Like a lot of caregivers, Dr. Jackson Griggs has struggled to keep his medical supply rooms stocked since the start of the pandemic. When COVID-19 first emerged, Griggs, who runs Waco Family Medicine—a group of fourteen primary-care clinics in Central Texas—lacked masks and other forms of personal protective equipment. Now, also like many others, he’s short on sterile gloves, needles, and plastic tubing. But the lack of supply that most concerns him is something called IV contrast dye—a liquid injected into patients’ veins before an imaging procedure, such as a CT scan or an X-ray. Griggs says the current dye shortage, which stretches around the globe, “has an urgency to it that the other inventory needs just can’t match.”

The source of the dye shortage is a single manufacturing plant run by GE Healthcare in Shanghai. That facility shuttered during Shanghai’s two-month-long COVID-19 lockdown that lasted from April until earlier this month. GE Healthcare is one of only two major suppliers of IV contrast dye, so the shutdown left health care providers desperately short on a product used in a wide range of sometimes life-saving procedures, such as those to identify the location of a blood clot. It’s also used for cardiac catheterizations and cancer screenings. “It’s not like we ran out of green paint,” says Dr. James McCarthy, the chief executive physician of Memorial Hermann Health System in Houston. IV contrast dye “is something that half of America uses for its medical imaging.”

GE says production has resumed in China, and that its Shanghai facility will be close to fully functional this week. But that won’t end the shortage immediately. Hospitals around the U.S. will have to wait for new supplies to be shipped, and already patients needing a variety of medical scans have been put on waiting lists until more dye arrives. Some hospitals are bracing for a significantly reduced supply of IV contrast dye over the next several months.

The dye shortage is the most acute problem facing hospitals in Texas, but there are plenty of others. In Waco, Griggs’s clinics are short on items ranging from chart containers to blood collection tubes. At Memorial Hermann, they don’t have all the IV saline bags they need. At Houston Methodist, they’ve struggled to stock all manner of plastic products. The supply-chain manager there told a local reporter in February that he had begun to pay extra to have some crucial supplies made in Houston.

Hospitals have long been accustomed to pivoting to other treatment methods because of intermittent supply shortages. Greg Roberts, the director of supply-chain services for University Medical Center in Lubbock, says that in his ten years on the job, not a day has gone by without some product being on backorder. But before the pandemic there were often somewhat seamless solutions to these shortfalls. If a hospital couldn’t stock IV saline bags of a certain size, for instance, it might temporarily use more bags of a different size—a change most patients wouldn’t notice.

Since the onset of the pandemic, however, shortages have been harder to deal with. For instance, Roberts says his hospital has received just 20 percent of its usual allotment of GE’s IV contrast dye. “The clinicians here have been really good when a product is in short supply,” Roberts says. But with the contrast dye shortage, “now you have to start prioritizing cases, because there is no alternative.”

In response, some Texas hospitals are pivoting to other imaging methods. Memorial Hermann, which operates some of the largest hospitals in the state, has reduced its use of IV contrast dye by about half. It’s delayed most imaging that is elective or not urgent. In order to reserve dye for emergency situations, the hospital is using MRIs or ultrasounds instead. Those alternatives can still be effective, but they may not offer as clear a picture as scans employing IV contrast dye.

The dye shortage isn’t likely to be the last major supply disruption for hospitals. “The biggest market that I’m truly worried about right now is the resin market,” Roberts told me. He notes that a huge variety of products—from tracheostomy tubes to furniture—rely on resins. Roberts says production hasn’t increased to meet demand, and much of the existing production is in China, where supply disruptions are often harder to predict. “There isn’t a good line of sight into where our shortages are going to be a month or three months or six months from now,” Griggs says.

Even products manufactured in the U.S., such as Abbott baby formula, have proved susceptible to devastating shortages. Though it’s not a medical supply, Griggs says the shortage of baby formula has been especially hard on his system’s patients. Seventy-eight percent of the adults that Waco Family Medicine serves fall below the federal poverty line. “This is a population that is already overburdened with the impact of acute and chronic health conditions,” Griggs says. “When you add shortages to important life-sustaining things like formula, it can quickly become a family crisis with serious medical implications.”

McCarthy and others say the industry needs to reassess how it sources supplies, and how much inventory each facility should have on hand. Many hospitals stock only a couple of days’ worth of supplies. The vast majority of those come from a single supplier, and typically health care providers can rely on regular replenishments. “The challenges we’ve had over the last two years,” McCarthy says, “and the challenge that we’ve got currently, absolutely are forcing the health care industry to completely rethink the way it sources medications, equipment, and materials.”

Federal regulators have said part of the solution may be more oversight of the supply chains of medical device makers. FDA commissioner Robert Califf told a congressional committee last month, “We’d like to be able to stress-test [supply chains] and prevent these things from happening.” But, Califf said, most suppliers have “fought us tooth and nail on requiring that there be insight into their supply chains.”

Some hospitals also seem reluctant to be forthcoming about how they source supplies and what changes could be made in that sourcing. Several hospital systems, including some of the largest in the state, declined to comment or failed to reply to multiple inquiries from Texas Monthly for this story.

Roberts notes that in other industries, such as food and retail, supply demands can be easier to predict. “The thing with health care is that it’s a very specialized genre of supply chain,” he says. While a big-box store might be able to look at past sales trends and apply predictive analytics to know what will be in demand in six months, there’s no way for Roberts to know what kind of medical emergency might strike in the 22-county area that UMC serves.

Still, because supply shortages have become so common during the pandemic, many health care practitioners have become especially adept at responding to shortages. That shift began near the start of the pandemic, in March 2020, when masks and other PPE were in especially short supply. “I think that was the first real painful awakening that we were going to have to be adaptive,” Griggs says. Back then, he posted a video to Facebook calling on locals to sew masks for caregivers. The video racked up tens of thousands of views, and masks arrived droves. If only they could similarly appeal to the general public for homemade contrast dye.