By Cody Mello-Klein and Missy Schrott

This article was updated on March 26.

As the COVID-19 pandemic escalates, one of the biggest questions on residents’ minds is, “How do I get tested for coronavirus?”

The number of available test kits is an ongoing problem nationwide, Dr. Stephen Haering, director of the Alexandria Health Department, said at a city council emergency meeting on March 18.

So who can get tested? Testing in Alexandria is limited to patients with symptoms of COVID-19 and a doctor’s order, city spokesman Craig Fifer said.

“Localities do not determine test availability or criteria,” Fifer said in an email. “… Localities can help around the edges of testing, but we can’t just ‘get everyone tested.’ There are not enough tests yet to test people who don’t have symptoms and/or high-risk factors.”

Most doctors are following the Centers for Disease Control and Prevention’s criteria for testing.

“The CDC criteria has been symptomology, which includes cough, fever, shortness of breath and previous exposure,” Dr. Rina Bansal, president of Inova Alexandria Hospital, said. “It’s really at this point clinical judgement. If you’re being assessed by a provider and that provider’s concerned that you are at risk for COVID-19, we will test you. What it excludes is people just walking in asking for COVID-19 testing, but if you see a provider and they’re concerned, we will test you.”

AHD advises that those with symptoms associated with coronavirus contact their private care physicians about getting tested. Private practitioners can either conduct tests themselves or direct patients to another provider with a doctor’s order. Once tested, samples are typically sent to private labs run by LabCorp or Quest Diagnostics or to the state public health lab, Haering said. It usually takes several days to get test results.

There are ongoing challenges with pushing people toward PCPs, given that local PCPs might not have access to test kits or the personal protective equipment – goggles, masks, gowns – required to administer tests.

“I didn’t have any [test kits] until a few days ago, and I was able to get 10 for my entire practice,” Dr. Matthew Haden, owner of Modern Mobile Medicine, a local house call-based practice with about 400 patients, said. “It’s the perfect storm of not enough test kits [and] even if you have the test kits, if you don’t have the personal protective equipment, you shouldn’t be doing a test.”

Some private practices haven’t been able to secure any test kits at all, including Belleview Medical Partners, a private practice based in Old Town with about 150 established patients. However, Dr. Vivek Sinha, founder of the practice, said there’s a silver lining being located in this region.

“We’re lucky that we’re in the DMV area where there are some world-renowned facilities that are actively taking care of patients with COVID-19, so obviously they have the ability to test and so forth,” Sinha said. “What we’re waiting for is just widespread access to the testing.”

Another challenge with pushing people toward PCPs is that some residents don’t have access to private care. At the March 18 meeting, Councilor Canek Aguirre asked Haering for advice for those who are underinsured, uninsured or do not have a PCP.

“Not everybody has a PCP, a primary care physician. Not everybody knows where to go if they don’t have a doctor,” Aguirre said.

“That’s the same problem the uninsured, underinsured have every single day in our country,” Haering said. “It’s exacerbated, compounded, when we have this sort of emerging infection. We don’t have a good answer. That’s the bottom line, I do not have an answer to that very complex problem.”

AHD is currently referring uninsured residents to urgent care centers.

Residents who meet criteria can get tested at Inova Alexandria Hospital. As of March 20, Inova had tested between 80 and 100 people, Bansal said.

“Our testing capacity is good, as in we are able to test patients who meet criteria who need to be tested,” Bansal said. “We have not turned away anyone who came to any of our facilities who needed to be tested without testing them, and we are continuing to work on expanding that capacity as well, in addition to what we currently have.”

Several community members have expressed interest in drive-through testing sites, which have been used in other parts of the country as well as abroad. However, there are currently not enough test kits in the region to do drivethrough testing in Alexandria, Fifer said.

Haering cautioned residents to only attempt to get tested if they are showing symptoms. The high demand but low supply of test kits means health professionals need to prioritize who gets tested.

“I don’t mean to minimize a person wanting to get tested to make sure that they haven’t exposed somebody, because that’s very important and this is a very, very serious illness,” Haering said. “The challenge is the lack of test kits that [are] available.”

Because of the scarcity of test kits, it’s highly likely that far more Alexandria residents have COVID-19 than realize it.

“I believe that there are a lot more people that have it than we can test for,” Sinha said. “And in a way, that’s good and bad. It’s good because there’s people that have it who really are not showing symptoms and they’re doing well, … but it’s also bad because if you don’t know that you have it, then you’re more likely to spread it to somebody who will not have a good outcome if they were to catch it.”

(Read more: Local healthcare providers brace for COVID-19 surge)