Indiana hospitals brace for supply shortage because of coronavirus

Hospital officials in Central Indiana need only look to the East or West coasts to see what the future might hold.

A scarcity of personal protective equipment such as gowns and masks has led health care workers to resort to less than ideal measures such as bandannas and hand-sewn facial coverings. Officials have started talking about establishing stand-alone temporary facilities to treat coronavirus patients.

Although Indiana is not yet experiencing the same dearth of critical supplies or a spike of cases, hospital officials here are taking steps in an effort to keep such dire shortages from occurring here. Health care workers are being asked to conserve these precious goods as much as possible to save them for what officials fear will be a surge of patients critically ill with COVID-19, the disease caused by the new coronavirus.

Meanwhile, painters, contractors and homeowners with similar masks in their garages are being asked to donate what they have.

On Monday Gov. Eric Holcomb announced that the five Central Indiana hospital systems will be working together to coordinate the response in Marion County, which has seen almost half the state’s more than 250 cases of the coronavirus. The hospitals will assist one another with supplies and other resources.

“We will not leave any health care delivery system alone in their struggle to take care of Hoosiers,” Holcomb said. “This is another example of Indiana responding to uncommon problems with uncommon solutions.”

For now, the chief problem in the U.S. remains supplies. With supplies limited, many hospitals around the country are following guidelines from the Centers for Disease Control and Prevention that allow for reuse of masks in special circumstances.

Much of the problem centers around the fact that demand for these supplies and other pieces of personal protective equipment has soared around the globe, along with the coronavirus case count, said Joe Meyer, senior vice president of system operations for Indiana University Health.

Complicating matters further, some of the largest manufacturers of these supplies were in China and shut down their factories when the virus hit hard in that country. While these factories are now up and running, Meyer said, they have not yet returned to full capacity. Social distancing that aims to flatten the curve of the disease will give the global supply chain time to catch up to the demand.

Dentist offices, plastic surgeons, veterinarians, painters, contractors and other individuals who have extra masks on hand have been donating supplies to hospitals.

The shortage has led the Indiana State Department of Health to Tweet that people with extras should contact them or the local health department.

For now, IU Health, the state’s largest hospital system, has sufficient supplies to meet the demand, Meyer said.

“The question we’re all trying to answer is how much of an increase in demand will there be,” he said. “We know there will be an increase in demand.”

The hospital system maintains its own distribution center in Plainfield that supplies all 17 of its facilities and in preparation for a local COVID-19 outbreak has been building inventory over the past month, he said.

As of Friday, IU Health had not donated any supplies to other hospital systems, he said. They had had requests for help from facilities that had not yet run out of supplies.

Other local hospital systems were keeping a close eye on their resources.

“We have reordered certain PPE through our supply chains and hope to bolster our inventories. Protecting all of our patients and the staff who care for them is paramount,” said Joe Stuteville, Franciscan Health spokesman in an email.

Community Health Network consolidated many of its outpatient primary care offices and MedChecks to under a dozen locations in part to conserve its stock of personal protective equipment, said Dr. John Kunzer, president of the Community Physician Network in an interview.

The move, which includes a shift to virtual visits when possible, also reduces the risk for patients and providers to contract the illness.

Supplies are sufficient — for now, Kunzer said.

“That’s one of the reasons for consolidation, to make sure that we have the supplies directed towards acute care,” Kunzer said. “We know that as the volume is going to increase here we have to conserve what we can whatever possible.”

Local hospitals also are taking steps now to prepare to handle a potential surge of patients. The new collaboration will help with that, said Brian Tabor, president of the Indiana Hospital Association.

Central Indiana hospitals already collaborate to help out when one hospital is facing an influx of emergency or trauma patients, he said. This would allow hospitals to try to shift around capacity, for instance, to use a wing of a skilled nursing facility to house patients with COVID-19 who are recovering.

“What this will allow us to do as a system is start reallocating resources and beds and potentially ventilators and other things so we can increase the capacity in the entire system so that two or three weeks down the road, we aren’t simply directing traffic with the extent of resources we have today but we may be able to create more places where people can be treated with COVID-like illness,” he said.

While this will not ensure that Indiana will never require a specialized facility to treat patients with COVID as has been discussed in other cities, the collaboration could help Indiana maximize what resources it has at this point, he said.

Meanwhile, he said, the Indiana Hospital Association has been collecting donated masks and talking to local manufacturers who have expressed interest in making surgical gowns to help fill the need.

Some private citizens also have been collecting. Lori Welge Fulk, a former nurse, saw a friend in Fort Wayne post on Facebook about a lack of masks in her hospital. So Fulk decided to start collecting as many masks as possible to ship to her friend.

Originally she posted on a few Facebook pages, offering to buy masks. People started offering them up, asking if she would consider taking masks from already opened boxes. Fulk collected nearly 40 in a few days and plans to pick up more.

Most she sent to her friend in Fort Wayne, though she gave a few to a local emergency room physician as well.

“I think people have some of them in their garages and just don’t realize what they’re looking for,” she said. "If you are down to nothing, this is definitely better than a bandanna.”

Now she is reaching out to families who have had loved ones die while in hospice to see whether they have any supplies at home to donate. One friend promised her 100 masks.

Such efforts can make a difference, but they are unlikely to solve the problem on the global scale, experts agree. That will take a much broader response.

“What we need is a steady supply, and we just don’t know when the regular supply chain will be restored,” Tabor said.

Contact IndyStar reporter Shari Rudavsky at 317-444-6354 or shari.rudavsky@indystar.com. Follow her on Facebook and on Twitter: @srudavsky.

Cancer drug shortage may force US doctors to ration chemotherapy

Sitting in an infusion center last Wednesday afternoon, Elizabeth Arnold wondered whether the cancer drug dripping into her vein would be enough to make a difference.

Arnold, 63, was recently diagnosed with advanced uterine cancer. Her surgeon said she needed chemotherapy to knock down the tumors before she could have surgery.

But because of a shortage of key medications, she was told she would get five bags of the drug carboplatin, not the usual six. The nurse at her hospital in Anchorage, Alaska, said the facility would probably run out before her next treatment in three weeks.

“I’m terrified, quite frankly,” said Arnold, a journalism professor at the University of Alaska and former reporter with National Public Radio.

She’s caught up in a frightening and frustrating national shortage of essential drugs that experts say has put the lives of more than 100,000 cancer patients, particularly women, at risk.

“The last six months have been the worst in my career, including some of the shortages we had during the peak of COVID. It’s just been incredibly challenging,” said Julie Kennerly-Shah, associate director of pharmacy at the Ohio State University Comprehensive Cancer Center.

Fourteen cancer drugs have been in shortage in recent months, mostly because of supply chain interruptions. Those in shortest supply include cisplatin and carboplatin, platinum-based drugs used to treat gynecologic, breast, testicular, bladder, head and neck and non-small-cell lung cancers.

The American Society of Clinical Oncology (ASCO) has been working to resolve the shortage and saw the first glimmers of hope last week after a national delivery of carboplatin, which has been in short supply for a month.

“I think we may very well have hit rock bottom and are starting to slowly see more release of drug,” said Julie Gralow, the society’s chief medical officer and executive vice president.

But it’s not yet clear whether the crisis is ending or whether the supply will continue to ebb and flow.

“None of us knows yet what that means. Is it going to be adequate? Are we going to be practicing week to week?” said Dr. Amanda Nickles Fader, a professor of obstetrics and gynecology at Johns Hopkins Hospital and president-elect of the Society of Gynecologic Oncology. “We obviously need long-term solutions.”

Fader’s organization surveyed its members in late April, and only a handful, most of them in rural or smaller hospitals, said they were near a crisis point. By last week, they had heard from facilities in more than 40 states, including some major medical centers, that they were running short of at least one key cancer medication.

“We’re at a critical juncture,” Fader said. “If this crisis worsens, every hospital in the United States is going to be impacted.”

Cancer treatment advances are underway:Here are 3 that could change lives.

Alternative approaches

Doctors often can give patients a different drug if one is in short supply, Fader said. But cisplatin, which has been limited since February, is often used as a substitute for carboplatin, and vice versa ‒ so limited access to both creates problems.

New guidelines from ASCO encourage doctors to stick to the lowest recommended dose and the longest accepted interval between doses.

That’s why Arnold got just five bags of carboplatin instead of six. It’s within the recommended range based on clinical trials, but still, Arnold would have preferred to throw as much as possible at her cancer.

And though using the minimum should be enough for most people, Gralow said, “we’re all worried about the risk to patients and that some patients might be getting inferior care.”

On Thursday, Gralow received messages from a cancer treatment center in Florida and another in Tennessee that said they were about to start rationing care. She hopes the recent release of some carboplatin will allow them to avoid that.

If hospitals are forced to ration lifesaving drugs, Arnold is worried she’ll be far down on the list. Medications will go first to patients with the highest likelihood of being cured. Arnold’s dangerous tumor type was down at No. 18 on a rationing list she was given by a Seattle doctor.

Providing too little chemotherapy might leave patients with terrible side effects but no benefit – or even worse, might make their tumors resistant to the drug, said Dr. Michelle Benoit, a gynecologic oncologist in Washington State who has consulted on Arnold’s cancer.

More:New cancer therapy takes personalized medicine to a new level

With the health care system already stretched thin, it can be challenging for doctors to identify an alternative course of therapy and then get an insurance company to cover it.

Fader’s society is working with insurance companies to relax prior authorization requirements so patients can get nonstandard treatments.

Some substitute therapies are just as effective but might require a different dosing schedule or carry more side effects, Fader said.

Even the fact that some drugs take longer to deliver than others can cause problems, she said, because tightly run infusion centers lack capacity to handle the longer schedules.

All these changes require “a lot of reworking of clinical pathways and workflows in order to get there,” Fader said.

Why there's a shortage of cancer drugs now

Although cisplatin and carboplatin are manufactured by five companies, all rely on a single supplier in India that was shuttered over the winter for safety reasons. Though some production has resumed, deliveries are behind schedule and supplies are low.

Drug shortages have been a problem in the United States for at least a decade, and the shortages were exacerbated during the pandemic, said Bindiya Vakil, CEO of Resilinc, which provides global supply chain mapping and monitoring.

And demand, particularly for cancer drugs, keeps rising as patients live longer with their disease.

Globally, spending on cancer drugs reached nearly $200 billion in 2020, according to the IQVIA Institute for Human Data Science. It is expected to reach $375 billion by 2027.

The irony is that these essential platinum-based drugs are in short supply in large part because they’re so inexpensive.

Cisplatin costs $15 a vial and carboplatin $25, said Matt Christian, director of supply chain insights at the U.S. Pharmacopeia, a nonprofit that sets standards for the pharmaceutical manufacturing industry.

Latest:A new research effort takes aim at 8 rare diseases. It could revolutionize many more.

Because companies stand to make so little from these medications, they have little incentive to create backup plans in case raw material suppliers or manufacturers run into trouble, Christian said. “It’s hard to incentivize redundancy if the price is $15 a vial.”

Also, the platinum-based drugs are delivered by sterile injection, which makes them trickier to produce than a pill. That’s why sterile injectables are three times more likely to see a shortage than the average generic drug, he said.

Manufacturers have no incentive to improve their process or product safety.

Plus, with such a small profit margin and because companies don’t want to reveal their competitive advantages, production is a closely guarded secret.

That means the American medical system doesn’t know when a factory is shut down in India or a raw material shortage affects the drug supply, so hospitals can’t plan ahead or encourage other drug companies to pick up the slack.

How to fix the problem

The Food and Drug Administration is working to address the drug shortage, said spokesperson James McKinney.

“While the agency does not manufacturer drugs and cannot require a pharmaceutical company to make a drug, make more of a drug, or change the distribution of a drug, the public should rest assured the FDA is working closely with numerous manufacturers and others in the supply chain to understand, mitigate and prevent or reduce the impact of intermittent or reduced availability of certain products,” he said via email. “The FDA understands that manufacturers expect availability to continue to increase in the near future.”

But that’s not enough, Gralow said.

Structural changes are needed. Congress should add regulations to require data-sharing, offer incentives to protect the drug supply, manufacture more medications in the U.S., and create a stockpile of essential drugs, she said.

Her organization, American Society of Clinical Oncology, has been lobbying both houses of Congress – and encouraging patients to ask their representatives – to improve the supply of critical medicines.

The U.S. government should use its buying power to encourage multiple manufacturers to make essential drugs rather than focusing on the cheapest source and a “race to the bottom,” Gralow said. “It’s a vulnerable system that needs to be strengthened."

The U.S. Pharmacopeia has been advocating for what Christian described as a “supply chain control tower.” The goal would be to increase demand information to raw suppliers and manufacturers so they can better plan their production and to hospital pharmacies so they could better predict fluctuations in supply.

“Our goal ultimately is to inform people with insights and help them take mitigative actions,” he said. “The patient impact is why we’re fired up to do this work.”

The state of cancer1.95M people may be diagnosed with cancer in 2023

Helping people on the ground

Arnold just hopes that changes will come in time to help her live longer.

She was a healthy marathoner before headaches, a high blood pressure reading and a nagging anxiety led her doctor to order a pelvic ultrasound.

She was diagnosed a month ago with an aggressive form of uterine cancer known as serous. It had already spread to her pelvis, stomach and colon. She was scheduled for a hysterectomy, but the surgeon said she wanted Arnold to get chemotherapy first to knock back the tumors.

Her first round of chemo and the first few days after her second have left her with abdominal pain, which she hopes is caused by cancer cells dying off. One marker of her disease improved dramatically after that first treatment, suggesting the medication is making a difference.

She’s working out every day – running when she has the energy, walking when she doesn’t – hoping to be among the one-third of people with her tumor type to survive more than five years after diagnosis.

At a time when she wants to be entirely focused on battling cancer, Arnold and her friends on “Team Betsy” have been trying to figure out how to ensure she gets the medication she needs.

She noted that President Joe Biden has been working toward a “cancer moonshot,” setting a goal of dramatically reducing cancer deaths. Arnold said she hopes the administration also is focusing “right here on the ground.”

Medications like carboplatin are already proven to work − but only if people can get them, she said.

“They will save lives and prolong lives. Like mine.”

Contact Karen Weintraub at kweintraub@usatoday.com.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

Hospitals doing elective surgery despite COVID-19 risk, short supplies

U.S. hospitals face a critical shortage of protective equipment and top federal officials have called for a halt to non-emergency surgeries amid the coronavirus pandemic. But some hospitals are ignoring the directive, raising concerns that patients and medical staff are at risk.

Hospitals including University of Pittsburgh Medical Center, Virginia Hospital Center in Arlington and Jackson Memorial Hospital in Miami as of Friday afternoon were still performing elective surgeries, such as for orthopedic problems, cataracts and other non-essential medical issues. Nearly 300 doctors, nurses and other UPMC employees signed a letter that went to members of management last night urging the health system to "postpone procedures that can be performed in the future, and prepare for the influx of patients that will urgently need our care in the coming weeks."

Elective surgery is a medical procedure scheduled in advance because it does not involve an emergency. Frequently, they are not a medical necessity. Examples include knee replacements or nose jobs.

Dr. Linda Alvarez, secretary-treasurer of the Service Employees International Union Committee on Interns and Residents, said medical residents across the country have contacted her with complaints that their hospitals are still performing procedures that aren't essential.

"What is crazy too is that these same residents are saying there is limited availability of N95 masks," said Alvarez, referring to the special masks that can protect against contracting COVID-19, the illness caused by the virus. "To be using this personal protection equipment in ways that are not judicious or addressing the concerns of the general public safety is appalling."

Get daily coronavirus updates in you inbox: Sign up for Coronavirus Watch

The U.S. reached more than 278 deaths and over 23,000 confirmed cases Saturday, according to the Johns Hopkins University data dashboard. The global death toll now exceeds 12,000, with almost 300,000 confirmed cases.

Pennsylvania, which announced its second death Saturday, had 371 confirmed COVID-19 cases, 31 of them in Pittsburgh's Allegheny County. When asked Friday about performing elective surgeries, University of Pittsburgh Medical Center's Dr. Graham Snyder told reporters his area is one of "relative calm."

"The health center's job is to take care of patients, not to put them at risk,” said Snyder, UPMC’s medical director for infection prevention and hospital epidemiology. “We are not northern Italy. We are not Wuhan right now. Taking the level of risk in our community, we have to balance that while still providing care."

Some states have reported few cases, but that's because of the slow pace of testing, experts say, and many more are thought to be infected. Federal officials say masks, gowns and other protective equipment, along with ventilators, should be conserved for medical staff and an expected onslaught of coronavirus patients.

Hospitals already are reporting supply shortages. Space also is a looming issue. While many elective surgeries don't require overnight stays, many do, especially if there are complications.

Nearly two out of three of U.S. hospital beds may already be in use, a report out Friday from the Urban Institute and Robert Wood Johnson Foundation found. The analysis of the country's 728,000 hospital beds also showed availability of unoccupied beds per 1,000 people varied significantly across urban and rural areas, states and counties across the country.

Coronavirus is spreading in the US:Here's everything to know, from symptoms to how to protect yourself

A USA TODAY analysis out last week showed if the nation sees a major spike in COVID-19 patients, there could be almost six seriously ill patients for every existing hospital bed.

Vice President Mike Pence, who heads the White House's Coronavirus Task Force, asked hospitals last week to stop doing elective surgeries and reiterated the call Wednesday at a White House news conference. The same day, the Centers for Medicare & Medicaid Services issued "voluntary recommendations" for elective surgeries to encourage cancellation of non-essential procedures until the COVID-19 outbreak is past.

"We're asking every American, and our medical community leaders, and hospitals to partner with us in delaying elective procedures across the country and our healthcare system to ensure that medical supplies and medical capacity go where they're needed," said Pence.

In addition to those concerns, Alvarez noted the procedures create yet another patient who is at higher risk for contracting COVID-19 because having surgery suppresses the immune system. (People with chronic health conditions and those older than 60 also are at higher risk of contracting the illness with serious symptoms.)

Sick at home with COVID-19:How to care for your loved ones infected with coronavirus

Surgeon General Dr. Jerome Adams and the American College of Surgeons also have asked hospitals to stop elective procedures. Adams' office issued a statement to USA TODAY saying its request was "in sync with current CDC recommendations for healthcare facilities."

“Dr. Adams and the President’s Coronavirus Task Force have encouraged healthcare facilities to consider rescheduling non-urgent outpatient visits and elective surgeries, as necessary, due to the demands on our healthcare system during the COVID-19 pandemic," said the statement. "We’re facing an unprecedented threat and it’s important we preserve critical hospital resources, like PPE and staff to ensure an adequate response to the COVID-19 outbreak.”

Hospital associations have pushed back against blanket recommendations. The American Hospital Association said such decisions "should be determined at the local, community level in consultation with hospitals and the clinical recommendations of physicians and nurses."

"It is important to recognize the definition of ‘elective’ procedures includes important life saving measures that will continue to be necessary," AHA said in a statement.

Pregnant and worried about coronavirus?'The hard part is we just don't have the data'

University of Southern California Medical Center in Los Angeles, one of the last major hospitals in the state still doing elective procedures, announced Thursday "many elective inpatient and outpatient surgeries will be rescheduled on a case-by-case basis." Spokeswoman Meg Aldrich said that means no elective procedures will be performed, but did not know when the policy was effective.

Jimmy Lewis, CEO of the rural hospital group Hometown Health based in Georgia, said less than 5% of his members are still doing elective surgeries, though he added most are acute care hospitals that do few such procedures.

"They stopped doing it unless they looked at a facility to see if a certain operation could be fit in without exposing other patients," Lewis said. "If you decide to do one $5,000 surgery, you have to do an analysis of having a contaminated patient come into the hospital versus the $5,000."

Lewis tells members it isn't worth it because of the "obvious ethical" issues, along with the "fear of liability." If hospitals decide to do an elective surgery, and a patient dies of coronavirus, plaintiff attorneys will come in later.

"They're going to ask, 'Why did you do an elective surgery that killed momma?'"

Five people who work at hospitals spoke on condition their names and employers not be used, but USA TODAY confirmed with hospitals the status of their elective surgeries.

Hospitals still performing elective surgeries as of Friday included:

• University of Pittsburgh Medical Center. Some facilities had busy elective schedules Friday and physicians were performing hernia repairs, cataract surgeries and orthopedic procedures known as scopes that involve small incisions to view and repair joint problems, according to two health care workers at the health system.

"Balancing our patients’ ongoing clinical needs with the avoidance of unnecessary exposure requires a nuanced approach – not an across-the-board cancelling of clinics and procedures," UPMC said in a statement Friday.

"We continue to serve our patients whose procedures our clinicians believe are not medically responsible to delay. Our careful triaging of upcoming elective procedures on a case-by-case basis meets the Centers for Medicare & Medicaid Services guidance.

"We have a multidisciplinary team of experts closely monitoring the situation and will adjust accordingly."

UPMC's Children's Hospital was doing elective dental procedures on Friday. CMS targeted dental procedures in its recommendations Wednesday because they always require "personal protective equipment" that's in short supply and because they "have one of the highest risks of transmission due to the close proximity of the healthcare provider to the patient."

• Virginia Hospital Center. The Arlington-based hospital on Friday had many patients recovering after elective surgeries, according to three people who work at the hospital and asked that their names not be used for fear of retribution. Every other hospital in the Washington, D.C area had stopped the procedures, a USA TODAY review found.

"Virginia Hospital Center is still performing elective surgeries," said spokeswoman Anne Kelsey. "While nationwide shortages exist, we have not had any reason to deviate outside of those guidelines."

Kelsey added the hospital is being "cautious and mindful about the allocation of all of our resources."

Saturday night, several hours after this article posted, VHC spokeswoman Maryanne Boster emailed a "clarification of the answer," that restated that it is using cautito allocate resources. She added VHC has "rescheduled most elective procedures. However, some procedures cannot be postponed, including those such as cancer cases involving tumor removal or biopsies."

USA TODAY confirmed some surgeries taking place on Friday and scheduled this week were neither cancer-related nor urgent medical needs. Meanwhile, the medical staff is reusing the N95 masks that protect against COVID-19, using cleaning rags with bleach-based solution instead of disposable bleach wipes, reusing masks after dealing with patients and not getting masks at all unless they have face-to-face contact with patients, according to two of the hospital workers.

• Jackson Memorial Hospital. The trauma hospital is based in Florida's Miami-Dade County, which now has the highest number of deaths in the state, with more than 100. The hospital said in a statement to USA TODAY Friday afternoon that "physicians have been given some discretion as to whether to cancel or proceed."

The hospital was "continuing to perform all emergent and urgent surgeries, procedures, and clinic appointments for now," the statement said.

At 7 p.m., more than three hours after Gov. Ron DeSantis issued an executive order requiring all "nonessential medical procedures be postponed," the hospital said it was "immediately complying with this order."

Jackson also said it has "sufficient PPE on hand for current and anticipated volumes," and "have enough ventilators and have rented additional to be prepared for future demand. We also have open orders to secure even more."

Alvarez said hospitals that have so much protective gear that they can afford to do elective surgeries should consider sharing with less well supplied hospitals. "I think hospitals should assess their communities, and the impact they are expecting to face not only in their area but in the surrounding areas as well, and use this to appropriately plan their need for PPE," said Alvarez. "It is also important now, more than ever, we come together in the medical community to promote patient and worker safety."

Got a story idea or tip? Email Jayne O'Donnell at jodonnell@usatoday.com and request her secure Signal information if preferred.

Hospitals grapple with shortage of crucial component for medical ...

CNN —

A shortage of a key component for some crucial imaging tests such as CT scans is leading to rationing within hospitals, patient backlogs and doctors across the United States making do with less-than-ideal alternatives across the United States.

The component is a liquid called IV contrast, which contains iodine. It can be injected into a patient’s bloodstream to highlight different structures on scans. It can reveal, for example, the location of a clot when someone is having a stroke.

The shortage stems from the temporary closure of GE Healthcare’s manufacturing facility in Shanghai in the midst of that city’s two-month “zero-Covid” lockdown. The lockdown began in early April and was mostly lifted by early June.

In a statement, GE Healthcare said that facility is in the process of getting production back up to speed. Its output had risen to 60% of capacity by May 21, and GE expects the plant to be back to nearly 100% capacity this week. The company said it had taken additional steps to mitigate the shortage, including ramping up production at a manufacturing plant in Cork, Ireland.

However, it may be weeks before that supply reaches hospitals. “There is still the challenge of bringing the contrast media across the ocean and distributing it to health care facilities across the nation,” Nancy Foster, the American Hospital Association’s vice president of quality and patient safety policy, wrote in an email.

GE Healthcare is one of four companies that supply iodine-containing contrast to the US, but the other manufacturers haven’t been able to scale up and offset the shortage, according to the Radiological Society of North America.

The hospital association estimates that about half of all hospitals in the United States rely on GE for contrast dye to perform about 20 million scans a year, or about 385,000 scans each week.

In a statement Wednesday, the US Food and Drug Administration said the supply is expected to continue increasing through June, “with a return to stocking levels in July 2022.”

Thousands of patients may be affected

Foster said the American Hospital Association doesn’t have data on how many patients have had scans delayed but believes it to be well into the thousands.

Doctors across the country say they have seen firsthand the effects of the shortage.

Oncologist Dr. Shikha Jain said her cancer patients are having trouble getting scans.

“For these patients, getting CT scans with contrast can be extremely important, not only in the diagnosis of a cancer upfront but then also assessing treatment responses, assessing if the cancer has come back,” said Jain, an assistant professor of medicine at the University of Illinois Cancer Center in Chicago.

She said she’s worried about patients delaying care – on top of all the other delays during the Covid-19 pandemic.

“I saw patients who probably had curable cancers at the beginning of the pandemic,” she said. “By the time they came in, their symptoms had progressed to a point where they had metastatic disease.”

Other doctors in states such as New York, North Carolina and California shared anecdotes and emails from hospital leadership, urging them to reserve contrast for emergencies and to find alternatives when possible. Alternatives may include ultrasounds, CT scans without contrast or MRI scans, which use a different type of contrast. But often, these aren’t ideal substitutions.

CNN granted the doctors anonymity to discuss internal communications from hospital administrators which they are not authorized to discuss with media.

Missed opportunities for diagnosis

One emergency doctor in California said she had a patient who would have gotten scans using contrast dye if not for the shortage. The woman was sent home after multiple other tests turned up nothing, but she came back two days later in severe pain and finally received contrast dye. Those scans revealed clots that were missed during her initial visit.

A physician at another California hospital said he had to run his contrast request for “a real surgical emergency” up the ladder “since they are so low.” The delay, he said, was “painful.”

Jain added that even in cases in which an MRI is an acceptable substitution, there have been delays due to the high demand for these alternatives.

“Our patients should be aware that hospitals are doing all they can to ensure we can reschedule scans that had to be delayed during this time of crisis,” Foster said. “As more dye becomes available, we will be reaching out to reschedule patients for their scans.”

Jain underscored that supply shortages have been a problem for many years, but since the pandemic began, they have increasingly happened on a larger scale, hitting more hospitals in more places at the same time.

“We’ve been having shortages throughout the pandemic. At the very beginning of the pandemic, it was PPE shortages. Now, we have contrast shortages and formula shortages for babies,” Jain said. “So this is not a isolated incident.”

An industrywide problem

Last month, FDA Commissioner Dr. Robert Califf told members of Congress during a hearing on the nationwide baby formula shortage that something needs to be done about US supply chains, which often rely on “large, single-source contracts.”

“The [medical devices and supplies] industry has fought us tooth and nail on requiring that there be insight into their supply chains,” Califf said. “We’d like to be able to stress-test and prevent these things from happening, rather than waiting until they happen and then scrambling.”

Get CNN Health's weekly newsletter Sign up here to get The Results Are In with Dr. Sanjay Gupta every Tuesday from the CNN Health team.

Foster said it’s not an easy fix to prevent such a shortage from happening again. It will require suppliers, distributors, providers and the government to take collective action such as “diversifying and expanding sources of critical supplies, so they are not sourced or manufactured at only one location.”

Another step “is looking at how supplies are transported and having some redundancy, so that if a weather event takes out a vital highway or railway, or a labor strike takes out a major port, we have alternatives,” she said.

“We have known for some time that the supply chain is too skinny and too lean,” Foster added, “and we need to ‘fatten it.’ The pandemic has only exacerbated the need to do so.”

Michael Nedelman Amanda Sealy Nadia Kounang

Shortages of antivirals, antibiotics compound stress of a rough ...

CNN —

Shortages of key medications used to treat common childhood illnesses like flu, ear infections and sore throats are adding to the misery of this year’s early and severe respiratory virus season.

“Right now, we are having severe shortages of medications. There’s no Tamiflu for children. There’s barely any Tamiflu for adults. And this is brand-name and generic,” said Renae Kraft, a relief pharmacist in Oklahoma City. Additionally, “as far as antibiotics go, there’s not a whole lot.”

Kraft often works in rural areas of the state, floating between pharmacies when extra help is needed. On Monday, she worked in Holdenville, where there are two pharmacies: Pruett’s and Walmart. The same wholesaler stocks both stores, so if one pharmacy is out, the other usually is, too.

Kraft estimates that she had 20 people come in to Pruett’s to fill prescriptions for Tamiflu on Monday, but she didn’t have any, so she sent them to Walmart, which still had some.

On social media, families say they’ve hunted for hours for oseltamivir, the generic version of Tamiflu, and the first-line antibiotics amoxicillin and Augmentin. Inhalers of the drug albuterol, which is used to open airways in the lungs, are also in short supply, according to the American Society of Health-System Pharmacists, which maintains a list of drug shortages.

Anyone can report a shortage for the society’s list, and pharmacists from the University of Utah verify the information with drug manufacturers.

“In my 25 years of being a pediatrician, I’ve never seen anything like this,” said pediatric infectious disease specialist Dr. Stacene Maroushek of Hennepin Healthcare in Minnesota. “I have seen families who just aren’t getting a break. They have one viral illness after another. And now there’s the secondary effect of ear infections and pneumonia that are prompting amoxicillin shortages.”

Respiratory viruses hit hard

The cause of these shortages doesn’t seem to be a manufacturing problem, says Michael Ganio, senior director of pharmacy practice and quality for the American Society of Health-System Pharmacists.

“It’s just increased demand ahead of schedule and higher than usual,” he said.

According to the US Centers for Disease Control and Prevention, more than half of US states have “high” or “very high” respiratory virus activity. Most of that is due to influenza, which hit early and hard this year. Respiratory syncytial virus, or RSV, is also playing a role. Nationwide, about 1 out of 5 tests for RSV was positive last week, a rate much higher than any point over the past two years.

There have been about 8 flu hospitalizations for every 100,000 people this season, rates typically seen in December or January. The cumulative hospitalization rate hasn’t been this high at this point in the season in more than a decade.

Prescription fills for the antiviral Tamiflu are at a 10-year high for this time of year, according to GoodRx.com, a company that helps people find discounts for prescription drugs.

People in the US are six times more likely to be taking Tamiflu at this point in the flu season as during the winter of 2019-20, which the next highest year.

As for the antibiotics amoxicillin and Augmentin – a combination of amoxicillin and clavulanate, an agent that helps guard against antibiotic resistance – it’s not entirely clear why demand is so high.

The CDC considers these to be first-line therapies for many common childhood ailments, like ear and sinus and throat infections.

Some viral illness, like influenza, can leave the body more vulnerable to secondary bacterial infections that may need treatment with antibiotics.

But these antibiotics have also been prescribed inappropriately when a child’s illness is really caused by a virus. Antibiotics kill bacteria, but they don’t do anything to fight viral illnesses.

“Anytime respiratory viruses kick up, people start prescribing antibiotics, even inappropriately, and that’s created a lot of demand. That wasn’t anticipated by the manufacturers of amoxicillin, so that’s led to shortages,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.

Companies work to resolve shortages

Pharmaceutical companies that make generic drugs don’t usually keep stocks of those medications on shelves. Instead, they manufacture medicines based on orders placed earlier in the year. This year’s orders didn’t anticipate the heavy season for respiratory illnesses, some manufacturers said.

In response, they are ramping up production, but it will take some time to get more product in stock.

Drug manufacturer Teva says it anticipates that some concentrations of amoxicillin that are on back order will be back in stock starting in early December and continuing to the end of February.

Sandoz, which also manufactures generic amoxicillin, said that shortage had many factors. “The combination in rapid succession of the pandemic impact and consequent demand swings, manufacturing capacity constraints, scarcity of raw materials, and the current energy crisis means we currently face a uniquely difficult situation,” the company said in a statement.

Hikma, another amoxicillin maker, said it has adequate supplies to fill orders and is managing its supply to make sure all orders are filled.

“We understand the importance of this medication and are looking at ways to increase production,” a spokesperson said in a statement.

Genentech, which manufactures Tamiflu, says it has plenty of the name-brand antiviral medication available.

“We have sufficient supply to meet the demand and are continuously evaluating the need to increase production. Tamiflu is also widely available and there are multiple generic manufacturers of oseltamivir. There is sufficient supply of branded Tamiflu,” a company spokesperson said in a statement.

Other companies that manufacture amoxicillin and those that make generic versions of Tamiflu reported to be in shortage didn’t respond to CNN’s request for comment.

The US Food and Drug Administration has taken steps to help amid the shortage, putting out guidance to pharmacists for how to make liquid amoxicillin for children from pill versions. Amoxicillin pills for adults are not in short supply, Ganio said.

Advice for parents

Although news of these shortages may generate some anxiety, parents should be aware but not alarmed, said Brigid Groves, a pharmacist and the senior director for practice and professional affairs at the American Pharmacists Association.

The most important thing families can do for a sick loved one is to get them tested, she said. Most doctor’s offices and some pharmacy clinics can do rapid tests to help determine whether your symptoms are coming from a viral illness or a bacterial one.

“We don’t want to treat somebody that has Covid with an antibiotic, because it’s not going to be effective,” Groves said. “And then we also run the risk of creating more resistance in our current bacterial antimicrobial agents out there.”

A recent study by the Pew Charitable Trusts concluded that about 30% of outpatient prescriptions of antibiotics for children were inappropriate, either because the medications were given to treat viral illnesses or because the recommended agent wasn’t used. Additionally, the study found that antibiotics increase the risk of C. diff, a bacterial infection that can be life-threatening; allergic reactions; and skin rashes.

“It’s important that a family or caregiver has their loved one appropriately evaluated to assure that whatever they are being treated for, they will get the appropriate therapy,” Groves said. That may be a viral illness or a bacterial infection, or a condition that calls for medication like albuterol for supportive care, making sure that the drug is being used appropriately for children who are wheezing or having trouble breathing.

Groves also said parents should know that it may take some hunting to fill a child’s prescription for Tamiflu or amoxicillin. They may have to drive farther or go to a store they’re not familiar with.

Get CNN Health's weekly newsletter Sign up here to get The Results Are In with Dr. Sanjay Gupta every Tuesday from the CNN Health team.

If all stores in the area are out, she said, it may be possible to get a prescription for a different antibiotic or antiviral.

“There are options to treat the same infection with a different agent,” she said.

A compounding pharmacy may be able to mix the medication you need, too.

Brenda Goodman Raenu Charles
Brenda Goodman
Raenu Charles

Hospitals in the US are the fullest they've been throughout the ...

CNN —

Hospitals are more full than they’ve been throughout the Covid-19 pandemic, according to a CNN analysis of data from the US Department of Health and Human Services. But as respiratory virus season surges across the US, it’s much more than Covid that’s filling beds this year.

More than 80% of hospital beds are in use nationwide, jumping 8 percentage points in the past two weeks.

Hospitals have been required to report capacity information since mid-2020 as part of a federal effort to track the effects of the Covid-19 pandemic.

Hospitals have been more than 70% full for the vast majority of that time. But they’ve been 80% full at only one other point: in January, during the height of the Omicron surge in the US. Back in January, about a quarter of hospital beds were in use for Covid-19 patients. But now, only about 6% of beds are in use for Covid-19 patients, according to the HHS data.

The broader respiratory virus season is in full swing across the US. All but six states are experiencing “high” or “very high” respiratory virus as seasonal flu activity remains “high and continues to increase,” according to the US Centers for Disease Control and Prevention.

The number of people admitted to the hospital for flu during the week of Thanksgiving was nearly double the number of admissions during the week before. And the latest surveillance data probably does not reflect the full effects of holiday gatherings, as it captures only through November 26, two days past Thanksgiving.

Nancy Foster, vice president for quality and patient safety with the American Hospital Association, says that an influx of flu patients is a key reason why hospitals are filling up. On top of that are challenges brought on by work force shortages and a backlog of patients who delayed care over the past few years.

“The rates are higher because we are seeing patients with the flu in many parts of the country and that has brought a lot of older adults and some young children into the hospitals. Additionally, RSV is filling pediatric beds and cribs along with patients who are sicker now due to putting off care during Covid-19, which has required more intensive and complex care,” she said in a statement to CNN on Friday.

“Workforce shortages have not only made it more challenging for hospitals, but also have diminished the number of patients who can be cared for in nursing homes and other post acute care settings. Thus, patients are spending more time in hospitals, awaiting discharge to the next level of care and limiting our ability to make a bed available to a patient who truly needs to be hospitalized.”

In a letter to the nation’s governors last week, HHS Secretary Xavier Becerra noted that flu and other respiratory viruses are “increasing strain” on the country’s health care systems. Becerra wrote that the Biden administration “stands ready to continue assisting you with resources, supplies, and personnel” – but he stopped short of making a formal emergency declaration, as requested by children’s health leaders last month.

Hospital bed capacity can change day to day, as hospitals adjust the number of beds they make available based on staffing and other resources.

Get CNN Health's weekly newsletter Sign up here to get The Results Are In with Dr. Sanjay Gupta every Tuesday from the CNN Health team.

As of Thursday, about 10% of hospitals are reporting a “critical staff shortage.” More than 90% of hospital beds are in use in Rhode Island, and more than 85% of beds are full in eight other states: Washington, New Hampshire, Massachusetts, Minnesota, Georgia, Missouri, West Virginia and Oregon.

Pediatric hospital beds also have been more full than usual for months. About 76% of pediatric hospital beds are in use, up from an average of about two-thirds full in recent years.

Iowa blood collectors hurting for donations following storm, shutdown

Below freezing temperatures brought more than just traffic, classes and jobs to a slowdown; it also created a hurdle for blood donation facilities in desperate need of inventory.

Both LifeServe Blood Center and the American Red Cross have declared emergency blood needs as local and national supplies run dangerously low.

"We've definitely felt the pain," said Danielle West, public relations and marketing manager for LifeServe, the sole provider of blood to Des Moines area hospitals along with a total of 120 hospitals across Iowa, Nebraska and South Dakota.

As snowstorms struck and temperatures plunged over the past two weeks, many Des Moines-area blood drives were canceled and West said local donation centers saw dozens of no-shows.

► More:Iowa's new tax law creates $1 million headache for nonprofit blood centers

She estimated that in the past week LifeServe lost nearly 1,000 donations — or about one-quarter of their weekly collection average — because of the weather.

As of Thursday afternoon, less than a two-day supply was available of more than half of the blood types, West said. Typically, Lifeserve aims to keep between a three and five day supply on hand.

Area hospitals are critically low on O negative blood — the universal donor — with only a one- to two-day supply available, she said.

Though West said it's typical "to feel the pinch with the weather," the holidays didn't affect LifeServe nearly as much as the mid-January winter weather.

While West doesn't believe the partial government shutdown affected LifeServe, a spokeswoman for the American Red Cross said the shutdown, combined with the polar vortex, was a "one-two punch" to their blood supply.

In January, the opportunity to collect more than 4,600 blood and platelet donations were missed as drives across the country were called off because of severe weather, according to the American Red Cross.

The government shutdown also factored into the cancellations with about 30 drives hosted by federal offices — equating to an estimated 900 units of blood — were canceled, said Laura McGuire, a Red Cross spokeswoman.

On average, 4 percent of the blood collected by the Red Cross comes from drives sponsored by military and state, local and federal agencies.

The Red Cross issued an emergency blood call on Jan. 14, citing the holiday and flu seasons as reasons why 27,000 fewer donations were collected than needed during the weeks of Christmas and New Year's Day.

Typically, the Red Cross aims to maintain a five-day supply of on-hand blood to fill the needs of regular patients and emergency situations, McGuire said. As of Thursday, they had less than a three-day supply available.

LifeServe donation appointments can be made online at www.lifeservebloodcenter.org or by calling 800-287-4903. To find nearby American Red Cross drives, visit www.redcrossblood.org.

NJ coronavirus: Health care facilities worry about equipment scams

A sales pitch to hospitals for a mask to protect medical workers from the novel coronavirus said the gear was certified by a federal agency — but it wasn't the proper agency. And a portion of the certification document was blotted out.

In a different case, a photo of a mask misspelled the acronym for a federal regulatory agency.

And three separate companies, all apparently fake, purported to be selling certified N95 respirator masks. The tipoff they were no good? Each company supplied an approval number to prove it was legitimate — but they all used the same number.

Doctors and hospitals have been inundated with pitches from people selling medical equipment like N95 respirator masks, which protect health care workers from being infected with the coronavirus and are in critically short supply across New Jersey. Some companies have been selling equipment that's substandard or not certified by the federal government.

That has led a state senator to propose legislation to increase criminal penalties for people selling counterfeit medical equipment during an emergency. And it has led doctors who purchase such equipment to read the fine print on documents intended to show that personal protective equipment, known as PPE, is legitimate.

Mask shortage in NJ:Severe shortage of masks for health care workers

NJ coronavirus:Sewing hobbyists shift to making masks for health care workers amid shortage

Helping out:These groups are stepping up to help NJ hospitals facing mask shortages

The proliferation of fake equipment is growing as health care facilities also contend with escalating costs, with some vendors raising equipment prices tenfold or more.

"Hospitals are in the throes of a crisis right now," said Stavros Christoudias, a general surgeon and chairman of the New Jersey Doctor Patient Alliance, a nonprofit watchdog made up of independent physicians. "What if some of this PPE slips through and someone uses it in a room and expects it to protect them. It can be a disaster."

Dealing with new vendors

The problem isn't limited to outright scams. In some cases, hospitals desperate for equipment are dealing with vendors and manufacturers they don't know.

That was the case when Holy Name Medical Center recently purchased 1,000 protective masks but opened the box and discovered they did not fit properly because of the way they were made. The masks were returned to the vendor, said Adam Jarrett, the hospital's chief medical officer.

He said the hospital was "not using the regular vendor" that it typically relies on for supplies and that it received a shipment of KN95 masks, "which is what we were expecting to receive." KN95 masks are similar to N95 but are made in China instead of the U.S.

A spokeswoman said the hospital "could not confirm" that the masks had been certified by the National Institute for Occupational Safety and Health, known as NIOSH.

A NIOSH spokeswoman, Arleen Porcell, said the agency doesn't certify KN95 masks and recommends they "only be used in crisis situations" when N95 masks are not available. She said they "should not be used during aerosol-generating medical procedures" unless the alternative is an ordinary "facemask or improvised device."

Jarrett said doctors were concerned that the KN95 masks wouldn't adequately protect workers.

"We didn't trust it," Jarrett said. "The mask has to be tight. We were not confident because of the way the mask was constructed."

Story continues below the gallery

He said the vendor made up for the mistake. A hospital spokeswoman said the vendor sent certified masks as a replacement. Such companies typically act as intermediaries, purchasing equipment and then reselling it to health care facilities.

The hospital declined to provide the identity of the vendor.

Companies 'taking advantage of the situation'

A Holy Name spokeswoman said it's not unusual for a single N95 mask to sell for $9 these days — up from about 50 cents before the crisis — but added that she did not know how much the hospital has been paying. It is among the hardest-hit health care facilities in the region, with 100 confirmed and probable coronavirus patients as of Wednesday, including 25 on ventilators.

Highlighting the importance for proper protective equipment for staff, the hospital said 38 employees have been furloughed, with 34 testing positive for the coronavirus and concerns that others have been infected. A spokeswoman said it had enough protective gear to last another "three to four days."

The National Institute for Occupational Safety and Health, known as NIOSH, which certifies protective medical equipment, has put on its website photos and other information about potentially counterfeit N95 masks. Certified masks have a NIOSH logo and a federal approval number stamped on them.

Christoudias said that in some cases vendors are saying masks are approved only by the Food and Drug Administration. But that's a sure sign they are fake, he said, because such approvals are made by NIOSH.

And he said three separate companies provided the same NIOSH approval number — which would not be the case if they were legitimate. Companies that manufacture such masks receive separate approval numbers for their products.

Christoudias said he knows of one doctor who purchased a large number of N95 masks to distribute to hospitals — and he's now stuck with them because the hospitals determined they were substandard.

The problem has led state Sen. Vin Gopal to propose legislation to increase the penalties for selling counterfeits during a state of emergency. Gopal, D-Monmouth, said a bill could be introduced within days.

"We have people taking advantage of the situation while others are suffering," he said.

The New Jersey Hospital Association said in a statement that it is aware of "a lot of bad actors coming out of the woodwork during the COVID-19 crisis."

Kerry McKean Kelly, a spokeswoman, said in an email that "numerous vendors" have contacted the association saying they have protective equipment, and that "it can be very difficult to vet out the legitimate companies from those trying to take advantage of the situation, and that’s a shame at a time when our hospitals are focused on caring for patients and protecting their staffs."

The association has developed a vetting process to help health care facilities determine which vendors to use. Kelly said it recommends asking vendors for a W-9 tax form, which is used to supply a taxpayer identification number to the Internal Revenue Service, and for proof that equipment is approved by NIOSH.

She said health care facilities should be "wary of a vendor requiring payment" before supplies are delivered and that the association is providing members with a list of vendors that can be trusted.

Abbott Koloff is an investigative reporter for NorthJersey.com. To get unlimited access to his watchdog work that safeguards our communities and democracy, please subscribe or activate your digital account today.

Email: koloff@northjersey.com Twitter: @abbottkoloff

Memphis hospitals conserve, collaborate, locate COVID-19 supplies

The novel coronavirus (COVID-19) is a pandemic. Reported illnesses range from very mild to severe, including death. Agencies anticipate widespread transmission will occur in the U.S. in coming months and recommend social distancing among other measures to slow the spread. Call your doctor and stay home if you are sick. Get more information at CDC.gov/coronavirus or contact the Tennessee Department of Health coronavirus information line at 877-857-2945 from 10 a.m. to 10 p.m. CT daily.

Memphis hospital executives issued an extraordinary statement Sunday, saying the region's four main health care systems are on high alert to secure needed supplies and handle the coronavirus outbreak.

Baptist, Methodist, Regional One and Saint Francis officials together made public a statement that outlines goals and says: "Meeting this moment requires each hospital to take strong action to prepare."

Hospital and medical clinics in the four networks, which together employ more than 25,000 people in metropolitan Memphis, are actively trying to conserve needed supplies and locate critical gear such as face masks, according to the statement.

Memphis' hospitals generally have been viewed as rivals. However, U.S. health officials expect a sharp rise nationwide in COVID-19 infections.

The message comes as the number of residents in metropolitan Memphis diagnosed with the virus reached 101 by early Sunday afternoon. Reported cases include 66 in Memphis and Shelby County along with 35 cases in Memphis' suburbs, including 18 in DeSoto County.

In the region, health, government and business leaders have emulated the response in cities throughout the nation. They have tried to disrupt the virus' transmission rate by suspending schools, closing public areas such as museums, bars and restaurants and advising people to stay home and work from home if possible. Currently, one report estimate 20% of working U.S. residents are laid off, idled or working from home.

Reports show most scientists are unsure how many of the 330 million people in the nation will catch the virus. California's governor has said 56% of the state's 40 million residents might get infected. For health officials, one concern is a rapid spike in infections that could overwhelm hospitals in any one city.

Hospitals throughout the nation currently have about 900,000 to 1 million beds, including about 4,000 beds in the nine main Memphis-area hospitals operated by Baptist, Methodist, Regional One and Saint Francis. About 1.4 million people live in the nine counties that form metro Memphis.

Most of this population relies on the Memphis hospitals for critical health care. Another 600,000 residents in a wider region known as the Mid-South regard Memphis as a medical, commercial and cultural hub. By serving much of this population of 2 million people, the health care industry in metro Memphis has grown to more than 70,000 employees.

In the statement on Sunday, the Memphis hospital officials say "while the number of cases in our area is well below other areas of the country, we know that appropriate action is required now to be ready."

Those actions include:

Continuing to secure more COVID-19 testing kits through multiple avenues, including public sector agencies, private-sector vendors and in some cases develop in-house testing capability.

Conserving critically needed supplies like personal protective equipment including masks and gloves.

Postponing non-urgent, medically unnecessary elective procedures to free up space, personnel and equipment to focus on COVID-19 treatment.

Modifying visitor access to our facilities to keep patients, caregivers and the public safe.

Screening anyone who enters our facilities, including our employees and providers.

According to a report by the American Hospital Directory, hospitals in the Memphis area contain about 4,000 beds. The report does not include St. Jude Children's Research Hospital, the 244-bed Memphis Veterans Affairs hospital, the 309-bed Methodist LeBonheur Germantown hospital or the 255-bed Methodist LeBonheur Memphis hospital.

Main hospitals listed in the directory are:

Gainesville hospitals postpone some surgeries, ambulances scarce

Gainesville area hospitals are postponing elective surgeries and taking other steps to cope with an onslaught of new COVID-19 patients who are filling up hospital beds and putting a strain on staff and resources, officials said.

Many of those being admitted to Alachua County hospitals for COVID treatment are coming from outlying counties where medical facilities are full and the vaccination rates are lower than Alachua County, officials said.

Lake City Medical Center’s 98 inpatient beds and 18 intensive care unit beds were 100 percent full as of Thursday morning, according to federal data.

As a result, patients from there who need advanced care are being transported to North Florida Regional Medical Center. Earlier this week, Alachua County Fire-Rescue services helped with a transport.

At Alachua County Public School's board meeting held on Tuesday, Dr. Amit Rawal, an emergency medical physician at North Central Florida Hospital, said that over the past few weeks there haven't been enough emergency response vehicles to respond to 911 calls.

Rawal said said that the shortage is due to the recent surge in COVID-19 hospitalizations.

"Surge plans are being (put) into place to increase hospital beds and staff for the swelling number of COVID-19 patients as the men and women in our hospital tirelessly take care of our community," Rawal said.

More:UF Health nears record for COVID-19 patients as nearby hospitals hit ICU capacity

Capacity for emergency care remains strong

Officials at UF Health Shands Hospital and North Florida Regional Medical Center say that they are still equipped to handle serious emergency medical cases, COVID or otherwise, and are encouraging people who need care not to hesitate to get it.

"For patients in surrounding counties that need a more advanced level of critical care, our teams work together to ensure those patients are provided the necessary support," said Sean Benoit, chief medical officer at North Florida RMC, in a prepared statement.

He said that it is important "that our residents continue to seek care in an emergency."

"Our team stands ready to support critical healthcare needs that expand beyond those resulting from the pandemic," he said.

More:Alachua County declares local state of emergency due to COVID-19 spike

Florida on Wednesday broke its own hospitalization record for the third day in a row. Data from the U.S. Department of Health & Human Services reported Wednesday an all-time high of 12,041 COVID-19-positive people hospitalized statewide, including 135 pediatric patients.

Some elective procedures paused

HHS also reports that a dozen Florida hospitals are contending with critical staff shortages, a number that is expected to grow.

Hospitals throughout the state are trying to cope with staffing shortages and dwindling rooms from a virus surge that has been spurred on by the highly contagious delta variant combined with high numbers of unvaccinated people.

Starting on Wednesday, Shands postponed elective adult procedures that would require intensive care following surgery.

"A procedure would only be postponed if it will not harm the patient,” spokesman Ken Garcia said in an email.

UF Health CEO Ed Jimenez said Thursday in a Zoom call with reporters that people should feel confident that the hospital is equipped to take care of them for COVID or any other serious health condition.

“To the community at large, I would say, ‘UF Health is here. We’re your resource. We’ll always be your resource,'" he said.

More:Alachua County declares local state of emergency due to COVID-19 spike

ICU beds fill up regionally

As of Thursday, 274 of Shands' 327 ICU beds were filled, figures from the federal Department of Health and Human Services show. Of the hospital's 1,014 beds, 834 were filled. Jimenez said 31 of the ICU beds are filled by COVID patients. And he said there were eight COVID cases involving people under 18, with at least one in ICU.

Even if all of the ICU beds fill up, UF Health has other space and resources to provide ICI care to people who need it, Jimenez said.

“An organization like ours is going to be able to swell up when needed,” he said. “It’s the human being who is super talented, and that’s what’s going to make our ICU capabilities."

He said people know they can trust UF Health if it needs to reschedule a surgery or if they have an emergency medical need.

“Imagine if you were living in Palatka, or you are living in Starke, or you are living in Live Oak” Are you comfortable? I don’t know," Jimenez said. "As you move out of here, your level of comfort just changed about what is going on. We need to stop the spread of this (virus).”

Jimenez said staffing is a challenge for UF Health, and said the large surge in cases has been demoralizing to hospital workers.

In five weeks, the daily number of COVID patients at Shands has jumped from 14 to 163.

“People are tired,” he said.

As of Thursday morning, only one intensive care unit bed at North Florida RMC's 70 beds was available, according to federal data. Of the 481 inpatient beds, 436 were occupied, the figures show.

The hospital has postponed all elective procedures for non-emergency surgeries.

“We are following guidance from the CDC, as well as our own infectious disease experts, and reviewing scheduled procedures based on a number of factors,” Benoit said in a prepared statement.

Among the factors: the urgency of the procedure, the clinical judgement of the hospital's physicians and circumstances in the facility and the community, he said.

“Based on these factors, at this time, we are rescheduling certain surgeries to increase our capacity to serve emergent needs in our community and patients who are impacted will be notified,” he said.

Hospital officials say that the vast majority of the people who are hospitalized for COVID have not been vaccinated.

“As COVID-19 continues to increase in our community, we strongly encourage everyone to become vaccinated against the virus,” Benoit said.