Asa Kitfield usually purchases the intravenous saline fluids that his company NutriDrip offers to hangover sufferers and “wellness”-seekers from wholesale medical supply companies.

But when Hurricane Maria struck Puerto Rico last September – wiping out the electrical grid and crippling one of the United States’ only manufacturers of IV fluids – Kitfield’s sources ran dry.

“That was a nightmare,” Kitfield said. “We actually lost a lot of money during that period.” He ended up turning to medical supply resellers, paying as much as a 600% markup for the sterile bags of saline solution that play a critical role in modern medicine.

But what worked for Kitfield and his affluent customers is not an option for the country’s entire healthcare system, which has been hobbled by a nationwide shortage for months now.

“Hospitals don’t have the money to pay that kind of markup,” said Erin Fox, director of the University of Utah’s drug information service, where she tracks and studies drug shortages.

The University of Utah’s hospital usually goes through about 800-1,000 “mini-bags” of IV fluids every day. Since the shortages began, Fox said, they are struggling to get by with less than half that.

“We’ve seen some pretty terrible shortages,” said Fox. “This shortage proves that things can always get worse … It affects every single medication that we are giving in our hospital.”

Mini-bags of IV fluids are ubiquitous in hospitals, where they are used to dilute and administer medication. There are only a handful of manufacturers in the US, and one of them – Baxter International – has all of its mini-bag factories in Puerto Rico. As of 4 January, electrical power had been restored to just 58.1% of Puerto Ricans, and some parts of the island are expected to remain dark until May.

Though the federal government has worked with Baxter to get the plants back online, and to allow it to import IV fluids from abroad, serious shortages persist.

“It really doesn’t speak very well to our healthcare system at this point,” said Dr Rita Jew, director of pharmacy at the University of California San Francisco’s Mission Bay hospital. “A lot of people are referring to this like it’s almost like we’re in a third world country, and there’s some truth to that. These are basic supplies that we have taken for granted. It’s kind of like we’re rationing water in the US.”

A home under reconstruction, after being mostly destroyed by Hurricane Maria, in San Isidro, Puerto Rico. Photograph: Mario Tama/Getty Images

Most hospitals have resorted to administering medications through “IV push”, a procedure that requires a nurse to inject the drugs directly into an IV line. The change in procedure has been “frustrating and stressful for nurses”, said Cathy Kennedy, a staff nurse and union representative at a Kaiser hospital in northern California.



“Nurses can’t quickly push these medications,” the 39-year nursing veteran said. “It could cause harm to the patient … Can it be done? Yes. But in order for it to be safe, then you have to look at your manpower.”

At UCSF, Jew’s team decided that an old-fashioned system known as a buretrol device would be “more efficient and safer” than IV pushes. Most hospitals haven’t used buretrols in over 10 years, Jew said, so younger nurses are learning the procedure for the first time.

Both the government and Baxter continue to assure the public that they are working hard to return to normal supplies, but in the meantime, hospitals can’t put patients on pause while they wait.

Jew is keeping an anxious eye on the progression of flu season, which is just beginning and has already killed 27 people under the age of 65 in California.

“I have been in practice for 27 years,” Jew said, “and this is the worst shortage we’ve ever had.”