Appointments for COVID-19 tests and vaccines are increasingly difficult to find in Portland amid the omicron variant’s arrival in Oregon and a long-anticipated surge in cases.
Health officials attribute delays to recent spikes in demand, holiday closures, extreme weather, health care worker shortages and lacking capacity after mass vaccination sites closed during the summer.
County and state officials and COVID-19 service providers acknowledged the often long waits for appointments while stressing the existing places Oregonians can get vaccinated or tested. Pharmacies – which are one of the main sites Oregonians get vaccinated and tested according to the Oregon Health Authority – have seen the most notable bottlenecks.
The state recently began ramping up efforts to secure more tests, though Gov. Kate Brown said it currently doesn’t plan to reintroduce COVID-19 restrictions amid record high daily case counts and an expected record number of hospitalizations and increasing deaths. The omicron surge is predicted to peak in late January, according to OHSU’s Dec. 31 COVID-19 forecast.
OHA purchased 6 million two-test at-home COVID-19 test kits on Dec. 30, with the goal to distribute the tests to at-risk groups and communities. Brown celebrated the purchase on Twitter, though numerous replies asked why it hadn’t come sooner, as the current surge was predicted weeks in advance when the variant was detected in the U.S.
Erica Heartquist, public information officer for OHA, said in an email to Street Roots the state was attempting to purchase a large amount of at-home tests for months before the successful Dec. 30 purchase.
At-home tests have been nearly impossible to find in stores, with many retailers selling out hours after receiving shipments.
Additionally, none of the four major Portland area hospitals that ran the “All4Oregon” mass vaccination site — OHSU, Providence, Kaiser Permanente and Legacy — said they had plans to reopen any mass vaccination or testing sites when asked by Street Roots. However, Providence and OHSU continue to offer no-cost walk-up vaccination clinics open to anyone. OHSU sites offer testing as well.
While OHA and the Multnomah County Health Department continue longstanding efforts to provide tests and vaccines, the recently added capacity has not met the demand created by the current surge.
Causes of delays
Though appointments for tests and vaccines as well as access to at-home tests are scarce right now, their respective supply chains — and the bottlenecks within them — share only some commonalities.
As omicron brings an explosion of demand for testing, the private companies manufacturing at-home tests struggle to keep up, creating widespread shortages nationally and locally, and leaving states, counties, companies and individuals scrambling to purchase them.
While at-home test shortages are driven by material shortages and supply chain issues created by increasing demand, neither vaccines nor lab COVID-19 tests have the same causes behind their unavailability.
In fact, part of what has caused shortages of at-home tests is the unavailability of appointments for PCR tests, Vox reported last month.
Similar to PCR tests unavailability, vaccine unavailability is not caused by a lack of actual supplies but by a lack of appointments and services to administer them.
PCR tests are manufactured by private manufacturers and then either purchased by governments and distributed to the public or purchased by private entities and sold to the public.
Vaccines are produced by private manufacturers, purchased by the federal government, allocated to the OHA on a weekly basis and sent to local providers who administer the shots.
“Generally, providers over the past few months have been able to get more than enough vaccine for the amount of appointments or expected demand,” Heartquist said.
Kim Toevs, the communicable disease and harm reduction director for Multnomah County Public Health, has seen increased demand on the ground at county-run vaccination sites, as well as pharmacies.
While Toevs said she can only directly speak to the county’s efforts, she pointed to a mix of more immediate and longer-term issues which could be causing the lack of appointments. On the more immediate side, she cited growing interest in the booster as omicron surges around the world.
“In early December, when the news came out about omicron, we started to see people be more interested (in vaccination),” Toevs said.
Multnomah County Health Department data shows calls to the county’s COVID-19 call center doubled from November to December due to increased demand for vaccine information and scheduling assistance.
The holidays also had direct effects on closures, with many testing and vaccination sites like OHSU’s Portland Expo Center site (which was also closed during snow at the end of December) temporarily closing.
Longer-term, Toevs said closures of mass vaccination sites like the All4Oregon site at the Oregon Convention Center in summer 2021 created a large population of people who would later need boosters but couldn’t go to those same mass vaccination sites.
“There’s a mismatch of capacity for the demands that we have now that people are a bit more concerned about omicron,” Toevs said.
Toevs said some increases in demand also have come as the CDC allows progressively younger age groups to get vaccinated and then their boosters, thus increasing the number of people seeking shots.
Finally, Toevs points to the impacts of widespread staffing shortages in health care. OHA echoed this.
“It’s important to understand that, for the most part, our vaccinators have had sufficient vaccine supply to satisfy demand in their communities,” Rudy Owens, OHA public affairs specialist, said in an email to Street Roots. “The more challenging issue has been workforce capacity to provide vaccinations.”
Owens said staffing issues also impact testing.
“The supply chain for (lab) testing is relatively stable and health care systems have not reported being unable to meet molecular testing demands due to test shortages; however, health care staffing shortages have reduced molecular test availability, causing delays due to fewer appointments being available,” Owens said.
Toevs said demand for tests and vaccines is high right now and timely appointments with many major providers are scarce, but only part of the full picture.
“I wouldn’t say that there’s an unavailability of (the) COVID vaccine right now,” she said.
Vaccine Availability
In the Portland area, COVID-19 tests and vaccines are administered by a complex web of providers including OHA, county health departments, community-based organizations, pharmacies, hospitals, primary physicians and urgent care centers.
While walk-up events run by counties, hospitals and others struggle under increased demand, providers using appointments such as pharmacies and some hospitals face the most significant delays.
Street Roots surveyed all major Portland-area vaccine and test providers’ appointment availability on Dec. 31, finding most did not have schedulable appointments until weeks into the new year for testing or vaccination.
Out of all vaccination providers surveyed, there were almost no appointments until Jan. 11. Many others did not have appointments until the third week of January or later.
Test appointments were even more scarce with two of four hospitals surveyed not offering testing to non-members. Five of the seven corporate pharmacy chains surveyed did not offer tests at all and the two that did – Rite Aid and CVS – had no appointments available at any of their locations.
“It’s important to understand that, for the most part, our vaccinators have had sufficient vaccine supply to satisfy demand in their communities,” Owens said. “The more challenging issue has been workforce capacity to provide vaccinations.”
Demonstrating both the high demand for appointments and the importance of checking frequently, Rite Aid briefly had a large number of January vaccine appointments throughout the Portland area only two days prior to Street Roots’ survey.
Scarce vaccine appointments are not only an issue in the Portland area.
A spot-check of pharmacies in all 36 Oregon counties the OHA conducted between Dec. 18 and Dec. 24 found 13 counties had no vaccine appointment availability within two weeks at 50% or more of the pharmacies in those counties, Owens said.
Owens said appointments within two weeks were particularly difficult to find in Curry, Deschutes, Lane and Multnomah counties.
The impact of these providers’ wait times is especially high because most people are getting vaccinated in their communities at places like pharmacies and clinics.
“Those vaccinators are providing about 90% of all vaccinations,” Owens said.
The number of vaccine doses administered per day in Oregon has trended downward by more than 66% since Dec. 8. Multnomah County saw a similar downturn. This may be partially attributable to the population of Oregonians who want to get vaccinated shrinking as vaccination efforts enter a second year. Google search data from Google Trends shows searches in Oregon for “vaccine” consistently trending down since August 2021.
Test availability
Demand for at-home tests has risen significantly in recent months, and the omicron surge has only increased that demand. On Dec. 30, Street Roots called 15 pharmacies throughout the Portland area and all were sold out of at-home COVID-19 tests. Most pharmacies told Street Roots they did not know when more tests would arrive. Pharmacists said when new shipments of at-home tests do arrive, they are quickly sold out — sometimes within hours.
Google searches in Oregon for “at-home test” are soaring, reaching their highest level ever in January and continuing to increase. Searches for “COVID testing” followed the same pattern.
The number of tests administered in Oregon varied through December, increasing between the first and second weeks then dropping steadily back to the initial level by the end of the month.
Concrete actions and questions of blame
On Dec. 21, Gov. Brown extended her declaration of a state of emergency and on Dec. 30, the OHA announced the purchase of 6 million two-test at-home COVID-19 test kits for statewide distribution.
The push to expand testing, which comes on top of the over 1 million tests already passed out, will prioritize BIPOC people, migrant and seasonal farm and agriculture workers, schools, shelters and other populations facing a disproportionate risk of illness and death from COVID-19.
Owens said OHA is in the process of creating additional high-volume testing sites throughout Oregon in January and “asking all vaccination providers to double or triple their administrations of vaccine, through using unused capacity or, if they’re running full, adding capacity.”
On the non-governmental front, pharmacies, hospitals and other COVID-19 service providers also continue providing tests and vaccines. OHSU and Providence both operate walk-up vaccine clinics and OHSU offers a number of testing options.
However, they face the same problems. The Oregon Nurses Association described extreme wait times at OHSU’s campus testing site impacting access to the hospital’s emergency room in a Jan. 3 press release.
Despite measures to increase testing and vaccinations, appointments are still often extremely difficult to find and at-home tests are still consistently unavailable to the public through any means. At the same time, COVID-19 cases soar and the state test positivity rate – a key metric in assessing how prevalent the virus is beyond cases reported to the state – reached the highest level ever at a staggering 23.3% on Jan. 5, and nearly matched it with a 22.1% weekend positivity rate on Jan. 11.
While the causes are undoubtedly complex, interconnected and deeply rooted, the lack of access to vaccines and tests amid a long-predicted surge has left many wondering why things are so dire.
When asked why this current spike got so bad, Toevs stressed structural factors and their local impacts on health care workers.
And with the pandemic coming after decades of disinvestment and piling health, safety and labor standards issues on top of a sector already dealing with a long history of those issues, undoubtedly her department and their peers at the state level and in the private sector have been through hell these last years.
Yet, the measures taken have simply not stopped the current surge.
And to Toevs, this is not a shock but the inevitable consequence of America’s for-profit health care system.
“The pandemic is just making things visible that we have to decide for the next pandemic, or for chronic disease and inequities, or for opiate overdoses or every(thing) … ‘well, how much tolerance do people in the United States have to let that system continue?’” Toevs said.
Toevs said while public health officials feel a responsibility to eradicate inequities, they are trying to “fill gaps in a system that we don’t run. It’s the for-profit system — so we try the best we can but we’re always going to fall short.”
To Toevs, the American health care system is piecemeal, leaving people to fall through the cracks.
“We’ve got folks who fall through the gaps and then we try, to the extent we can, to piece things together to have those gaps get covered,” Toevs said.
But she cautioned that with a virus as contagious as COVID-19, the popular expectation people can be totally protected is “beyond what we all have the science to do.”
This reality, especially in light of delta and omicron’s increased ability to evade vaccination and spread, has led to a change in Multnomah County’s efforts.
“We’re not trying to prevent COVID from occurring, including all the versions that are like the common cold,” said Toevs. “We’re trying to prevent people from getting severely ill and having like either losing their life or having significant long-lasting health consequences.”
These efforts are particularly focused on populations that face a disproportionate risk of illness and death from COVID-19 like residents of long-term care facilities and BIPOC people.
In an attempt to mitigate inequities in the pandemic response, the health department shifted from a focus on vaccinating children at WIC clinics to targeting elders and those with high-risk medical conditions within communities of color and immigrant communities. Toevs still said vaccine clinics are open to people of all eligible ages for any shot in the sequence.
The state echoed Toevs’ sentiment, saying it was prioritizing vulnerable populations that lacking access to vaccines and tests.
“OHA’s mandate is to reduce health disparities by targeting populations for testing who do not have access through traditional channels,” Heartquist said when asked if it’s OHA’s “responsibility to meet surges in demand for testing and vaccines.”
While the Governor heralded the purchase of the 6 million test kits, the measure – and the current state and local response at large – is triage.
“The 12 million tests were acquired to target vulnerable communities without access as well as critical hospital workers,” Heartquist said. “They are not sufficient to meet all testing needs statewide.”
Both Owens and Toevs said while their respective agencies are working to provide essential services to slow the spread of COVID-19, ultimately, every individual must take steps to protect themselves, their community and other Oregonians.
“Getting vaccinated and then boosted is the best protection against serious illness and death from COVID-19,” wrote Owens.
Noting the severity of the coming omicron surge, Toevs emphasized what is by now conventional wisdom.
“If you can get a booster, do,” Toevs said. “If you can get a good fitting mask and use it, do. If you feel like you’re one of those people who might get a severe version of the illness, now’s probably not the right time over the next month or so to be in a large group setting.”