UNIVERSITY CITY - More than 2 months have passed since a pair of hurricanes devastated Puerto Rico, and the impact goes on.
Puerto Rico has more than 100 drug and medical device manufacturers, and produces $40 billion in healthcare products for the American market.
That's more than any state or other U.S. territory.
However, the electricity problems there means some essential supplies for hospitals here are in short supply.
With many factories still crippled on the island, hospitals here say supplies, especially of I-V fluids, are tight.
At most hospitals, including the Hospital of the University of Pennsylvania, many drugs are mixed into bags of intravenous saline or dextrose.
The infusion is then used to treat everything from infections to cancer.
"We actually compound around 2000 IV products a day.," says Rick Demers, R.P.H., the hospital's director of pharmacy.
Demers says supplies were slim before Hurricanes Irma and Maria slammed Puerto Rico.
But since then, they're even tighter.
"It seems to be the smaller dosage forms of these, the sizes between 50, 100, 250 ccs that are in the shortest supply," he notes.
Hurricane Maria temporarily knocked out 3 major plants for one saline manufacturer.
2 have since had power issues.
Demers says the HUP staff adjusts daily, changing dosage sizes, depending on what's available - sometimes using larger bags, or putting smaller mixtures into syringes.
Last month, the F-D-A took several steps to ease the shortages:
It gave approval to import saline from other countries, urged the expansion of production at existing facilities, and expedited the review of new product applications.
It also urged FEMA to make supplying or restoring power to plants owned by Baxter, the major saline maker, a priority.
Read FDA statement here.
But even so, the shortage continues.
"Sometimes our supplies are limited to having only 2 or 3 days on hand, which is very small for us," says Demers.
He hopes the situation will improve over the next several months, and that the problem is addressed, so it won't happen again in the future.
The FDA is also closely watching 30 other medical products made primarily, or ONLY, in Puerto Rico.