As the new coronavirus spreads in Arizona, more and more people may get fevers, coughs and shortness of breath — the hallmark symptoms of COVID-19.

But many Arizonans will never know whether or not they had the virus.

A variety of laboratories, clinics and even telemedicine groups have started offering tests in Arizona, but guidelines are strict for who gets a test. For the most part, unless you’re very sick and present multiple symptoms or known exposure, it may be difficult to get tested.

The state issued March 25 new guidance for testing to primary care providers, urging them to “consider removing this diagnostic ‘tool’ from their toolbox and managing patients with respiratory conditions as if they have COVID-19.”

The state’s “current reality” is that demand for testing outpaces supplies, according to Dr. Cara Christ, the director of Arizona’s Health Department.

“Keep working with your commercial vendors for testing, but do not depend on having test results for your management,” she said. “There is no specific treatment or management strategy (for COVID-19), and results should not change clinical management.”

Christ estimated that illnesses would peak in April and hospitalizations would peak in May.

Test kits and the chemical reagents used in the process are in short supply across the country. Arizona is also short of swabs needed for the tests, Christ said. There are not enough tests for everyone who feels sick and wants to know if they have the virus.

Testing is no remedy in itself, but it can help public health officials see hot spots for the virus and plan the best response. It can also motivate individuals who test positive to self-isolate and practice social distancing to curb the spread of the coronavirus.

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Statewide testing capacity

The Arizona Department of Health Services website details how testing has stepped up across Arizona. The weekly numbers include tests from private labs as well as the state public health lab:

  • By February 23: 3 tests.
  • By March 1: 53 tests.
  • By March 8: 1,235 tests.
  • By March 15: 8,918 tests.
  • By March 22: 20,605 tests.
  • By March 29: 21,057 tests.

While there was a big jump in testing in mid-March, the rate of increase has significantly dropped since then, possibly correlating with Christ’s urging for more restrictive testing. Fewer than 500 tests were conducted statewide the week of March 22.

Arizona’s lab capacity is “really quite limited,” said Dr. Marjorie Bessel, Banner Health’s chief clinical officer. Banner’s tests, even for inpatients, were taking almost 60 hours to get results, she said.

Bessel said she agrees with the state’s prioritization of testing inpatients, health care workers and first responders, followed by those in vulnerable places such as nursing homes.

“While I agree with the (state’s) prioritization, what I would hope for, and what we need to do from a state perspective, is we’ve got to get more in place and loosen that up so that we can go to more wide testing,” she said.

With such limited testing, Bessel said, it’s hard to know what the spread looks like, how many people are infected and how many people should get tested.

“It puts us in a position where we are just not as well aware,” she said, referencing Arizona’s lower rates of testing per capita comparedwith other states.

For Arizonans, testing may be unlikely for most but there are a number of options patients can try and several major labs are processing tests. Some of them are outlined below.

Banner’s drive-up test sites

Banner Health, Arizona’s largest health system, opened four drive-up test sites on March 23, three in the Phoenix area in one in Tucson.

Patients must be prescreened on a phone call with a Banner clinician before getting a testing appointment. Patients who just show up will not be tested.

Criteria for getting tested include symptoms and other indications of the “likelihood of having COVID-19,” company spokeswoman Becky Armendariz said.

The three Phoenix area sites are in the northwestern Valley, the southeastern Valley and Mesa. Addresses are not provided to limit people driving up without being prescreened.

When Banner announced it was opening the sites on March 23, officials said they hoped to open even more drive-up sites. But by March 27, they’d backed off on those plans, at least for the time being.

The phone number to call is 844-549-1851 to speak with a clinical team member to determine if testing is appropriate. The line will be staffed from 7 a.m. to  6 p.m. Monday through Thursday and 7 a.m. to 5 p.m. on Friday.

Tests are free for those with insurance and Banner Health will not decline tests for any uninsured individuals.

Maready Medical: Mesa drive-up site

Another option is Maready Medical, a Mesa-based primary care office.

Individuals are evaluated during a virtual assessment that takes into account symptoms, exposure and risk level. Patients do not get tested if they lack COVID-19 symptoms or known exposure, said Phoebe Morris, Maready Medical’s practice manager.

If a patient meets the criteria for testing, they go for a drive-up test in Mesa. There is no out-of-pocket payment for the virtual evaluation or the test for patients with health insurance. Uninsured patients pay $90 for the virtual visit and $77 for the test, although both may be reimbursed depending on legislation, Morris said.

In the two weeks since testing began, Maready has conducted about 200 tests from 800 requests. Of the results received, three have been positive.

Patients can schedule a telehealth appointment by calling the office at 480-626-2444 or booking online at www.mareadymedical.com.

Telemedicine offers at-home testing

United Telehealth Corp., a Scottsdale-based telemedicine company, has integrated at-home COVID-19 tests into its house calls. Technicians visit patients’ homes and, if patients qualify, they administer a coronavirus test and provide any needed follow-up care as well as a video call with a doctor.

Dr. Nima Ghadimi, president of United Telehealth Corp. and Scottsdale Physicians Group, said when COVID-19 hit, the telehealth model he had created filled a unique role of providing health care while maintaining social distancing.

“In order to keep these patients out of the public domain, someone, somehow, needed to bring the care to them and be able to do a physical examination and actual testing to either confirm the infection with this COVID-19 or rule it out,” he said.

The group’s technicians began bringing test kits to home visits two weeks ago. But like other groups, Ghadimi said they are selective about who gets tested.

“We don’t want to just go ahead and test everyone because we know that for more than 90% of the cases, it’ll come back negative, which is wasting a very scarce tool,” he said.

Ghadimi said his group gets 60 to 70 new patients a day. Maybe 20 to 25 of them feel they’ve been exposed or may have coronavirus, Ghadimi said. In the several weeks since starting testing, 15 tests have been administered. Five cases have come back positive.

Patients, whether insured or uninsured, have no out-of-pocket payments for coronavirus-related expenses, Ghadimi said.

For more information or to book a telehealth appointment, call 480-268-2670 or visit www.unitedtelehealthcorp.com.

Sonora Quest: carrying the bulk of state testing

Sonora Quest Laboratories has completed about 14,000 COVID-19 tests since it began processing samples on March 20 at its Tempe lab, per Brian Koeneman, Sonora Quest’s scientific medical director. Much of that has been from test locations in Maricopa County, he said.

That’s about two-thirds of the 21,058 total tests completed in Arizona as of Wednesday.

Sonora Quest’s initial positive rate for tests was around 5% to 6%, he said. It’s now closer to 6% to 7%. Koeneman expects the rate of positive tests to increase in the weeks ahead.

Sonora Quest receives samples from physicians and health care providers who have swabbed patients. Patients cannot visit a Sonora Quest lab site for testing. Patients typically learn results from the ordering physician in about 50 hours.

The lab has completed such a large portion of all state tests given its size, facilities, personnel and capacity to meet a high demand, Koeneman said.

But Sonora Quest does still face the “daily battle” of getting enough reagent solution and supplies to keep up, he said.

Test results are forwarded to the state health department on a daily basis, Koeneman said. Sonora Quest is working with the health department and partners nationwide on data analytics to better track testing, hot spots and cases state-by-state and county-by-county.

Other testing options

Arizona State Public Health Laboratory: The state lab provides some coronavirus testing and is focused on the highest-risk patients. The phone number for statewide COVID-19 information is 1-844-542-8201.

HonorHealth: HonorHealth facilities are performing COVID-19 tests. Health care providers determine if a patient needs to be tested. Results may take up to five days. Individuals with a fever above 100 degrees, cough and shortness of breath should call the nurse line at 480-587-6200 to be evaluated. HonorHealth advises people who feel sick to call ahead before visiting. Their website also has a symptom checker and live chat.

Abrazo Health: Abrazo Health has an online COVID-19 assessment to determine if testing is necessary. Depending on the assessment, an individual may be recommended for a virtual consult with a health care professional to determine next steps.

Mayo Clinic: Mayo Clinic locations in Arizona are testing Mayo Clinic patients who have a doctor’s order. In-house tests are only for Mayo patients. Patients who are high-risk, symptomatic or more vulnerable, and have a Mayo doctor’s order, will be tested at a drive-thru collection or a lab at the Mayo campus. Since testing began on March 11, the clinic has completed more than 2,000 tests.

NextCare: This urgent care group has collection sites for testing at clinics when resources are available. If patients meet criteria, they may be tested and the sample sent off-site, with results available in two to seven days. NextCare has started offering curbside services as well, including COVID-19 testing when possible.

Coconino County: Residents can call 928-679-7300 from 8 a.m. to 9 p.m. Monday through Friday and from 9 a.m. to 4 p.m. Saturday and Sunday. They may be referred to the county-run specimen collection site at Fort Tuthill for swab testing, which is open 10 a.m. to 3 p.m. Sunday through Thursday, while supplies last. An order from a medical provider is required to get tested. Coconino previously ran another test location at Coconino Community College, but it closed because of limited students returning there and limited PPE supplies.

Phoenix VA Medical Center: The VA is testing veterans for the coronavirus. Nationwide, the group has administered nearly 17,000 tests. In Phoenix, there are three positive veteran cases: two inpatient and one outpatient, according to the VA website. There are three outpatient cases at the Prescott location and two inpatient, two outpatient at the Tucson branch.

LabCorp: LabCorp labs nationwide, including in Arizona, are testing for COVID-19. Tests must be ordered and collected by doctors or health care providers and then sent to LabCorp for processing. Results are available in three to four days. Tests cannot be ordered directly by patients.

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