that as they look to fully resolve manufacturing operations at their North Cove facility, they are increasing allocation levels of their highest-demand IV fluids for longtime direct customers from 40 to 60% and for distributors from 10 to 60% effective Oct.9. This increase is based on the company’s efforts to increase manufacturing capacity at its other sites across the world and assessment of when products will arrive.

Also, due to the vulnerability of the patients they serve, allocations for IV solutions and nutrition products for designated children’s hospitals were increased to 100%.

The company said allocations help limit stockpiling and increase the likelihood of equitable access to available products.

In addition, they are increasing high-concentration dextrose and sterile water for injection allocations and expect to be able to make additional increases for certain product codes by early November. They also continue to deliver supplies to current peritoneal dialysis patients.

The company said its goal is to restart production at the North Cove facility in phases and return to 90 to 100% allocation of certain IV solution product codes by the end of the year.

In the meantime, HHS said it is working with public and private partners to support the supply chain while the Baxter facility is brought back to full operational capacity, adding that the Administration for Strategic Preparedness and Response (ASPR) is providing technical assistance and support to increase manufacturing at other domestic sites where possible.

ASPR has identified the possibility of Hurricane Milton further disrupting operations. It is currently pre-deploying assets to prepare broadly for its impacts and working to move product away from the projected path of this next potentially catastrophic storm.