The sun has just begun to rise over the Sangre de Cristo mountains east of Santa Fe and, already, a line of cars twists through the parking lot at the back of the Presbyterian Medical Center hospital and out towards the road. By 6 am, a security guard starts turning people away from the COVID-19 drive through test site, even though testing doesn't begin for another two hours.

New Mexico has more than 100 testing sites run by different entities—the health department, hospitals, emergency rooms, pharmacies and others—and ranks fourth in the US for the average number of tests performed per capita, according to the John Hopkins University Coronavirus Resource Center. New Mexico reports running 7,256 tests a day on a seven-day rolling average, surpassing its reopening gating criteria of 5,000 tests per day. As of July 20, New Mexico had run a total of 469,215 tests and tested approximately 20% of the state's population.

The robust and diverse testing landscape comes with challenges and, SFR finds, uneven experiences ranging from frustrating to hassle-free.

When Jeffrey Kaplan had his annual physical in early July, his doctor ordered a COVID-19 test, among others. While Kaplan lacked symptoms, he has asthma—a preexisting condition that could make him more vulnerable.

He completed the rest of his lab work at the Presbyterian Santa Fe Medical Center but, when he went for his COVID-19 test, security told him they were finished for the day. It was the first of five testing attempts Kaplan made over the next week: He tried to secure appointments at CVS pharmacy only to have them rescheduled or be told they were full, and was repeatedly turned away at Presbyterian, despite his doctor's note. He still had not been tested at presstime.

"I feel for the people that maybe are falling through the cracks," he tells SFR.

Still, Kaplan's experience isn't universal. Donald Apodaca started the summer traveling from state to state. The nomadic veteran arrived in Santa Fe on July 13 hoping to settle here for a bit and volunteer at St. Elizabeth's Shelter, as he had during a previous stint in Santa Fe. Shelter staff directed him to the public health office for testing and, Apodaca says, he called, received an appointment two days later and was in and out in 15 minutes.

He says he tried to get tested in California, Nevada and Florida, but Santa Fe is the first place he's succeeded.

"It was so easy and efficient; I just think that New Mexico is doing a great job. This is exactly what we need right now," Apodaca says.

And so it goes. For every person like Gail Odom, who made an appointment at her primary care doctor's office and was in and out and had test results in hand within 24 hours, there's someone like SFR Copy Editor Cole Rehbein, who waited nearly 10 days for results. Presbyterian's Balloon Fiesta Park site in Albuquerque has been so busy, its DOH listing recommends having "a full tank of gas, water and snacks in your car."

Apodoca, Odom and Rehbein's tests were all negative.

Health officials acknowledge the bumpy testing landscape, as well as the possibility that its terrain might be leaving symptomatic and high-risk individuals untested. At a July 17 news conference, Human Services Secretary David Scrase said the state is working with private providers to create a less chaotic system, perhaps by dividing the duties of testing symptomatic and asymptomatic individuals between private and state sites.

"We are looking at that process to figure out how to prioritize and better ensure that people with symptoms get a test," Scrase said.

Presbyterian Santa Fe Medical Center Director Chief Executive Jon Wade tells SFR the hospital has a small supply of rapid tests that can produce results within an hour, reserved for people having medical emergencies. The hospital next prioritizes patients with scheduled surgeries—who can expect results within 24 to 72 hours—followed by people with primary doctor referrals, who can access the priority lane at the drive-up site.

Everyone else faces a first-come, first-served basis at the drive up site, which has a daily capacity of approximately 130 people. Various factors set that limit, including staff availability and testing supplies, as well as the labs' capacity to process the tests.

Santa Fe's other testing sites allow for advanced appointment booking, which eliminates some frustrations, but can create other barriers.

CVS Pharmacy allows for online scheduling at its Cerrillos Road site, but also requires prospective patients to screen for eligibility with an emphasis on symptoms and pre-existing conditions, and show insurance at its drive-through site.

Christus St. Vincent Regional Medical Center's test site, located at a former school building off Zia Road, requires a doctor's referral to register ahead of time, which can pose challenges for someone without a primary care doctor or those who are asymptomatic.

Shannon Barton, director of operations at the site—which also can administer up to 120 tests each day—says patients rarely have to wait more than a day for appointments. But wait times for results can vary considerably. The hospital recently acquired a machine that can process large numbers of tests within a day or two in-house; however, Barton says limited supplies of the chemical reagent used to process the tests requires the hospital to send some tests to other labs, such as Tricore Reference Laboratory and the Mayo Clinic, which can take up to 10 days to return results because of increased demand.

"Since July Fourth weekend, we've definitely seen an increase in patients," she says.

The public state health department's Santa Fe office also offers appointments for testing, available to asymptomatic people without a doctor's note. But they only book 24 appointments daily, with walk-in availability dependent on staffing levels.

Health department spokesman David Morgan tells SFR the office's main focus is conducting "rapid response" in workplaces and homes where someone has tested positive.

"While we aren't always able to have a lot of appointments available, there are some good reasons for that in the form of the rapid testing and making sure we are working with other state agencies to stop outbreaks from known cases," Morgan says.