COVID-19 testing sites are popping up all over Hawaii as the state increases its testing capacity. But can anyone get a test on demand and, if not, how is that decided?
Back in early September, when new daily coronavirus cases soared past 300, officials invited anyone who wanted a COVID-19 test to participate in a mass effort to detect the virus in the community.
Cars lined up for the surge testing at multiple locations, including on the H-3 freeway, which was closed for the drive-through event, although federal transportation officials didn't approve.
There were a lot of tests then and no one needed to have symptoms to get tested.
That may not always be the case.
If fewer tests are available because of a surge in cases or other circumstance, a state policy now in draft form ranking who gets tested first could kick in.
At the top of priority list are those with symptoms. Second are those who are asymptomatic but who work in health care, live in nursing homes or are imprisoned.
The third group are those in a surveillance testing program or those without symptoms working in retail, food service, education and public transportation.
And last are those who are asymptomatic with no tie to essential services.
"Because it's our lowest priority group, testing is available to this group only when resources permit," said Edward Desmond, the state Department of Health laboratories director.
There are enough testing resources for now. Tests, both rapid tests and the more reliable PCR swabs, are seemingly everywhere.
"Low-priority people can go to drive-up clinics, and right now our resources are adequate. If we had another wave so that our resources became strained, and [it] became difficult to test everybody, that lowest priority group might have to be deferred," he said.
Desmond says because most tests are processed by private laboratories, it’s the labs that tell the clinics and other health providers who administer the tests whether they can handle the demand.
A spike in cases or testing demand could stem the open access to tests that we’re seeing now.
Hawaii can comfortably run about 7,362 tests per day but could ramp up to 8,000 daily, if needed. But as with everything else about COVID, that capacity is constantly changing.
Desmond says at least one private lab worries about interisland travelers; they can now avoid the mandatory 14-day quarantine by taking a negative pre-flight test, and their numbers could grow.
"It’s conceivable for that second laboratory, that increasing the volume of testing for travelers might kind of pinch their ability to do their diagnostic work," he said. "They would make sure they collected no more samples than they could test, while also keeping up with their higher priorities."
Heather Pierce, senior director at the Association of American Medical Colleges, said one of the main reasons why tests are so confusing is that their availability constantly changes.
"Part of the confusion is that we have a piecemeal approach to testing that differs state by state," she said. "In some states, that have ample supplies and testing areas, there are walk-up or drive-up testing centers for anyone who wants to test. Sometimes there are symptoms required before someone can prescribe a test for you. What we're concerned about is that the virus isn't different from state to state."
Pierce said once there is a vaccine, antibody testing may become more important.
"That's the goal of vaccination. So people build up antibodies so that if they're exposed to COVID-19, which is SARS COV-2, the virus that causes COVID-19, they will not catch it."
She and Desmond say if the vaccine that is eventually distributed is limited, the antibody test could help determine who gets it first -- those without antibodies could get priority.
But since so much is unknown about how long antibodies protect people, that strategy may need more study.
Desmond hopes that by next year, there will be clearer science developed.