As Washington residents prepare to enter a two-week lockdown in most of public life, the Department of Health announced that there are 904 confirmed cases of the novel coronavirus in 18 counties statewide.

Of the 48 people have died due to COVID-19 in the state, the majority have been older than 60 or had underlying health conditions. Several confirmed cases in the Seattle area are tied to about a dozen long-term care facilities, including Life Care Center in Kirkland, where 29 former residents have died due to the virus.

The virus has spread to six counties east of the Cascades, but health care providers in Spokane are still experiencing challenges with the availability of testing, which continues to hamper efforts to see how widespread the novel coronavirus is in the community.

“This testing is an essential piece for us to get a sense of the prevalence of COVID-19 in our community,” Spokane County Health Officer Bob Lutz said at a news conference Monday.

The region’s primary health care providers acknowledged that they are not able to test a wide swath of people despite loosened guidelines.

“We are gearing up and doing our best, but on this day, there’s not a lot of testing,” Dr. David Ward, acting medical director for Kaiser Permanente Spokane, said.

This is due to a national shortage of the actual materials needed to conduct the test, Ward said.

No local health care providers in Eastern Washington actually have test kits for COVID-19, and they rely on the University of Washington lab and State Public Health Lab in Shoreline as well as commercial labs, like LabCorps and Quest Diagnostics for testing. If a person is swabbed for COVID-19 locally, the turnaround time is about three days at best for results, Lutz said.

LabCorps is testing COVID-19 samples at labs in North Carolina and New Jersey. Quest is testing COVID-19 samples in San Juan Capistrano, Calif, for now. Both companies expect to ramp up and expand their capacity to test this week, but the lag has forced local health care providers to continue prioritizing testing for high-risk patients and reinforced the message to the community, to “stay home.”

“If you are ill and can get treated at home, if you have a fever and cough, you should be staying home and contacting your medical care via home, not necessarily coming in to be tested, as of today,” Ward said. “This is an incredibly fluid conversation that will change day by day as we understand what resources our community has.”

There have been 11,582 people tested for COVID-19 in Washington state. Lutz had only received about 75 test results regarding Spokane County so far, with three confirmed positive cases.

The majority of lab testing capacity in the United States is in the private sector, U.S. Surgeon General Jerome Adams, told reporters Monday.

“Testing has not gone as we would have like so far, but we are at a crucial turning point,” Adams told reporters on a media call Monday. “And over the next week you will see an increase of testing.”

LabCorp and Quest expect to have much broader testing capacity by the end of the week. LabCorp expects to conduct 10,000 tests per day by the end of this week and 20,000 tests per day by the end of the month. Quest also expects to conduct 10,000 tests a day by the end of this week and 20,000 tests a day by the end of the month.

The surgeon general said the next two weeks are critical to determining if the United States can slow the spread of infection like South Korea or watch it climb as it has in Italy.

This story is developing and will be updated.