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Hawaii can test as many as 250 potential coronavirus samples per week, but strict testing requirements remain in effect, public health officials said Tuesday.

As of Tuesday, only six people in Hawaii met sufficient . The first three tests conducted on Friday and over the weekend returned negative. Patients had the common cold, according to authorities. The state laboratory expected the remaining three samples to have results by the end of Tuesday.

“The volume of tests are determined by the number of suspected individuals who might have it,” Gov. David Ige said at a press conference held at the state laboratory on Tuesday.

To be tested for the coronavirus, one must be referred by a physician. Doctors will consider taking a throat or nasal swab sample from people who have symptoms like fever or shortness of breath that haven’t been otherwise diagnosed as the cold or a flu. Those with a travel history to areas where the outbreak is worst, including China, Iran, Italy, Japan and South Korea, will also be considered for testing, based on recommended by the Centers for Disease Control and Prevention.

Cases Will Rise In The U.S.

As the number of cases of the coronavirus also known as COVID-19 continue to rise internationally and on the mainland, Hawaii Department of Health Director Bruce Anderson said Hawaii residents can expect the number of people under investigation, or “PUI,” in the islands to grow. In the event of an emergency, the state could conduct as many as 500 diagnostic tests in a week.

“You very well will see an increase in the number of PUIs; don’t be alarmed, it means we’re doing a lot more tests because of this expanded criteria,” Anderson said.

The state laboratory verified its three testing kits on Friday, which will be able to conduct about 600 tests each, according to State Laboratories Division Administrator Edward Desmond.

At this point, the state is covering all costs of testing. If needed, the state will consider working with private laboratories to conduct additional testing, following the announcement this week by the CDC that it would make testing kits available to the private sector. Those laboratories would need approval by the Food and Drug Administration, and would be subject to sending their sample results to the qualified Hawaii state laboratory.

“We’d want to make sure they do it accurately and they’d send their positives to us,” Desmond said.

As of Monday, were infected with the coronavirus, and six people have died, many of whom were older patients.

have reported cases among people who caught the virus in their communities, which could signal the virus is circulating.

Lab Capabilities

Five technicians are certified to manually test the samples at the Pearl City state laboratory, according to Desmond.

The Tripler Army Medical Center also received testing kits from the CDC and is capable of testing for the coronavirus as well, and the state has an arrangement in the making to formalize how it would work with Tripler if additional help or testing is needed.

Technicians wear protective equipment and extract the virus’ nucleic acid from samples and use a machine that can identify the virus within a matter of three to six hours.

Any positive test results will trigger an additional test by the CDC to confirm the Hawaii lab isn’t getting false positives.

In the chance that the state will need more kits, officials can request more from the CDC and acquire them within a week’s time, Desmond said.

The state is focused on testing patients, but may consider a more randomized testing approach in the future, Anderson said. The state already conducts blind testing for influenza and rhinovirus, and could add coronavirus to the mix. Such testing could provide a better picture about the virus’ prevalence, but the nature of blind testing means the department wouldn’t be able to track down the person who provided the sample. Those are details the health department are still discussing, Anderson said.

Travel Advisories

The state health department continues to discourage Hawaii residents from traveling to China, Iran, Italy, Japan and South Korea, and the list of countries could grow.

For those who do decide to travel, only those who travel directly to China will be subject to mandatory quarantine.

U.S. citizens including Hawaii residents who travel to Iran, Italy, Japan and South Korea will be asked to self-monitor for any symptoms and see a doctor in the event they fall ill.