Hospitals across the United States are being forced to ration medical scans and procedures after a lockdown in Shanghai hit a plant that produces a widely used contrast dye.
The dye, made by General Electric, is used for a variety of purposes, many of them life-saving. Typically injected into patients' veins, it provides higher contrast than imaging procedures like CT scans without dye. The increased contrast helps doctors more easily diagnose a brain bleed or clot, see how a heart or other organ is functioning or determine whether a tumor is growing or shrinking, among other things.
Because of the shortage, hospital systems from New York to California told NBC News they have started deferring nonurgent medical procedures and using alternative imaging and diagnostic tools that don't require the dye when appropriate.
"It's very difficult to know what harms are going to occur from this, either from a delayed diagnosis or a misdiagnosis," said Dr. Matthew Davenport, vice chair of the American College of Radiology commission on quality and safety. "And I'm confident that there will be some delayed diagnoses or misdiagnoses because we are using imaging techniques that are not optimized, not perfect."
He added that an estimated 50 million scans with contrast are performed each year in the U.S.
"Unfortunately we don't have the option to just give everybody contrast like we used to, so a bit of it is going to be the best of the bad option: Would I rather have no imaging, or an imaging technique that's not optimal?" he said.
GE's Shanghai plant is a major supplier of the dye for U.S. health systems. Around 50 percent of U.S. hospitals and imaging centers likely use GE's product, according to Nancy Foster, vice president of quality and patient safety policy at the American Hospital Association, though she added that the exact portion is hard to pin down.
"Most hospitals, for a product like this, would keep on hand maybe a couple weeks of supply," Foster said. "But this shortage has been going on for a couple weeks now."
The shortage is the result of a strict lockdown imposed on Shanghai on March 27 as part of China's "zero-Covid" strategy. It caused the GE plant there to be shuttered for several weeks, though a spokesperson for GE Healthcare said in a statement that the plant has begun to reopen and is "working to return to full capacity as local authorities allow."
The spokesperson added that GE is accelerating deliveries by shipping by air, instead of by boat, from both its Shanghai plant as well as a plant in Cork, Ireland, to address the U.S. supply issues.
But even so, health systems do not anticipate immediate relief. The shortage could last into the summer, forcing medical providers to postpone lower-priority imaging as they ration their stockpiles.
"Some have weeks left," Davenport said, referring to remaining supplies of the dye. "But others are in deep trouble and they have days or a week left."
In San Diego, Scripps Health said in a statement that it is limiting imaging procedures requiring contrast "to exams that are time-sensitive and clinically necessary." For nonurgent procedures, it added, alternatives like ultrasounds and MRI scans — which use a different contrast dye — are being considered. Some procedures are being deferred up to eight weeks if it is safe to do so.
Similarly, Northwell Health, New York's largest provider, said it is trying to maximize its current supply by "using non-contrast CT, ultrasound and MRI studies when clinically appropriate."
Orlando Health, meanwhile, said it has established an "interdisciplinary team to assess our IV contrast utilization and carefully manage our supply," while ensuring the dye will be available for emergencies and other essential needs.
The three health systems' actions are in line with recommendations from the American College of Radiology, which has advised that during the shortage, hospitals defer scans if they are not immediately medically necessary, do scans without contrast if possible, or lower the amount of dye used per patient.
Davenport commended health care professionals who have worked to conserve their supplies of contrast dyes but said he still worries about the consequences. Opting for an alternative type of scan without contrast might result in a 10 to 20 percent reduction in diagnostic accuracy, he said.
Other sources of the dye are limited, however. Foster said members of the American Hospital Association have reached out to the other major supplier to the U.S., Bracco Imaging S.p.A. of Italy, but have not had luck making purchases recently. Bracco did not immediately reply to an inquiry from NBC News.
Contrast dye is hardly the first medically necessary item to be in short supply during the pandemic. Personal protective equipment, ventilators and oxygen have all hit critical lows at times.
"There are a lot of conversations underway at the national level about how do you appropriately diversify sources of critically needed supplies so that a weather event, a political event, something else that happens does not wipe out your ability to have access to that supply?" Foster said. "We need a coming-together of all the manufacturers, the providers, the federal agencies to think through: How do we create that more resilient supply chain?"
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