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

A variety of laboratories, hospitals, clinics and even telemedicine groups have started offering tests in Arizona, and state guidelines for who gets tested have relaxed in recent days.

The Arizona Department of Health Services announced April 23 that anyone who thinks they could be infected with COVID-19 or who has been recently exposed to it can get tested.

Previously, only individuals who were considered high-risk or those with symptoms like a fever or respiratory issues could get a test. The state early on urged primary care providers to consider avoiding testing if possible and instead use other "diagnostic tools" as demand for tests outpaced supplies.

For many weeks, people had trouble getting tested and often had to try multiple test locations. Test kits and the chemical reagents used in the process have been in short supply across the country. Arizona also has been short of swabs needed for the tests, said Dr. Cara Christ, the director of Arizona's health department. There have not been enough tests for everyone who feels sick and wants to know if they have the virus, but the state says that is changing.

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.

And testing is essential to understand the disease spread and deciding when Arizona should reopen its economy and relax social distancing.

Statewide testing capacity

As of April 28, the state reported a total of 67,438 completed tests. That number includes tests from private labs as well as the state public health lab.

According to public health experts, Arizona is not doing nearly enough testing to provide the data needed to consider reopening the economy, something that could begin in Arizona as early as May 1.

The state has not done enough teststo determine how widespread COVID-19 is in a state as large as Arizona, experts argue. Some say Arizona needs 100,000 tests every month to understand the spread clearly enough to safely reopen. Arizona consistently has ranked among the bottom states in tests per 1 million residents.

Gov. Doug Ducey and the state health department in late April announced a "testing blitz." The goal is to test 30,000 to 60,000 people over the next three weekends.

The plan is to test between 10,000 and 20,000 Arizonans for three consecutive Saturdays. The surge begins on May 2 and will continue on May 9 and May 16.

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 and one in Tucson.

It opened a fifth drive-up location for prescreened patients the week of April 20, company spokeswoman Becky Armendariz said. The site is in the metro Phoenix area.

The addition of a fifth site will take the company's testing capability to 8,000 tests per week, Armendariz said.

Banner opened an additional testing location this week at the Arizona State Fairgrounds. The new location is the system's largest testing operation and can accommodate individuals without cars.

Anyone experiencing symptoms or with concerns of possible exposure can now get tested through Banner. Previously they had to have symptoms or be high-risk.

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.

The Phoenix-area sites are in the northwestern Valley, the southeastern Valley and the east Valley. Addresses are not provided to limit people driving up without being prescreened and making an appointment.

"We continue to have more ability to do testing, both from the equipment and the reagent perspective, as well we've got good, ongoing supplies of swabs and the viral media it needs to be transported in," Dr. Marjorie Bessel, Banner Health's chief clinical officer, said.

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 $95 for the test, although both may be reimbursed depending on legislation, Morris said.

Since testing began in mid-March, Maready has conducted about 275tests. Of the results received, 12 have been positive, as of April 1.

The clinic is looking into antibody testing, but wants more information before it offers it, Morris said. She expects increased requests for tests as the economy begins to reopen but said the clinic is ready.

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

Walgreens: El Mirage and Tucson sites

Walgreens opened two drive-up test sites on April 17: one in El Mirage outside of Phoenix and one in Tucson.

Testing is available by appointment only and only for individuals who meet CDC testing criteria. Individuals must first complete an online health assessment at www.walgreens.com/coronavirus.

Tests are conducted outside the pharmacy buildings. Walgreens pharmacists oversee patients' self-administration of Abbott's new ID NOW COVID-19 test. Patients get results back within 24 hours.

CVS to offer Minute Clinic testing

CVS is ramping up free COVID-19 testing in Arizona and nationwide, the company announced April 27.

Free self-swab testing will be available at up to 1,000 CVS Pharmacy locations nationwide by the end of May. This accounts for more than 1 in 10 of the company's U.S. stores. Individuals will be tested if they meet U.S. Centers for Disease Control and Prevention criteria.

The initial focus is on CVS Pharmacy locations with Minute Clinics, spokeswoman Monica Prinzing said. Arizona has 34 Minute Clinics.

People can schedule a test appointment online starting in May. Testing will happen in parking lots or at drive-thru windows, not inside stores.

Escalera Health: drive-up testing in Tucson

Escalera Health in Tucson has been offering COVID-19 testing for about three weeks. As of April 1, around 400 tests have been completed, many for health care providers and front-line workers.

Of the swab tests, around 30 have come back positive, according to CEO Dr. Christian Moher. The clinic offers antibody testing. Nasal swab tests are sent to a private lab and antibody tests are processed on-site.

Individuals who want to be tested do not need to call in advance or schedule an appointment. They can drive up to the clinic and they are screened as they arrive. Testing is open to everybody.

“We use screening questions to see if patients have symptoms or exposures, using CDC guidelines, but also use clinical judgment,” Moher said. “We are hoping our community-based approach keeps people out of the overcrowded ERs and hospitals.”

The clinic is located at 2224 N. Craycroft Road, Suite 100, in Tucson. For more information, call the clinic at 520-209-1919 or visit www.escalerahealth.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.

The group sees "record-breaking numbers" of new patients worried that they have COVID-19. The vast majority are not tested, per CDC guidelines. In the weeks since the group started testing, 55 tests have been administered and five have come back positive, as of April 1.

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

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

Sonora Quest: carrying the bulk of state testing

Sonora Quest Laboratories has completed more than 33,000 COVID-19 tests since it began processing samples on March 20 at its Tempe lab. Much of that has been from test locations in Maricopa County, said Brian Koeneman, Sonora Quest's scientific medical director.

That's well over half of the total tests completed in Arizona.

Sonora Quest's initial positive rate for tests was around 5% to 6%, he said. It's now closer to 9%.

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 31 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 has been 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.

Sonora Quest announced April 24 it would begin antibody testing. The lab expects to perform 1,000 to 3,000 tests a day initially. In May, it hopes to offer antibody testing available to individuals without a doctor's order.

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 Clinic Phoenix campus. Since testing began on March 11, the clinic has completed more than 4,000 tests as of April 1.

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. Monday through Friday, 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 over 95,000 tests. In Phoenix, there are 38 positive veteran cases and two inpatient deaths, according to the VA website. There are 10 positive cases at the Prescott location and 23 positive cases and two inpatient deaths 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.

Republic reporter Stephanie Innes contributed to this story.

Reach the reporter at Alison.Steinbach@arizonarepublic.com or at 602-444-4282. Follow her on Twitter @alisteinbach.

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