A shortage of IV fluid in the wake of Hurricane Helene is shining a spotlight on the fragility and vulnerability of the country's medical supply chain.  Hospitals were left scrambling after the storm flooded a Baxter manufacturing plant in Marion, N.C. The plant makes about 60 percent of the IV fluid in the country, including hydration and dialysis solutions. The resulting shortage has forced hospitals to ration supplies.   Some are postponing elective surgeries, and some are restricting the use of IV bags unless it’s an emergency. The shortage could last until at least the end of the year, posing a problem as hospitals enter into respiratory infection season.  “On the one hand, you know all hands are on deck and moving forward where it needs to be. But I just hope that [officials] understand the scope of the issue,” said Chip Kahn, president and CEO of the Federation of American Hospitals.  More than 86 percent of health care providers are experiencing shortages of IV fluids in the aftermath of Helene, according to a survey of more than 250 health providers from supply chain company Premier Inc. Shortages were evenly spread nationwide, across all provider types.   The survey found nearly 17 percent of providers were starting to cancel elective procedures, and more may follow suit in the next month if the situation doesn’t improve. About 54 percent of providers in the survey reported they had 10 days or fewer of IV fluids in inventory.    “When you take that much supply out of the supply chain in the U.S., it creates havoc,” said Nancy Foster, vice president for quality and patient safety at the American Hospital Association. “So everyone is on allocation from their supplier. ... Everyone is being told to be very careful with their supply of these IV solutions and other fluids.”   Experts have long warned about allowing critical supplies to be highly concentrated in one place, especially as climate change fuels more powerful and unpredictable storms.   But manufacturing requirements for sterility means a high barrier to entry into the market, and with low returns on investment for manufacturers, hospitals and their suppliers have few options for recourse. It’s common to see the same products go on and off the shortage list for years. Prior to Helene, certain IV solutions had been in shortage for almost 10 years.   "Unlike shortages for car chips, for example, it is a major concern and a life-threatening issue when there's a medical supply chain disruption,” said Tom Cotter, executive director of Healthcare Ready, a nonprofit that helps bolster supply chains during and after disasters. “The risks are so much higher for disruptions affecting patient care.”  Cotter and other experts said the only way for manufacturers to make a profit given the current environment is to consolidate and produce their products at a large scale.    “So now you have consolidated manufacturing for essential medicines in a small number of large manufacturing facilities, and when those go down, you take out a very large percentage of the market,” former Food and Drug Administration (FDA) Commissioner Scott Gottlieb said Tuesday on CNBC.  Baxter’s North Cove plant shut down in late September, when record amounts of rainfall from Helene inundated western North Carolina communities, including Marion. In an update posted Monday, Baxter said they expect to have 3,000 people on site contributing to recovery efforts this week.  The company said its goal is to restart production in phases by the end of this year, and to return to allocating 90 to 100 percent of certain IV solutions in the same period. A temporary bridge needed to be built in the area to help move products off site to ship to customers, and the company said a second is currently being built.   But they do not yet have a timeline for when production will be fully restored to pre-hurricane levels.   “Our primary message to hospitals and health systems is conserve, conserve, conserve,” said Soumi Saha, Premier’s senior vice president of government affairs.   Saha said she hopes lawmakers and federal officials have serious conversations about strengthening health care supply chains. Providers can try to take steps to prepare for potential shortages, including keeping extra supplies on hand. But stockpiling isn’t cheap, especially when any given product could go into shortage.  “We know it will happen again, but it's impossible to predict to what product. And so it is a constant game of whack-a-mole,” Saha said.   Last week, FDA approved temporary imports of IV fluid from Baxter facilities in Ireland, the United Kingdom, Canada and China to ease the shortage.    FDA also released guidance providing new flexibility that makes it easier for hospitals and other facilities to make their own IV solutions during the shortage.  Kahn said that added flexibility is helpful only up to a point, because hospital pharmacies can’t make nearly enough.   “It's not going to be sufficient production there to answer the supply need overall,” Kahn said. “It's useful and important in a comprehensive response to the problem, but it's only a small part of whatever a short-term solution is.”  The aftermath of Hurricane Helene was far from the first time hospitals and federal officials have needed to navigate shortages of critical drugs.  In a similar situation in 2017, a Baxter plant in Puerto Rico that manufactured small IV bags shut down after the island suffered a direct hit from Hurricane Maria.   In 2023, a tornado damaged a Pfizer plant in North Carolina that made nearly 25 percent of the company’s generic sterile injectable medicines used in U.S. hospitals.   That same year, cancer centers across the country struggled to obtain key chemotherapy drugs. A failed inspection at a plant in India led to massive downstream shortages and desperate searches for new suppliers.  “I'm hopeful that over time, events like this continue to keep attention on the fragility of the supply chain and the vulnerability of our patients to drug shortages,” said Michael Ganio, senior director of pharmacy practice and quality with the American Society of Health-System Pharmacists.  Cotter said he thinks there have been some lessons learned from past crises, but he isn’t sure there’s enough being done to stop the same issues from happening again.  “I don't know if it's political will or what, but we're acting very shortsighted as a country. All of the investments that we need today needed to be made 10 years ago, because it takes time to build a resiliency into [the] supply chain. It doesn't happen overnight with a grant,” Cotter said.