In the war against COVID-19, Oregon Health & Science University is racing to vaccinate as many Oregonians as quickly as possible.
As the state’s academic health center, OHSU also operates the largest single hospital in the state. That means it has both a moral and practical imperative to stop the spread of a deadly, mutating virus before it overwhelms hospital capacity in Oregon and complicates the ability of health systems to care for all Oregonians.
To that end, OHSU is collaborating with other health systems and organizations to stand up community vaccination clinics at Portland International Airport’s Red Economy Parking Lot, the Oregon Convention Center, its own campus on Marquam Hill and in mobile vans that can be deployed to vaccinate eligible groups in communities lacking easy access to health care anywhere in the state.
“No one is protected until everyone is protected,” said Renee Edwards, M.D., M.B.A., senior vice president and chief medical officer for OHSU Health. “Everybody – everybody – understands this is a crisis and that no one can accomplish this on their own. It speaks to the spirit of Oregonians to ask, ‘How can I help?’”
The Port of Portland is among those stepping forward. The Port, which operates PDX, saw an opportunity to make use of the 22-acre economy lot, which had been closed and was empty with the reduction in air travel during the pandemic.
“We’re all in,” said Dan Pippenger, chief operating officer for the Port. “We’re a public agency and we believe this is a role we can play – beyond the movement of passengers and cargo – to help our broader community.”
The Port is providing the site and coordinating logistics at no cost to OHSU, while the American Red Cross is providing volunteer support.
As the vaccine supply ramps up in Oregon, OHSU expects to be able to handle as many as 10,000 vaccinations per day at the airport site alone. University officials have established a model that’s capable of ramping up to 12-hour days with plans in place to bring in additional volunteers from the community to help with everything from traffic control to vaccinations.
Cheers, tears, happy faces
Among all the medical clinics operated by OHSU, the one in the Red Economy Parking Lot at PDX isn’t the most elaborate.
But it may be the most critical to the health and well-being of Oregonians right now.
On Sunday, jetliners roared overhead as a stream of cars entered the lot in a cold, pelting rain. Volunteers from the Red Cross directed traffic, registered patients, and, under the shelter of drive-through tents, health care workers inserted needles into the arms of people among the first waves of Oregonians vaccinated against COVID-19.
By the end of the day, 1,200 people with intellectual and developmental disabilities along with their caregivers had been vaccinated with the limited supply of Moderna vaccine doses.
Handling those doses requires temperature-controlled storage and care.
“There’s a lot of special handling involved with these vaccines,” said Joe Ness, M.H.A., B.S.Pharm., a pharmacist by training who serves as senior vice president and chief operating officer for OHSU Healthcare. “Especially when it comes to the Pfizer vaccine, we have special handling requirements and it needs ultra-cold storage. We can’t treat it like the average flu vaccine.”
On Sunday, health care workers carefully sorted vials of the Moderna vaccine.
Erin Corella, Pharm.D., OHSU assistant director for pharmacy services, started her day at 6 a.m. when she arrived at OHSU Hospital to pick up the doses that would be administered that day at the airport’s economy parking lot.
She used two special refrigeration packs – embedded with a probe to ensure they stayed between 2 and 8 degrees Celsius – and filled them with 120 vials of Moderna vaccine allocated to OHSU by the Oregon Health Authority and reserved specifically for this invitation-only event. That’s 10 doses to a vial, 1,200 doses in all.
Inside a small heated trailer and outside at a table beneath a rain shelter, a cadre of OHSU pharmacy techs, pharmacists, nurses and other health care providers carefully prepared the doses: A half milliliter into each syringe, tighten the needle, secure the cap and send it out in a clear plastic bag with nine other doses to the vaccination station for injection into waiting arms.
Plenty of pharmacists work in pop-up outpatient clinics during flu season, but this is unique.
“The teamwork and collaboration is such a positive experience for us,” Corella said. “It’s gratifying to hear the cheers and to see the tears and happy faces when people get vaccinated.”
‘It’s an army’
All those cheers are the result of an enormous amount of behind-the-scenes planning and organization involving about 300 people at OHSU. In the case of the PDX drive-through clinic, it came together barely two weeks after a happenstance conversation between two longtime colleagues.
Abby Tibbs, OHSU’s vice president for public affairs and marketing, regularly talks with Kristen Leonard, chief public affairs officer at the Port of Portland. During one of their conversations, the pandemic inevitably came up and Tibbs mentioned the logistical challenges with vaccine distribution.
“Kristen said, ‘There’s no more important issue to the Port than helping get Oregon back on its feet again. OHSU has a lot on its plate. The Port would love to help with the vaccine distribution,’” Tibbs recalled.
Within 24 hours of the initial conversation, the Port and OHSU agreed to stand up the drive-through vaccination site at the airport with the support of an army of volunteers provided by the American Red Cross and OHSU. OHSU already had months of experience with a mobile testing site established in a parking lot near Hillsboro Stadium as the pandemic took hold in March.
“We knew we already had a model that worked,” Tibbs said. “Oregonians need a variety of ways to access the vaccine.”
At the direction of university leadership, Tibbs, Kevin O’Boyle, OHSU’s vice president of ambulatory care, and Banning Hendriks, the OHSU director of patient experience, formed the Covid Management Team at OHSU.
The team coordinates all aspects of a rapidly evolving public health initiative across the various sites.
Staffing; vaccine allocation; traffic control; supplies; communications; community relations; patient registration and appointments are among the myriad aspects of the initiative that have to be closely coordinated and managed.
At any one time, OHSU is deploying hundreds of people across multiple sites: The airport, a site jointly operated by other health systems at the Oregon Convention Center, and another vaccination clinic in Multnomah Pavilion on the university’s Marquam Hill campus. That’s in addition to the ongoing operation of the Hillsboro Stadium testing site, which continues to provide testing for hundreds of people per day.
“It’s an army,” Hendriks said. “We know that this is going to have to be a sustained effort over the next nine months to a year, and we are going to need a massive workforce to sustain it.”
OHSU is doing all this while simultaneously operating a hospital and health system that remains at nearly full capacity. By establishing the template, OHSU officials hope that other organizations – including the federal government – will be able to step in and provide support over the weeks and months to come.
“Ultimately, we’re going to need an influx of ongoing support,” said Edwards, senior vice president and chief medical officer for OHSU Health. “Whether that’s from the National Guard or other public and private organizations, we’re going to need help to continue maintaining these vaccination sites over the long term.”
Right now, vaccines are scarce and only available to people who meet criteria determined by the Oregon Health Authority and Oregon Gov. Kate Brown. Health care workers are first in line, with additional waves covering vulnerable people such as those with disabilities and their caregivers, teachers and older adults who are most vulnerable to the virus.
Vaccinations, therefore, require an appointment. When people arrive, someone needs to check them in and schedule each patient for a second dose in the case of the Moderna and Pfizer vaccines available now.
“It sounds simple, right?” said Steve Kassakian, M.D., an OHSU primary care physician who also serves as associate chief health information officer.
It may be simple for patients, but establishing secure networks at remote sites like an airport parking lot is in fact quite a complex undertaking. In the case of the convention center site – jointly operated by Kaiser Permanente, Legacy Health, Providence Health & Services and OHSU – it’s even more complicated to coordinate electronic health record systems among various health systems.
In addition, site managers are coordinating with state public health authorities who have unveiled an online tool for people to register online and make appointments. For people who aren’t necessarily connected to the internet, OHSU is planning to supplement the online portal with a call center established early in the pandemic to field questions and provide resources for people anywhere in Oregon.
Kassakian said dozens of people are coming together to build on existing infrastructure and adapt it through the evolving needs of the pandemic.
“This is a once-in-a-century event,” he said.
Ready to ramp up
O’Boyle, OHSU’s vice president for ambulatory services, called it the most stressful but also most rewarding period of his career in academic medicine. That’s a credit to the scores of employees who have stepped up to go above and beyond their normal duties to expand OHSU’s mission beyond simply caring for patients inside OHSU Hospital and OHSU Health clinics.
For example, barely a quarter of the people who have received testing at two low-barrier testing sites are OHSU patients.
Over time, O’Boyle expects OHSU will be able to make use of mobile vans to bring vaccines directly to remote corners of Oregon or even directly to people who lack the ability to easily leave their homes. Right now, the vans are available to provide COVID-19 tests in communities lacking easy access.
“We’re in discussions right now about how do we pivot those vans to deliver vaccines, particularly in rural counties,” O’Boyle said.
The timing will depend on the availability and speed of vaccines reaching Oregon.
“I wish we had more vaccine supply,” said Ness, senior vice president and chief operating officer for OHSU Healthcare. “It’s an imperfect process, but we are moving fast and we are poised to ramp up quickly as vaccines become available. We are ready to deliver all the doses that are coming at us to Oregonians.”
A note of caution
The goal is to vaccinate as many Oregonians as quickly as possible to break the momentum of the pandemic. However, OHSU scientists and physicians caution that people will need to remain vigilant in the months ahead.
The virus continues to mutate as it copies itself again and again with each new infection. This raises the potential for variants that are more contagious for those who haven’t been vaccinated or elude the body’s immune system even among people who have been vaccinated or previously infected.
That means it will remain worthwhile for people to practice public health measures – physical distancing, wearing facial coverings, hand washing – whether they’re vaccinated or not.
Over time, the goal is to drive the virus into submission by cutting off its ability to spread.
OHSU will continue to do its part.
“It’s part of our mission, part of our DNA,” Edwards said. “Our role is in forging collaboration with other health systems and community organizations on behalf of the health and well-being of Oregonians.”