On a recent weekday afternoon, a long line of cars eased forward in the parking lot outside the Portland Expo Center.
One by one, a medical assistant dressed in full personal protective equipment – including face mask, face shield, gown and gloves – bent down, asked driver and passenger alike to lean back against the vehicle’s head rest and then deftly inserted a small swab deep inside the nose for a quick swipe of mucus.
As part of its mission to improve the health and wellbeing of Oregonians, Oregon Health & Science University stood up its first mobile testing site in early March in a parking lot at Hillsboro Stadium. With overall case counts on the rise, both the Hillsboro and Expo Center sites have become overwhelmingly popular with wait times often exceeding two hours or more.
Barely a quarter of the people who arrive at the sites are OHSU patients.
“We’re here to provide a community service,” said Debbie Lamberger, OHSU’s director of ambulatory operations.
Melissa Preciso-Temple, who manages the corps of “float pool” health care workers staffing the mobile testing sites, said most people appreciate the effort.
“People are usually kind and grateful,” she said, “even though it’s uncomfortable.”
At a pace of one test every 90 seconds, thousands of people have been tested through the outdoor assembly line-style process. OHSU currently accommodates as many as 600 people a day at both sites and is making plans to increase capacity in the months ahead. OHSU will bill insurance for those who have it, but no one is turned away as long as they meet Oregon Health Authority criteria for a test.
Right now, OHSU processes test results within a couple of days.
All of this happens through intensive coordination among hundreds of OHSU employees – from clinicians who wield the swabs, to lab technicians processing the samples, to logistics employees adapting to an ever-evolving supply chain of testing supplies and personal protective equipment for health care workers. It’s a complex response orchestrated across the university since the earliest days of the pandemic.
‘Wake up, work, go to sleep. Repeat.’
Even before the first confirmed case in Oregon on Feb. 28, Mike McCaffrey found his life turned upside down.
As OHSU’s associate vice president for logistics, McCaffrey heads up a department of about 125 people focused on making sure Oregon’s only academic health center is well supplied with everything from hospital gowns, to procedure masks, to the tiny glass pipettes commonly used by OHSU researchers to handle microscopic organisms in liquid.
With the virus spreading elsewhere around the world, McCaffrey and his team had to scramble to maintain supply chains that began drying up with the shutdown of factories in China.
“It was basically wake up, work, eat, go to sleep and repeat,” he said. “There was no difference between a Saturday and a Wednesday. It all rolled together.”
Improvisation and teamwork across the institution became the key.
At one point, logistics staff weren’t able to secure full test kits, complete with swabs, containers, vials and chemical reagents. So a group gathered in an OHSU warehouse early in the pandemic to assemble test kits cobbled together from individual pieces secured from myriad manufacturers both in North America and overseas. The group included employees from across the institution, including physical therapy, occupational therapy, perioperative services and from OHSU’s March Wellness and Fitness Center. “We had to get creative,” McCaffrey said.
McCaffrey credited clinical staff for doing everything possible to extend the use of scarce supplies such as face masks and gowns. While the logistics team focused on supply, clinicians across the institution found ways to reduce demand. Health care workers reduced unnecessary exposures that required personal protective equipment such as face shields, and they also found ways to safely reuse or extend their use.
Local businesses also stepped up with hand sanitizer fashioned by distilleries and face shields produced by Oregon-based Nike.
Medical-grade supplies aren’t available in your typical grocery store. Swabs are a case in point: They require a special kind of material to snake its way through the nose to the back of the throat, with a tip designed specifically to pick up mucus.
“It’s like a high-end Q tip,” McCaffrey said.
The mobile sites alone generate more than 3,000 samples a week. In addition, OHSU health care workers test patients in OHSU Hospital, ambulatory clinics, the emergency department and among staff through OHSU occupational health.
All of it arrives for analysis at OHSU’s own in-house lab on the Marquam Hill campus.
Constructed, stocked, staffed and operational within just 14 days, the lab initially had the capacity to process about 250 samples a day. Now, it’s turning around as many as 1,300 samples daily – over 5,000 a week – and the organization is exploring opportunities to expand capacity even further to meet rising demand. In addition to the standard test looking for RNA of the SARS-Cov-2 virus itself, the lab has recently begun processing blood samples in search of antibodies indicating previous infections.
Demand is rising as the virus continues to spread, and staff are increasingly educating people about the right reasons to come in for a test.
In light of limited supplies, state and federal guidelines prioritize testing for the people most vulnerable to the disease. Yet even then, there is a limit to the effectiveness of testing without taking other measures to prevent the spread of the virus.
“You could be negative today, and positive tomorrow,” said Donna Hansel, M.D., Ph.D., chair of pathology in the OHSU School of Medicine. “You could get an exposure at any point that you may not be aware of. Even testing every three or four days is not perfect.”
That’s why Hansel said it’s critical for people to stick to the tried-and-true methods that have slowed the spread of the virus: Maintain physical distancing, wash your hands, wear a mask.
“It’s hard to not be fatigued about having to be mindful all the time, but it’s got to be like Oregon Strong,” Hansel said. “It’s not going to be forever, but it is going to take time for us to get past this.”
OHSU mobile site testing locations:
- Hillsboro Stadium – 4450 NE Century Blvd, Hillsboro, OR 97124
- Hours: Monday - Saturday, 9 a.m. to 4 p.m.
- Portland Expo Center – 2060 N Marine Drive, Portland, OR 97217
- Hours: Monday - Saturday, 9 a.m. to 4 p.m.
Who can get tested?
Note: If you are a Kaiser, Legacy or Providence patient, you will be directed to those health care systems.
- Those with symptoms: People over age 2 months can be tested if they have one or more of the following:
- Shortness of breath
- Trouble breathing
- Or at least two of the following symptoms:
- Repeated shaking with chills
- Muscle pain
- Sore throat
- New loss of taste or smell
- Nausea / vomiting
- Those without symptoms: People without symptoms can get tested if they meet any of the following:
- They are giving birth, or they are having surgery or another qualifying procedure at OHSU.
- They have a vulnerable immune system and are following steps to end isolation (tested positive at least 14 days ago AND have not had any symptoms for 14 days).
- They have been in close contact with someone who has been diagnosed with COVID-19.
- A public health department has required them to get tested for contact tracing.
- One or more of the following
- The person is a migrant/seasonal agricultural worker.
- The person is Black, African-American, Latinx, American Indian/Alaska Native, Asian, Asian-American or Pacific Islander.
- The person has a disability.
- English is not the person's first language.
- People without symptoms who have tested positive before:
- OHSU is no longer testing people who previously tested positive until 90 days after they were first diagnosed.
OHSU’s testing criteria follow Oregon Health Authority and CDC recommendations. Guidelines may change at any time based on updated recommendations.