How a COVID lockdown in China has led to South Florida hospitals rationing medical scans
Some South Florida hospitals are rationing supplies of a contrast dye used for medical imaging, such as CT scans and MRIs, and prioritizing the drug for patients with emergencies or critical cases that require surgery, including heart attacks and strokes.
No South Florida hospital has reported a disruption in patient care due to the global drug shortage, which is expected to last another six to eight weeks. The shortage occurred after a COVID-19 lockdown in China in April shut down a GE Healthcare plant in Shanghai that produces a key ingredient for contrast dye.
The iodine solution is injected into blood vessels to allow a CT scanner or MRI to diagnose problems in the heart, brain, kidneys and other parts of the body. Contrast dye is also critical for surgeries that many hospitals perform every day, such as cardiac catheterizations to treat heart conditions, thrombectomies to remove blood clots from arteries and veins, and endovascular coiling procedures to stop blood from flowing into an aneurysm.
A GE Healthcare spokesperson said in an email that the company is trying to boost production levels of the critical drug and trying to keep customers informed.
“We are working around the clock to expand capacity of our iodinated contrast media products, including drawing on our global manufacturing network,” said Jennifer Fox, a spokesperson.
GE Healthcare has reopened its Shanghai factory and boosted production of the contrast dye at a factory in Ireland.
Some hospitals postpone elective procedures
But the global shortage has forced some hospitals to reconsider how often they use contrast dye for patients, said Dr. Hany Attalah, chief medical officer for Jackson Memorial Hospital in Miami.
Jackson Memorial is part of Miami-Dade’s public hospital network, Jackson Health System, and the largest safety net hospital system in Florida, performing medical imaging procedures every hour every day.
Attalah said doctors in some cases may perform a medical imaging procedure without contrast dye, or use a different mode of imaging that does not require it, such as a plain X-ray or an ultrasound.
“The big ones we really need to make sure we preserve our contrasts for are patients who are having true emergencies, so heart attacks and strokes specifically,” he said.
Attalah said “it’s the elective things” that are being postponed or reconsidered for medical imaging with contrast.
“If you come to the emergency room and have appendicitis or signs and symptoms for an infected appendix, there’s good literature that a CT scan can be done without contrast,” he said. “The difficult part of the situation is there’s not a lot of data on this. These are things we’re taking on a case-by-case basis, reviewing each case, looking at the risk and determining the best imaging modality.”
At Memorial Healthcare System, the public hospital network for South Broward, doctors are also conserving supplies of contrast dye, said Kerting Baldwin, a spokeswoman.
“Memorial currently has an adequate supply of these contrast agents, but recognizing the challenges, we have employed proactive conservation strategies to manage through this shortage by making clinical decisions on when these tests are necessary to provide a course of treatment to patients, and when we can delay, reschedule or use other alternate imaging modalities without impacting the well-being of our patients,” she said in an email.
Some South Florida hospitals not impacted
But not all South Florida hospitals have been affected equally by the shortage.
A spokeswoman for Broward Health, the public hospital system for North Broward, said they’re not experiencing any shortages of the drug.
Jorge Hernandez, Broward Health’s chief procurement officer, said GE Healthcare is one of the world’s largest manufacturers and suppliers of contrast dye for medical imaging but that the hospital system uses a number of different sources for the drug.
“We’re in a good position right now with our inventory and supply levels,” he said, “but we still have to explore conservation strategies.”
Broward Health has not stopped using contrast dye for elective procedures, Hernandez said, but the hospital system’s doctors are closely monitoring use of the drug.
Baptist Health South Florida, the region’s largest nonprofit hospital system, said it buys contrast dye from a supplier that is not affected by the current global shortage.
“There are no impacts to our procedures or patient care at this time,” Patty Abril, a Baptist Health spokeswoman, said in an email. “We are monitoring the situation closely.”
At South Florida hospitals where supplies are being conserved, pharmacists and doctors have been meeting daily to anticipate the need for the drug, said Vanessa Goodnow, director of pharmacy at Miami’s Jackson Memorial.
“We’re able to prioritize what we do have. It’s not that we’ve run out,” she said.
Goodnow said she anticipates that GE Healthcare will deliver more supplies next week.
Shortage stems from GE Shanghai plant
GE Healthcare alerted customers in April to a shortage of one type of contrast marketed as Omnipaque, according to a statement from the American Hospital Association on Tuesday.
On Monday, May 9, the Food and Drug Administration reported a shortage of a second contrast dye manufactured by GE Healthcare in China. That contrast dye is called Visipaque, and the FDA said supplies are expected to increase through May and June and return to “stocking levels” in July.
As Chinese authorities have allowed increasing numbers of workers back to GE Healthcare’s Shanghai plant, output should increase significantly in the coming weeks, according to the company.
Until supplies return to normal, doctors at some South Florida hospitals will be carefully considering if and when to use contrast dye. But Jackson Memorial’s Attalah said that in no case will doctors withhold contrast dye from an imaging procedure if it were to risk harm to a patient.
“We’re being very intentional so that we can continue to provide care to our patients,” he said. “But in some cases, we are calling patients and saying we need to delay your case for a little bit.”
This story was originally published May 11, 2022 at 6:38 PM.
