Months into crisis, cities across U.S. still lack testing capacity.

Lines for coronavirus tests have stretched around city blocks and tests ran out altogether in at least one site on Monday, new evidence that the country is still struggling to create a sufficient testing system months into its battle with COVID-19.

At a testing site in New Orleans, a line formed at dawn. But city officials ran out of tests five minutes after the doors opened at 8 a.m., and many people had to be turned away.

In Phoenix, where temperatures have topped 100 degrees, residents have waited in sweltering cars for as long as eight hours to get tested.

And in San Antonio and other large cities with mounting caseloads of the virus, officials have reluctantly announced new limits to testing: The demand has grown too great, they say, so only people showing symptoms may now be tested — a return to restrictions that were in place in many parts of the country during earlier days of the virus.

‘A failure of the system’

“It’s terrifying, and clearly an evidence of a failure of the system,” said Dr. Morgan Katz, an infectious-disease expert at Johns Hopkins Hospital.

President Donald Trump tweeted on Monday that “our great testing program continues to lead the World, by FAR!” Vice President Mike Pence said last week that the country had so improved its testing capacity that “we will literally test anyone who comes into a testing site or comes to their local pharmacy.”

A spokeswoman for the Department of Health and Human Services said federal officials had been working closely with states to develop and meet testing goals since early April. So far, she said, the federal government has distributed about 26 million swabs nationwide, and was on track to “meet all the needs for July.”

But testing in the United States has not kept pace with other countries, notably in Asia, which have been more aggressive. When there was an outbreak in Wuhan last month, for instance, Chinese officials tested 6.5 million people in a matter of days.

All along, the United States has struggled with issues tied to testing. In February, the federal government shipped a tainted testing kit to states, delaying a broader testing strategy and leaving states blind to a virus that was already beginning to circulate.

Many places have been able to overcome some of the supply constraints that defined the earlier days of the outbreak, in part with their own resources. New York City, once faced with severe shortages as an epicenter of the virus, is now testing 30,000 people a day, officials say, an expansion that included the city building its own testing kits and partnering with private labs.

But even as Gov. Andrew Cuomo announced last week that anyone in New York state who wanted a test could get one, officials in other states have been left seeking a more robust testing system, and setting new limits on who can take one.

“We are too fragmented,” said Dr. Michael Mina, an assistant professor of epidemiology at Harvard’s T.H. Chan School of Public Health. “We don’t have a good way to load-balance the system.”

The problems in Texas

Testing delays and shortages have increasingly become a problem in Texas, where cases are surging.

Cities like San Antonio and Austin have reverted to testing only those who are showing symptoms as a way to manage the demand and a backlog of tests.

“We’re now focused on the highest priorities,” Mayor Steve

Adler of Austin said Monday.

Adler, a Democrat, said the testing crunch was the result of the demand for tests statewide, brought on by the uptick in coronavirus cases after Texas reopened in fast-moving phases starting on May 1.

Dr. Jennifer Avegno, the director of the New Orleans Health Department, said the problem her agency was seeing now was different than the one it experienced in March, when states competed over swabs and test tubes.

Now the problem is a shortage of reagents,the director said, which are the chemical ingredients needed to detect whether the coronavirus is present in a sample.

The supply chain shortage has led officials in New Orleans to reduce the tests they carry out: At one site on Monday, officials handed out just 150 tickets for testing, which were gone in minutes.