In the race to expand testing for the novel coronavirus and track the results, California has fallen behind New York and other hot-spot states as an assortment of public and private groups pursue testing programs in an uncoordinated fashion.

A fragmented landscape akin to an orchestra playing without a conductor has emerged with public officials at the city, county and state levels scrambling to come up with testing options and priorities. At the same time, various universities and an increasing number of private, for-profit labs have developed their own testing schemes.

The result has been a confusing, incomplete picture of the virus in California.

Public health experts warn that a robust, coordinated testing program is crucial so the state knows not only who is infected but how quickly and where the virus is spreading in order to effectively deploy limited resources, such as protective equipment, ventilators and medical staff.


“We are cobbling together various approaches,” said Susan Butler-Wu, an associate professor of clinical pathology at USC’s Keck School of Medicine and a director of a clinical microbiology lab in Los Angeles. “The whole thing is badly discombobulated.... I think 100% that the system is broken.”

Certainly, Butler-Wu said, California is not alone, as the failure of federal health officials to establish a coordinated, nationwide testing strategy has given rise to a similar mishmash of testing options around the country. The impact, however, has been particularly blunt here, where the sheer size of the state and the large number of testing operations have exacerbated the problem.

In California, there are at least 22 state laboratories, seven hospitals and two private outfits conducting tests. It is unclear how testing at those sites is being tracked, in part because Gov. Gavin Newsom has not provided details.


Newsom said Monday that part of the problem has been an inability by the state to accurately collect all test results. He has deflected, however, questions about California’s overall testing capacity and whether it could have ramped up more quickly.

By Sunday afternoon, approximately 26,400 tests had been conducted in the state, which has about 40 million people, according to the state’s official tally. The total was an increase of just 200 tests from the day before.

By contrast, New York, which has half as many residents and is grappling with the nation’s largest number of COVID-19 cases, had performed more than 78,000 tests as of Monday, according to the COVID Tracking Project, an independent group.

1 / 29 Workers at the Ralphs grocery store in Westchester measure out social distancing guidelines for its customers with markers every six feet and limiting the number of customers it allows in to shop. (Jason Armond/Los Angeles Times) 2 / 29 At Echo Park Lake, friends gather with their dogs and enjoy a Sunday afternoon in the park. Social distancing and home isolation remain in effect due to the coronavirus. (Carolyn Cole/Carolyn Cole/Los Angeles Times) 3 / 29 During the coronavirus pandemic, people continue to walk and ride their bikes along the path at Junipero Beach in Long Beach. (Francine Orr/Los Angeles Times) 4 / 29 People run and walk on the Veterans Parkway in Manhattan Beach even with signage saying the space is closed to help minimize the spread of the coronavirus. (Dania Maxwell/Dania Maxwell/Los Angeles Times) 5 / 29 Jesus Mendoza sells roses on the sidewalk in downtown Los Angeles. Mendoza said his business was overwhelmed by hundred of boxes of roses they could not sell. (Francine Orr/Los Angeles Times) 6 / 29 Riverside County medical personnel administer a coronavirus test to a driver at a drive-though testing facility at Diamond Stadium in Lake Elsinore. (Gina Ferazzi/Los Angeles Times) 7 / 29 Drivers line-up to get a coronavirus test administered by Riverside County medical personnel at a drive-though testing facility at Diamond Stadium in Lake Elsinore. Those tested have symptoms or have had a risk of exposure. (Gina Ferazzi/Los Angeles Times) 8 / 29 Xiao Ping, holding a tray of eggs, looks back at the long line of egg buyers on Saturda morning in Chino. Spooked by coronavirus people from nearby Inland Empire cities started lining up early morning at Maust’s California Poultry in Chino. (Irfan Khan/Los Angeles Times) 9 / 29 Spooked by coronavirus fears, people from nearby Inland Empire cities lined-up to buy eggs at Maust’s California Poultry in Chino. (Irfan Khan/Los Angeles Times) 10 / 29 The sparsely trafficked intersection of the 101 and 110 freeways in downtown Los Angeles is seen in a drone image. (Carolyn Cole / Los Angeles Times) 11 / 29 School buses sit idle since all schools have been closed in Los Angeles County. The image was taken by drone. (Carolyn Cole / Los Angeles Times) 12 / 29 In this drone image, the Westfield Topanga mall parking lot sits empty, as new regulations have closed all indoor shopping centers in Canoga Park. (Brian van der Brug / Los Angeles Times) 13 / 29 Vehicles flow smoothly along Interstate 5 and the 110 Freeway in Los Angeles in this drone image. (Brian van der Brug / Los Angeles Times) 14 / 29 The city of Santa Monica has closed the Santa Monica Pier, and few people were on the beach Friday. (Carolyn Cole / Los Angeles Times) 15 / 29 Shops are shuttered on historic Olvera Street in downtown Los Angeles. (Irfan Khan/Los Angeles Times) 16 / 29 The intersection of the 101 and 110 freeways in downtown Los Angeles. (Carolyn Cole/Los Angeles Times) 17 / 29 Hollywood Blvd. is devoid of the usual crowds as most shops are closed. (Brian van der Brug/Los Angeles Times) 18 / 29 Hollywood Blvd. is devoid of the usual crowds as most shops are closed. (Brian van der Brug/Los Angeles Times) 19 / 29 On the first day of L.A.'s ‘Safer at Home,” most major avenues and streets in downtown Los Angeles have very little traffic. (Irfan Khan/Los Angeles Times) 20 / 29 Empty streets in downtown Los Angeles. (Irfan Khan/Los Angeles Times) 21 / 29 The main entrance to Union Station is closed. (Irfan Khan/Los Angeles Times) 22 / 29 Union Station was restricted to only ticketed passenger and main entrance closed. (Irfan Khan/Los Angeles Times) 23 / 29 Commuter protect themselves with a face mask while riding a bus at El Monte Metro Station. (Irfan Khan/Los Angeles Times) 24 / 29 Salvation Army volunteer Christina Cuevas sets up cots for homeless at Westwood Recreation Center in Westwood. (Brian van der Brug/Brian van der Brug/Brian van der Brug/Los Angeles Times) 25 / 29 Popular shopping destination Rodeo Drive is all but deserted as retail shops are shuttered in Beverly Hills. (Brian van der Brug/Los Angeles Times) 26 / 29 The Apple store is among all the stores which have closed during the coronavirus outbreak in Newport Beach. (Gina Ferazzi/Los Angeles Times) 27 / 29 With all the stores closed, Fashion Island is a ghost town except for an occasional customer getting food for take-out Newport Beach. (Gina Ferazzi/Los Angeles Times) 28 / 29 People walk the beach, but maintain “social distancing” during the coronavirus outbreak at Crystal Cove in Newport Beach. (Gina Ferazzi/Gina Ferazzi/Los Angeles Times) 29 / 29 During the coronavirus epidemic people continue to walk, ride thier bikes, and play basketball at Junipero Beach in Long Beach. (Francine Orr/Los Angeles Times)


Based on population size, California’s official test numbers are not at the bottom of the state rankings, but it is below the national average of nearly 90 tests performed for every 100,000 residents, according to a Los Angeles Times analysis of testing numbers tracked by the group. California also lags behind other states that have experienced large outbreaks of the virus, including Louisiana and Washington.

The United States as a whole was slow to ramp up testing for the virus after a test designed by the national Centers for Disease Control and Prevention was found in early February to be flawed. Federal regulators then kept other labs from designing and using their own tests until Feb. 29, when they belatedly relaxed their rules.

Since then, dozens of companies as well as public and private labs have designed tests. But laboratories have struggled to process the sudden surge in demand.

In light of those backlogs, as well as shortages of materials needed to perform the tests, county health officials and hospitals around the state have largely stuck to guidelines from the CDC that reserve tests for those showing symptoms of the virus and at highest risk of contracting it.


Universities and other healthcare networks, such as UCLA, UC Davis and Kaiser Permanente, have developed their own tests, although the number being performed remains relatively small.

And local authorities across the state have been left to try to boost their own capabilities. Los Angeles County announced Monday it has secured 20,000 tests with a processing capacity of 5,000 tests per day. The kits will be free, and healthcare workers and first responders will be given priority for testing.

Los Angeles Mayor Eric Garcetti announced a smaller testing program Monday for the city that will focus as well on first responders, but will also test some residents considered at high risk of becoming infected. L.A. Councilman David Ryu said city officials are in talks with a South Korean company that could make tens of thousands of tests available.


“There are not enough supplies to meet the demand,” Butler-Wu said. “It’s basically every system or hospital for itself and that is not what you want for a pandemic.... You need a coordinated system that is rolled out across the state, across the county.”

This piecemeal approach, said Harvard epidemiologist Michael Mina, is a key problem with testing in California and nationwide.

“We have a decentralized healthcare system and we have no way to scale for government means,” Mina said. “Everything is privatized, everything is individualized in our country and it’s become our Achilles’ heel in this case.”

On Monday, when he was asked why fewer people are being tested in California compared with New York, Newsom said the state’s numbers do not include all tests being conducted.


“We have a number of different test protocols that are underway that are not part of the 26,400 number that you received this morning,” Newsom told reporters.

The governor said the state would release more accurate figures on Wednesday that include data from more facilities now conducting tests. The new number, he said, “will substantially increase” the current totals.

Newsom said as the state moves to increase testing, it will focus in part on community surveillance to better understand the scope of the crisis.

“The bottom line for us is we want to know what the spread is,” Newsom said Saturday. “We want to know if we’re bending the curve. We want to know if our stay-at-home orders are effective. That’s fundamentally the point of testing in terms of the broader sample.”


Mina echoed the importance of this approach, saying, “We are flying blind through this tunnel at the moment, and we don’t know where we are in the epidemic curve.”

Newsom said the state has conducted so-called community surveillance testing in Santa Clara, Los Angeles and Orange counties. The governor said the tests have been “very helpful” and he expects to expand them throughout the state, but did not say what the tests had found.

Among the fragmented snapshots California is gathering are drive-up testing programs now in four counties, through a state partnership with a subsidiary of the Google tech empire. The first week the project tested 1,200 people, prioritizing healthcare workers and initially including some people with no virus symptoms. The state expanded the project over the weekend to Riverside and Sacramento counties.

Conducting random sample tests, Newsom said, will not supplant traditional tests for people who show signs of infection or work in jobs with a high risk of exposure to the virus.


But with resources so limited, the two needs are in competition with each other. While the governor is charged with protecting the broader health of the entire state, doctors are trying to treat patients and protect themselves. With the lack of available tests, the two responsibilities are colliding.

That collision is playing out especially in hospitals in the Bay Area and Los Angeles, which have the highest numbers of infected people.

At L.A. County-USC Medical Center, for example, the slow pace of testing is exacerbating shortages in safety equipment medical staff wear to guard against becoming infected. When it’s not clear someone with respiratory problems has COVID-19, staff members have to behave as if they do, which means doctors, nurses, support staff and cleaners can waste precious protective gear while awaiting test results.

As of Friday, the turnaround time for tests was between five and seven days, a spokeswoman for the county Department of Health Services said. In an effort to find a work-around, the county has purchased equipment to perform in-house testing, but is still a few weeks away from being able to do so, she said.


Times staff writer Harriet Ryan contributed to this report.