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May 31, 2022

The contrast dye shortage has left many patients 'in limbo'

Daily Briefing

    The United States is currently experiencing a nationwide shortage of the imaging agents used in approximately 50 million exams annually—a shortage that has forced many hospitals to delay procedures and ration their limited supply, Reed Abelson reports for the New York Times.

    The dye shortage

    In recent weeks, experts around the country have voiced growing concern over the contrast dye shortage that has resulted from the closure of GE Healthcare's Shanghai plant amid Chinese Covid-19 lockdowns.

    Earlier this month, the American Hospital Association (AHA) wrote a letter urging GE Healthcare to distribute supplies as needed throughout the shortage. In response, the company said it is "working to return to full capacity as soon as local authorities allow."

    Last week, GE Healthcare announced that its supply of imaging agents was continually increasing. However, it did not provide an estimate for when the shortage would end.

    "After having to close our Shanghai manufacturing facility for several weeks due to local Covid policies, we have been able to reopen and are utilizing our other global plants wherever we can," the company said.

    In the statement, GE Healthcare said the plant was operating at 60% capacity and would be at 75% within the next two weeks. In addition, the company said it had taken further steps to ease the shortage, including increasing production at its plant in Cork, Ireland, and shipping products to the United States.

    Still, lawmakers have expressed concern over the shortage. "In the wealthiest nation on Earth, there should be no reason doctors are forced to ration lifesaving medical scans to compensate for a shortage of material," said Rep. Rosa DeLauro (D-CT). "We are seeing supply chains break down because of consolidated industries experiencing manufacturing shortages and offshoring American jobs to China."

    "The shortage of a vital imaging agent is the latest example of the country's vulnerability to disruptions in the global supply chain and its overreliance on a small number of manufacturers for such critical products," Abelson writes.

    How dye shortages are impacting care

    While FDA said it was working closely with manufacturers "to help minimize the impact on patients," some experts have said the shortages could last through the summer because of distribution delays—further delaying procedures and potentially threatening patient safety.

    According to Elliott Haut, a trauma surgeon who oversees quality and safety at the department of surgery at the Johns Hopkins School of Medicine, the shortage "is probably one of the biggest risks for patient safety since COVID hit." 

    On Thursday, FDA Commissioner Robert Califf said the shortage was "just unbelievable," while testifying before a Senate committee. "Someone with a stroke or heart attack wouldn't be able to get an angiogram," he added.

    "We continue to be concerned about the impact of the delayed, deferred or ignored screening over the last few years," said William Dahut, the chief scientific officer for the American Cancer Society.

    According to Dahut, a lack of contrast dye in a screening exam can make it harder to diagnose cancer and more difficult to determine whether a treatment is working. "Patients could be in a situation where clinical decisions are going to be negatively impacted," Dahut said.

    In addition, the shortage has left many other patients "in limbo," Abelson writes.

    "It's definitely causing more stress for patients," said Shikha Jain, an oncologist in Chicago. "There are patients who are getting frustrated because scans are delayed or canceled."

    Ultimately, the full impact of the shortage is difficult to predict. For health care workers, many of whom have been struggling with supply shortages and the pandemic, "it feels like a never-ending marathon," Jain said.

    As concerns over the contrast dye shortage have increased, many hospitals have been forced to ration their supply.

    For example, Memorial Hermann Health System has "throttled back" its use of contrast for elective procedures to preserve its existing supply, said Jamie McCarthy, chief physician executive at the health system. According to McCarthy, the health system is currently performing about half of its typical daily volume of CT scans.

    When hospitals in the Delaware area started running out of dye, they began referring patients to ChristianaCare. But even at ChristianaCare, the shortage "became a serious issue very quickly," after it began in mid-May, said Kirk Garratt, the medical director for the group's heart and vascular health center.

    "It impacted our burn rate," Garratt said. "We're really worried here," he added while explaining why the health system decided to delay elective procedures. "We feel we have to make this change now to ensure we have a supply so we can keep doing the urgent care we need."

    Meanwhile, Nancy Foster, AHA's VP of quality and patient safety policy, compared the contrast dye shortage to other shortages seen throughout the pandemic.

    To help prevent future shortages, Foster urged GE to share more information about the shortage. "We need to figure out how to really create a much more robust, not as lean, supply system that has some give to it," she said. (Abelson, New York Times, 5/26)

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