NEW YORK (NYTIMES) - New Yorkers stood for hours in long lines to be tested for the coronavirus Friday (Nov 13), a disturbing indicator that shows the basic public health challenges that the country still faces many months after the pandemic first hit.
People waited for tests they needed for work or school. Some feared they might have gotten sick after flouting social distancing while celebrating after the election. Others hoped to safely visit family on Thanksgiving, which suggested that the problem might only worsen over the coming holidays.
And some, dissuaded by the prospect of lingering on sidewalks for more than three hours in the rain, walked away untested.
"It's so frustrating," said City councilman Mark Levine of Manhattan, who chairs the council's Health Committee. "We keep hitting new problems in tests. We solve one and another pops up."
The lines and escalating demand for testing underscore how a second wave of the virus is threatening New York City, and come as the rest of the country confronts record numbers of new cases - more than 181,000 nationally Friday (Nov 14). Several governors have warned that they are seriously considering further restrictions in a last-ditch effort to curb the outbreak.
Governors of California, Oregon and Washington urged their residents to avoid all non-essential interstate travel in the days ahead. In Utah, which also just set a case record, Governor Gary Herbert issued a statewide mask mandate this week and told residents to limit casual social gatherings to households.
In Illinois, which has seen more than 80,000 new cases in the last week, Governor J.B. Pritzker warned that the state could soon impose a stay-at-home order.
Mayor Bill de Blasio in New York announced that it was highly likely that the city would have to shut down the school system, the nation's largest, with 1.1 million children, because the seven-day test positivity rate in the city would soon hit 3 per cent.
In Washington, President Donald Trump made his first appearance to discuss the outbreak since the election and touted the possibility that coronavirus vaccines could be widely available by spring.
He also deepened his feud with Governor Andrew Cuomo, threatening to withhold a vaccine from New York state because of Mr Cuomo's criticism of the administration's vaccine distribution plan.
It was not immediately clear what impact that would have, given that Mr Trump is leaving office on Jan 20. President-elect Joe Biden is a close ally of Mr Cuomo and is likely to put in place a different distribution plan.
By all accounts, even if things go well, vaccines are still months away. For now, much of the attention is focused on testing problems, which were threatening to delay results and hinder efforts to control the spread of the virus.
New York City had a record number of tests Thursday, more than 74,000, officials said. Across the country, nearly 1.5 million people a day are being tested, according to the Covid Tracking Project - nearly double the number in August and far more than during the first wave of the pandemic in the spring, when there was far less capacity.
Public health systems around the country are once again straining under the need for testing. Some areas face looming shortages of laboratory capacity. In others, such as New York City, clinics and other testing sites have been swamped by huge numbers of people seeking to be tested.
"The spring pales in comparison to what we are experiencing now," said Dr Karissa Culbreath, the medical director and infectious disease division chief at TriCore laboratories in New Mexico, where cases have rocketed upward lately.
In recent months, millions more tests have become available to Americans, but demand has grown faster.
"We cannot continue to just throw more testing at this pandemic without more strategy," Dr Culbreath said.
From March to October, Dr Culbreath said, her team ran a half-million more diagnostic tests than is typical for their facility, a harried attempt to keep pace with the pandemic while still testing for other infectious viruses and bacteria that continue to afflict patients.
This week, the American Clinical Laboratory Association, which represents large commercial labs, like Quest Diagnostics, that have shouldered much of the coronavirus testing burden, warned that turnaround times for results would start taking longer, too.
The group said that its member labs had performed nearly a half-million virus tests Wednesday and were experiencing shortages of pipette tips and other testing essentials.
"Labs have managed to make it work," said Dr Patrick Godbey, the president of the College of American Pathologists and the director of two labs in Georgia. "Pathologists and lab scientists have made heroic efforts to answer the call. But demand has not gone down, and now the numbers are going up again. You're seeing it now in Illinois, in Wisconsin."
In Washington state, Providence Health and Services, which operates a drive-thru testing site near Olympia with Thurston County, had to turn motorists away when more than 200 cars lined up for tests Monday, the healthcare provider said in a statement. In Denver, testing sites were reporting hours-long waits.
Facing escalating complaints, city and state officials in New York tried to play down the delays, saying that people could obtain tests if they searched around.
Still, many New Yorkers were finding that it was not so easy.
New York City had for months promoted its progress in improving testing, but the lines this week showed that the public health structure was still facing difficulties in addressing the outbreak.
Collecting samples should be the easiest part of the process, given the demand for testing.
The government has relied in large part on existing urgent care clinics, like the CityMD network, to do much of the sample collection. But there are simply not enough collection sites to keep up.
Ms Joy Lee-Calio, a spokesperson for CityMD, which has more than 130 clinics in the New York City area, said the number of visits, most of which were coronavirus-related, had jumped 25 per cent over the past several weeks.
Government-run testing sites in New York had waits, but they were often somewhat shorter.
At a testing site under a large white tent in front of a public housing complex in Harlem, the line at midday did not extend far.
"I specifically avoided going to a CityMD because the lines don't move there," said Mr Josh Fiene, 31, who after 20 minutes was at the front of an eight-person line.
He did not have symptoms, but decided to get tested because his roommates had been hanging out with someone who was recently exposed to the virus.
But for many, the trouble was simply getting inside a clinic.
At 10am, Mr Avi Weinstein, 31, was waiting in line under a light rain on West 88th Street on Manhattan's Upper West Side, inching his way toward a CityMD urgent care centr ewhere he hoped to get tested. "I've been here for an hour and a half," Mr Weinstein said.
He said he had come down with a fever the previous night and was worried that he might have been infected while celebrating the election results last week with friends.
"I was expecting a long line," he said, "but not this long."