I was away most of the last several weeks because I was recovering from surgery. I was lucky, not only because surgery fixed a life-threatening problem, but because I had IV bags and tubing for saline and pain medication.

lt doesn’t seem like this should be a big thing but it is for many critical health care situations. Imagine having major abdominal surgery, followed by days of post-surgery care. The pain could be debilitating without a continuous drip pain medication. Imagine the extra labor required to administer pain medication if automated IV drip feeds aren’t available.

Now imagine caring for an unconscious influenza patient suffering from dehydration. Imagine a ward filled with these patients, including children and elderly who may be difficult to hydrate by mouth. Imagine not having enough IV bags and tubing for a severe flu season.

No need to imagine this; hospitals have been dealing with this very shortage for more than a month. Some hospitals are administering Gatorade by stomach tube because they don’t have enough IV bags for hydration.

I hate to think of the challenges for patients in treatment for cancer and other long-term illnesses.

Why the shortage? It’s because Hurricane Maria affected the largest U.S. manufacturer of IV products. Baxter International’s three Puerto Rican plants make 44% of IV bags used in the U.S.

Most Americans aren’t aware 46% of Puerto Rico’s economy is manufacturing. Pharmaceuticals represent the lion’s share, including IV products. This industry represents 18,000 jobs, $40 billion in pharmaceutical sales, and $3 billion in federal tax revenues.

Hurricane Maria may have caused other pharmaceutical shortages. If so, production increases in other locations or substitutions remediated the effect. But there aren’t alternatives given IV products’ manufacturing concentration in Puerto Rico.

The Trump administration has done a pissy job handling post-Maria hurricane recovery in every respect. It almost looks personal, as if he’s punishing the island for a Trump-branded golf course’s failure.

But here’s the kicker: the Federal Emergency Management Agency says it’s done with emergency response in Puerto Rico. It’s pulling out though many residents are still without water and lights. Chalk it up to more bad faith on the part of this administration.

Why hasn’t the administration treated Puerto Rico’s pharmaceutical industry as critical infrastructure? The National Infrastructure Protection Plan (NIPP) lists health care as critical.

Is it because former President Obama’s Presidential Policy Directive 21 (pdf) established the NIPP? Trump has systematically unwound 20 or more Obama policy directives to date.

Trump’s proven he could give a rat’s patootie about brown-skinned people. If Trump mentions Puerto Rico in his SOTU speech tonight he’ll call federal response a success. FEMA gave him a news peg with ample time for his speech writer to stuff it into tonight’s hypocritical bloviating. He counts on the mainland blowing off Puerto Rico now the way it has sloughed off the island’s thousand-plus hurricane-related deaths.

But with the IV products shortage and the ongoing flu season’s severity, this indifference isn’t affecting only Puerto Ricans. It may already have cost lives while increasing health care costs here in the continental U.S.

Heaven help the rest of us if we face a mass casualty event or a pandemic before we fix Puerto Rico — and Trump.