Kari Collins and their girlfriend stood in line at Sayre Health Center on Wednesday, waiting for coronavirus tests.

The couple had been tested at the West Philadelphia site each month for most of the pandemic as a precaution. After being vaccinated in the spring, they’d stopped.

But now they were back, spurred by a roommate’s COVID-19 exposure and concerns about breakthrough cases that can be caused by the highly transmissible delta variant.

At Sayre, the number of people seeking tests each day has increased from 20 or fewer a couple of months ago to 100 on some days this month. Many come because they’ve been exposed, and a large portion are vaccinated, said Jill Gansert, a doctor at Sayre. Some, like Collins, were regulars pre-vaccine.

“People who I think felt safe for some time now are back to using testing as their safeguard,” Gansert said. “Obviously I tell people, ‘Welcome back,’ but nobody’s happy we’re back in this situation.”

After a lull in early summer, the demand for testing is again increasing across the region — driven by the delta-fueled rise in cases among unvaccinated people, the possibility of infection in the vaccinated, and employers requiring regular testing.

» READ MORE: Pa., N.J., and Del. leaders weigh vaccine-verification options, but largely hold off on mandates

And with vaccinated people back among those seeking testing for exposure or mild symptoms — and cold viruses circulating as people return to the world after isolation — the calculus for capacity needs is changing.

At-home rapid tests are flying off pharmacy shelves. Many more patients are getting swabbed at sites run by health systems, they report. Pennsylvanians are searching for “rapid covid test” more frequently than they have since the holidays, according to Google trends data.

“A lot of things are happening right now,” said Gopal Sankaran, a public health professor at West Chester University. “Students are going to school. Young adults are going to college. Parents are going back to work.”

And more people are being exposed. In Pennsylvania, the number of new cases reported each day is approaching levels not seen since the spring, with a similar but slightly slower rise in New Jersey. Hospitalizations are also increasing, primarily among the unvaccinated, though they remain far lower than in earlier surges.

About 8,000 more people are seeking tests each week in Philadelphia compared to last month, according to the city. Demand has also jumped for at least a dozen public and hospital-run testing sites across the region, spokespeople said.

The number of people getting PCR tests at local CVS stores each day is the highest it’s been since December, a spokesperson said, while at-home tests are its top-selling item in the region.

So far, there’s no concern about a shortage of tests, said providers, experts, and local health departments, even as they predicted the higher pace would continue into the fall. But whether you can get one immediately, for free, and in your neighborhood can be chancier.

» READ MORE: Coronavirus spread is high and hospitalizations are rising across the Philadelphia region

Katy Otto of Pennsport ran into dead ends trying to book appointments this week: She found some testing sites closed, some booked, and some with no one answering phones, she said. On the CVS website, drugstore after drugstore showed no availability.

Eventually, she and her husband scored appointments in New Jersey. Two days later, they got negative results, but the wait meant her husband, a letter carrier, was missing work, so they still visited drugstores looking for at-home tests.

“I just can’t understand how we’re this deep into the pandemic and we haven’t mastered testing yet,” said Otto, 43, who thinks the vaccinated couple got runny noses and coughs from their 9-month-old daughter. “We’re here trying to do the right thing.”

Finding tests

The U.S. testing system never graduated from a patchwork approach that often requires people to hunt for appointments online or call an array of drugstores, hospitals, and urgent care clinics.

Sites have varying hours. Some require symptoms, exposure, or a doctor’s referral. Others charge a fee. Some have closed since the spring: Chester County, Main Line Health, and Virtua, for instance, scaled down or shuttered sites, with the two health systems closing big clinics in favor of testing by their urgent-care centers or doctors.

In Philadelphia, some places may not be able to accommodate walk-ins, said a spokesperson, but the city’s testing partners indicated it was “not a systemic problem” even with rising demand.

Experts also said there’s not enough messaging about when and where to get tested, which can confuse those seeking tests and cause a rush on the most recognized providers, like CVS.

“Any of the ones that we usually go to, we couldn’t get an appointment,” said Sasha Spassoff, 48, of the Roxborough-area CVS stores he tried last week.

In the Bryn Mawr Hospital and Lankenau Medical Center emergency rooms, people have increasingly shown up in recent weeks frantically looking for testing, said Jonathan Stallkamp, interim chief medical officer for Main Line Health. He urged the public instead to contact their doctors and go to designated testing sites.

Others, though, reported easy experiences. Collins said it was “very straightforward, very easy” at Sayre. When Karen Cravens of Voorhees got a cold after traveling, her husband quickly found an at-home kit at a drugstore and she tested negative that day. For Ellen Sager of Vineland, making an appointment, getting tested, and going home took an hour from start to finish.

Providers in and around Philadelphia, as well as the state and city health departments, emphasized that tests are available for anyone who needs one. And several providers said they are prepared to boost capacity.

More people in Pennsylvania and New Jersey are getting vaccinated, too, with August beating July for the number of first shots given. The more people get vaccinated, said Esther Chernak, director of Drexel University’s Center for Public Health Readiness and Communication, the less critical testing will be.

» READ MORE: Facing new vaccine mandates, more Philly-area residents are agreeing to COVID-19 shots

At least 935 testing sites are operating in Pennsylvania and more than 950 in New Jersey, according to the state health departments. Both have seen demand increase over the last two months, with the daily number of PCR tests having risen 40% since July in New Jersey.

The departments said state and commercial laboratories were now well-equipped to handle surges.

‘Trying to feel out’ the future

The evolving nature of the pandemic and return of some restrictions have left vaccinated people uneasy.

“I think for the general population it’s difficult to keep track of the changing messages,” said Abby Rudolph, associate professor of epidemiology and biostatistics at Temple University. “What breakthrough infections are and how likely we’d expect them to be is a point that seems to be particularly confusing to people.”

» READ MORE: How many people in Pa. got vaccinated and still got COVID-19? The state isn’t counting.

Breakthrough infection remains unlikely, experts said, and data indicate a vaccinated person who is infected may not be contagious for as long as an infected unvaccinated person. Vaccinated people who are exposed to COVID-19 should be tested three to five days after exposure, said Chester County Health Director Jeanne Franklin.

And everyone, including vaccinated people, should stay home and get tested if they have symptoms such as a runny nose, congestion, cough, or fever, Children’s Hospital of Philadelphia epidemiologist Julia Sammons said.

For Sager, 57, of Vineland, her test in early August was her first since getting vaccinated.

“I will get tested without hesitation if I get a cold or any other symptom,” Sager said, “because I fear for the health of my grandkids and all kids/people who cannot get the vaccine.”

Collins and their girlfriend are “trying to feel out” whether to change their behavior now that the delta variant means breakthrough cases are more likely.

“We may go back to getting tested regularly,” said Collins, 34. “We thought we knew what we were doing … and now it feels a little up in the air again.”

When to get tested for the coronavirus

When to get tested:

  • You have symptoms including fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea.

  • You’ve been exposed to someone who’s infected, if you’ve been within six feet of the infected person for 15 minutes or longer.

    • If you’re fully vaccinated, get tested three to five days after exposure and wear a mask in public.

    • If you’re not fully vaccinated, quarantine and get tested immediately. If you get a negative result, get tested again five to seven days after exposure. In Pennsylvania, the health department says you can stop quarantining after seven days if you have a negative test on or after day five.

  • You are not fully vaccinated and must travel: Get tested one to three days before your trip. Get tested three to five days after travel and stay home for seven days after travel, even if you test negative.

What else to know:

  • Your school, employer, doctor, or health department may refer you for testing.

  • Some people decide to test before or after travel, or before or after close contact with immunocompromised, unvaccinated, or otherwise vulnerable people.

  • The New Jersey Department of Health recommends testing for anyone who is not fully vaccinated after being at a large gathering where social distancing was hard to maintain or in a crowded indoor setting.

  • Seek emergency medical care if someone has trouble breathing; chest pain or pressure; confusion; inability to stay awake; pale, gray, or blue skin, lips, or nail beds; or other severe symptoms.

Sources: U.S. Centers for Disease Control and Prevention; Pennsylvania Department of Health; New Jersey Department of Health