Last Friday, Maya Edelman and her husband lined up outside a CityMD clinic in Park Slope to get tested for coronavirus. It was a scorching hot day and there were at least 20 people before them in a snaking line, but the couple felt a sense of urgency. They were planning to visit family in Maine in the coming days and wanted to make sure they would not be carrying the virus with them. Under a partnership with the city, the urgent care clinic, which has 66 locations in the city, has been offering free testing.

Earlier into the pandemic, a friend had told Edelman that she had gotten tested at a CityMD and that the results took only three days.

But after Edelman entered the testing facility, a CityMD employee told her that the wait time would be around seven days. The 39-year-old was stunned. Were she already infected, it might be possible that the virus would have already cleared her system by then. It's also possible she could contract the virus during the week-long lag between the test and the result, essentially resulting in a false negative.

"If you wait seven days before you get your results, the results are more likely to not be true by the time you get them back," she said. "I heard that there are tests where you can spit on a thing and get it back within a day."

At the onset of the pandemic, public health officials stressed that the war against the coronavirus could only be won by ramping up the supply of testing. In New York, city and state officials were quick to jump on the effort, striking out in early March to get testing performed at public labs and forging relationships with private ones.

Now, three months into the crisis, New York, along with Rhode Island, routinely perform the most tests per capita of any state in the country. The state has tested roughly 60,000 people daily in recent weeks. New York City alone has tested more than 35,000 individuals in a single day, relying on both its own publicly-run testing facilities as well as private urgent care clinics.

But as testing has become more available, increased demand across the country is lengthening the turnaround time for results at private labs, something that city officials have recently acknowledged. While New York has an apparent abundance of testing, other cities and states are only now trying to get up to speed as they face a surge of virus cases.

"Unfortunately this is becoming a problem," said Dr. Jay Varma, the mayor's senior public health advisor, during a press briefing on Tuesday. "We are seeing longer turnaround times from certain laboratories."

He added: "When there is an increasing demand for testing from other parts of the country, that can backlog New York City specimens."

The predicament reflects the struggles of the U.S. testing industry, which was mobilized too slowly by the federal government and is at the mercy of a complicated international supply chain. In New York City, specimens from coronavirus testing sites are shipped to a host of different processing facilities, from the city's own public health lab to hospitals and academic medical centers to commercial private labs.

Commercial labs have the greatest capacity but they provide testing services not only to New York City, but cities across the country. At a press conference on Wednesday, Governor Andrew Cuomo said the federal government is telling those labs to prioritize other states facing a surge in COVID-19 infections.

But these commercial labs handle only 30% of the testing capacity for New York state, Cuomo noted. Secretary to the Governor Melissa DeRosa added that the 200+ state-run testing sites across New York use labs that offer a much faster turnaround time of a few days. (Some New Yorkers, however, have recently experienced results from state testing sites have taken almost a week.)

"I don't believe there is any more water that could be wrung out of that stone," Cuomo said, when asked if there was anything the state could do to speed up test results. "We have every lab working."

Quest Diagnostics, one of the largest national commercial labs, has reported results of approximately 6.6 million diagnostic tests for COVID-19. But on June 29th, the company announced that demand nationwide had outpaced its capacity.

The average turnaround time for reporting test results is now one day for high priority patients and 4-6 days for all others.

"We are doing everything we can to bring more COVID-19 testing to patients in the United States at this critical time," a spokesperson for the company said in a statement. "This week, we intend to ramp up our capacity to reach 120,000 molecular diagnostic tests a day, compared to 115,000 last week. Over the month of July, we will continue to ramp up our capacity to reach 150,000 molecular diagnostic tests a day."

The ramifications of testing delays are acute, especially as the city works to improve its test and trace initiative, a program that has had a shaky start.

"It undermines the entire purpose of testing," said Mark Levine, the City Councilmember who chairs the health committee and recently tweeted about the problem. "You want people to isolate if they are contagious. This means people are going to be out for seven days spreading the virus potentially before they need to quarantine."

Levine blamed the delays on a national shortage of lab resources and the federal government's handling of its pandemic response. In April, New York City began reporting on a shortage of swabs and test tubes that make up a test kit. In response, the city partnered with several companies to make its own test kits, essentially swabs and the tubes used to hold testing samples.

This time around, states and cities are grappling with an exploding demand for reagents, a key product in testing produced in bulk in China that isolates the virus’s genetic material so that it can be tested. U.S. public health officials noted a shortage in reagents back in March as the pandemic raged in Europe.

"I don’t know if this can be solved locally," Levine said. "Things like chemical production are beyond the capabilities of New York City."

But not all reagents are the same, nor can they be processed by the same machine. New York City's public hospital system, Health and Hospitals, has been trying to diversify the machines they use to process reagents so that they can shift accordingly as one reagent runs out. The city is now trying to address the backlog of tests at private labs through a variety of methods, including reaching out to other labs and enhancing its capacity at its own public health lab.

Possibly as a result of its efforts, the median turnaround at city-run facilities has been between 1-2 days.

Gareth Rhodes, a deputy superintendent and special counsel at the New York State Department of Financial Services who is also serving on the state's COVID-19 task force, said the supply chain for reagents are limited.

"We're managing turnaround time to the best of our ability, sometimes beyond our control, where the reagent supplies are," he said. "There's international supply issues where even if we call the CEO of a company and say, 'Our lab is out of chemical kits, we need them, we need to get more,' they will say, 'I'm getting calls from every other governor and every other president, every other country.'"

Nonetheless, he said that New York worked early on to form relationships with suppliers as well as to buy testing equipment, putting it in a far better position to scale up testing than other states.

But the expansion of rapid testing has eluded state and city authorities. In South Korea, which launched an extensive testing program, test results can come back as quickly as one day.

Asked about the status of a rapid test last month, Mayor Bill de Blasio acknowledged the need for greater speed. "We have to make it much faster and we need a lot more cooperation from the labs to do that," he said. "I think they're working hard, but we've got to get to a much faster turnaround."

For Edelman, the prospect of having to wait one week for her and her husband's test results amounts to a loss of confidence in government. Why was the city partnering with CityMD, she wondered, if it could not provide New Yorkers with timely test results. Practically speaking, the delay is also a big inconvenience. It means that they will arrive in Maine this week without being able to assure her in-laws about whether they have the virus.

"We might have to go and camp out in their yard and not touch them until we get our results," she said.