Hospitals around the U.S. are postponing CT scans and rationing care while waiting on shipments of medical dye made in a Shanghai plant that just restarted production amid the city’s lockdown.

Called contrast media or dye, the fluid made by General Electric Co. helps doctors peer inside the bodies of patients having a heart blockage, stroke or dangerous lung clot. It’s also routinely used tens of millions of times a year in non-emergency scans, including to help diagnose and track cancers.

GE is one of a handful of major manufacturers of the dyes, and most of its supply for the U.S. comes from the Shanghai manufacturing facility. The location was shut down when the Chinese city was put on a Covid lockdown on March 27, cutting off production.

On Monday, GE said in a statement that the plant is back to 50% capacity. The Boston-based company is sending shipments of the dye, which usually travel by boat, on flights from Shanghai and another plant in Ireland. But many U.S. hospitals have already begun rationing scans and canceling procedures, and it is expected to take weeks for the supply crunch to ease. 

Concern is running so high that the American Hospital Association asked GE in a letter Monday to prioritize distribution to hospitals treating the most urgent patients. Despite widespread efforts to conserve dye, “there will be a period of time in the near future where supply severely fails to meet demand,” the letter said.

GE is “working to return to full capacity as soon as local authorities allow,” and to get more workers into its plant, the company said in a statement.

‘Biggest Risks’

The contrast shortage “is probably one of the biggest risks for patient safety since Covid hit,” said Elliott Haut, who oversees quality and safety in the Department of Surgery at the Johns Hopkins School of Medicine. 

If you get into a car crash, a CT scan using contrast dye can reveal internal injuries, said Haut, a trauma surgeon. If you have a heart attack and need a stent to open a blood vessel, the contrast illuminates where the device should go. If you have cancer, scans with contrast monitor the tumor’s progress. Across specialties and hospitals of all sizes, he said, “this is a life-saving medical item that we use literally millions of times every week.”     

Shortages of all kinds have abounded during the pandemic, from toilet paper to baby formula. But in the medical sphere, the current contrast dye shortfall appears to be the most far-reaching shortage since the 2020 run on medical protective equipment, and it’s sparking anger and worries about patient safety. 

“It’s Groundhog Day all over again” with one shortage after another, from bags of saline to drugs, said Erin Fox, senior pharmacy director at the University of Utah.

Fox monitors shortages nationally and sees hospitals divided into contrast dye “haves” and “have-nots.” Those who buy from other makers are fine, while those who buy from GE Healthcare face weeks with as little as 25% of their usual supply.

Though increased production in Shanghai is good news, Fox said, “hospitals still aren’t getting deliveries, and 50% manufacturing capacity doesn’t help much if your hospital is almost out.”

Dried Up

Hospitals in Boston demonstrate the wide variability of supply. Boston Medical Center, the region’s biggest safety-net hospital, uses a contrast dye made by a GE competitor, Italy’s Bracco Imaging SpA, and is unaffected. But Mass General Brigham, the state’s biggest hospital system, sent out a memo last week asking physicians to conserve contrast. 

“We are still projected to receive only 20-30% of our normal shipments from now until the end of summer,” the hospital told doctors.

The Food and Drug Administration lists the shortage as expected to continue through July.

Hospitals have grown used to handling shortages, said Paul Biddinger, chief of preparedness and continuity at Massachusetts General Hospital. 

“But each time, it threatens really important clinical care,” Biddinger said. “And it absolutely calls into question whether we need more redundancy, more safety built into the supply chain, so that a single site — whether it’s IV fluids made in Puerto Rico or intravenous contrast made in Shanghai — doesn’t cause such global disruption.”

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GE has plants that make contrast agents in Cork, Ireland, and Norway as well as China. A company spokesman said it increased production at the Irish plant to offset the Shanghai losses. Most of the U.S. supply comes from Shanghai, however, which is expected to remain under lockdown through June. 

Every Last Drop

Some hospitals are squeezing more doses out of a vial of contrast fluid by repackaging the dye in smaller amounts, said Nancy Foster, vice president of the American Hospital Association, a trade group. The association is hearing from members that they are postponing scans, mainly for outpatients, she said, and reserving the contrast dye for severely ill inpatients or emergency procedures.

GE would not say what its market share is in the U.S., but Foster said it’s believed to supply about half the country’s needs.

Pennsylvania radiologist Shervin Dean said the shortage affects care for cancer patients who rely on CT scans using contrast to assess whether a tumor has grown or shrunk. It’s possible to do a different scan without contrast, he said, but it’s not as good; it’s like “you have a Lamborghini and you have a Gremlin, and your dad won’t give you the keys to the Lamborghini.”

GE notified customers of the looming shortage in late April, Dean said, “so all of us started to panic and look at our stock, and each hospital is stocked differently, it turns out.” Among four hospitals he covers, Dean said, one had enough at current rates of scanning for only one week, and none had enough for more than a month.

“There is no question that someone, somewhere, is going to show up with a stroke or a torn blood vessel, and we’re not going to be able to diagnose it properly and they’re going to have a terrible outcome or die,” Dean said.

He blames GE for depending too much on one plant, as well as the government that allowed the situation to go on. Medical executives who did not build reserves also bear some responsibility, he said.

“Why do we rely on this just-in-time supply chain?” he asked. “It is ridiculous.”

Multiple high-level discussions are underway to prevent such shortages in the future, said the American Hospital Association’s Foster. Fox, from the University of Utah, has participated in one of them: a National Academies of Science, Engineering and Medicine committee on the security of the country’s medical supply chain. 

Among other failings, Fox said, the committee found that though recent federal law, known as the CARES Act, requires companies to have contingency plans in case of supply disruption, no one enforces that requirement.