Minnesota public health officials on Sunday confirmed the state's first three cases of community transmission of the COVID-19 coronavirus, a worsening sign for the outbreak that means the virus has likely begun to circulate in communities in the state.

Minnesota now has 35 confirmed cases of COVID-19, including 14 that were reported Saturday night and Sunday morning. The newest cases, involving patients ranging in age from 20 to 94, include one person who was hospitalized. No deaths have been recorded in the state.

During a conference call with reporters Sunday, Minnesota Department of Health officials focused on three cases of community transmission, in which the virus passed to people who hadn't traveled outside of Minnesota or knowingly been exposed to someone else with a confirmed case.

The cases were reported in the state's three most populous counties — Hennepin, Ramsey and Dakota — and signaled that the virus' spread is wider than previously known, said Kris Ehresmann, the department's infectious disease director.

"People who are 70 and older, or people of any age who have underlying health conditions that put them at a higher risk of severe illness from COVID-19, should stay home and avoid gatherings or other situations of potential exposures, including travel," she said.

State officials are aggressively investigating how the known cases may be connected. Aside from people who live together in a home, there have been no confirmed clusters of COVID-19 cases among people connected in any other way, Ehresmann said.

The three community transmission cases prompted intensified urgency from state health officials, who reiterated the importance of social distancing. In the first 21 confirmed cases in Minnesota, patients had links to travel or exposure to known COVID-19 patients.

"The single most important thing we can do is to stay home when we're sick, whether we think that has anything to do with COVID or not," said state Health Commissioner Jan Malcolm. "We have a strong work culture of toughing it out in Minnesota, and this is not the time to do that."

Limitations on the nation's capacity for coronavirus testing mean that in Minnesota there's "much we don't know about the potential degree of community transmission," Malcolm said.

With diagnostic tests in limited supply, Ehresmann said patients should show symptoms before being tested. Even then, their doctors may test for other respiratory illnesses first, like influenza A or B, before running a COVID test. Those other tests can often be done quickly, using "point-of-care" devices in clinics.

The Centers for Disease Control and Prevention have said that virus transmission by people who are not showing symptoms of COVID-19 is not thought to be the main way the virus spreads. But new research reports from Massachusetts and Germany show that asymptomatic transmission "is very important," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

"It means that our recommendation for individuals who are at higher risk of complications and severe disease, avoiding large groups, gatherings [and] travel is that much more important," Ehresmann said. "It would suggest that you can't count on a visual cue of someone appearing to be ill to kind of distance yourself."

Emergency declared, closures

As the cases spread, cities, businesses and the state Legislature began taking action. House and Senate leaders announced Sunday night that they will meet on an on-call basis from Monday through April 14 in places where people can stay at least 6 feet apart. They'll also try to work remotely when possible.

In St. Paul, Mayor Melvin Carter declared a local state of emergency, closing all libraries and Park and Rec facilities — including the Como Park Zoo and Conservatory — from Monday until March 27. Carter also requested that Ramsey County Sheriff Bob Fletcher suspend all evictions.

The Minneapolis Park Board said Sunday that its park buildings will be closed and its programs canceled from Tuesday until April 5.

Also in Minneapolis, Seward Community Co-op closed its E. Franklin Avenue store on Sunday after one of its staff members tested positive for COVID-19. A cleaning company is coming to clean the store by Monday evening, according to a post on the co-op's website. The store will reopen when it is determined there's no risk to the community, the post said.

The co-op was contacting all employees on Sunday. The staff member who tested positive worked a "very minimal schedule" over the past two weeks, and the co-op is working to identify other employees who may have been in close contact with the person.

Another location, at 317 E. 38th St., will open late, at 10 a.m., on Monday so it can be fully stocked after a week of "intense business."

Elsewhere, the St. Paul Jewish Community Center said it closed early Sunday to be disinfected because a member who visited last week has a relative who tested positive for COVID-19. And CorePower Yoga, a national chain with several studios in the Twin Cities, is temporarily closing all locations.

Two hospitalized

On Saturday, the Health Department reported the first case in the state affecting a teenager, identified as a Dakota County resident who was not a student. Ehresmann on Sunday said the teen was in fact a student, but she did not identify the school.

Two patients are hospitalized with COVID-19, including a previously reported case in critical condition.

Earlier, Malcolm had said it's not a matter of if, but when Minnesota sees its first cases of community spread. Now that it's happened in the state, people need to take action to slow it down.

"How effectively we can slow down and spread out the growth of this disease in our communities is the key to reducing, most importantly, damage to health for Minnesotans, but also the ripple effects on the health care system and our critical infrastructure," she said Sunday.

Last week, the Health Department issued community-level strategies to mitigate the chance of person-to-person transmission by reducing close-contact interactions (defined as interactions with others within 6 feet for 10 minutes or more). The guidance included canceling or postponing large gatherings with more than 250 people, such as concerts or sporting events, and smaller events in crowded rooms or auditoriums.

"For those of us who are frequenting bars and restaurants, it's really important to monitor our own behavior to try to achieve social distancing in those places that are open — and we want them to remain open as long as possible — but to do that in a way that is mindful of the importance of social distancing, even in those venues," Malcolm said.

The goal is to slow and spread out the growth in cases so the health care system and other critical infrastructure "can absorb the impact of this disease, which we are going to be learning to live with," she said.

Staff writer Mara Klecker contributed to this report.

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