| IV fluid supplies across the US will likely remain unstable until early December, forcing more hospitals to adopt conservation measures to combat shortages as the federal government tries to police cases of price gouging. After Hurricane Helene came ashore in Florida in late September, heavy rains caused widespread flooding across the Southeast. Among the businesses that suffered catastrophic damage was Baxter International's North Cove operations in Marion, North Carolina. The facility accounts for about 60% of intravenous fluid solutions for American hospitals. "It is a massive hole in the supply chain," Chris DeRienzo, chief physician executive at the American Hospital Association, said in an interview Friday. "We know that patients are experiencing an impact from it and we can expect them to continue to experiencing that impact for the coming weeks." Faced with a sharp drop in available shipments, hospitals and dialysis clinics have been forced to conserve IV bags by postponing elective surgeries and offering alternatives like oral hydration. Imports from Europe and China are also being flown in, but officials say it's still a tight situation. "The intensity required to manage through the shortage still remains very high," DeRienzo said. Read More: IV Shortage Exposes Drugmakers' Climate Risks Baxter is posting regular updates on its website as North Cove recovers gradually. The latest update, dated Oct. 31, says a key production line has restarted and that the earliest shipments from the facility will happen in late November — ahead of original estimates.  Debris from damage caused by hurricanes Helene and Milton in Florida. Photographer: Tristan Wheelock/Bloomberg For IV fluids, the medical community realized well before Covid that concentrated supply chains are vulnerable. In 2017, Hurricane Maria damaged many medical manufacturing plants in Puerto Rico, including Baxter's, leading to a shortage of different IV medicines. The pandemic reinforced and broadened the lessons learned: that supply chains stretched across the world pose vulnerabilities, prompting politicians to promote friend-shoring and near-shoring as ways to improve resilience. 'Right Next Door' But the current IV crunch illustrates that even goods produced almost entirely at home can encounter unpredictable problems ranging from natural disasters to cyber attacks. "Five years back people were talking about how everything's abroad," said Vijay Mohan, vice president of industry solutions and global life sciences leader at Dallas-based o9 Solutions, whose software helps identify supply disruptions and forecast demand. "Here's an example where it was happening right next door but we got impacted." Read More: US Doctors Run Low on IV Fluids After Hurricane Helene Mohan said mapping the supply chain, scenario-planning, and both geographic and producer diversification are going to be critical to minimize these kinds of issues in the future. "Single-sourcing is the biggest risk here," he said. Mike Schiller, executive director of the AHA's Association for Health Care Resource & Materials Management, said that by the first week of December, there should be "a more stabilized environment where hospitals will begin to see a more consistent delivery of the allocations that Baxter has been discussing." He said products arriving from Europe are similar to what's usually available in the US. The inventory that's imported from China has different labeling and comes with some different instructions, so they're getting shipped to dialysis centers rather than into the wider hospital supply chain. Schiller also said they're seeing "grey market manufacturers'' offer pricing that is "significantly higher" than the rates that hospitals typically pay. In these instances, there's a Department of Justice website where hospitals can report such cases of price gouging to the federal government. —Brendan Murray in London Click here for more of Bloomberg.com's most-read stories about trade, supply chains and shipping. | 
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