Coronavirus infections have risen back above Minnesota's high-risk threshold, but health officials hope immunity levels will limit the number of cases that result in hospitalization or death.

Minnesota for the first time in two months has identified more than 1,000 infections in a day, despite the rising popularity of at-home rapid antigen COVID-19 tests that aren't included in state tallies. The 1,003 infections among samples collected April 13 drove Minnesota's COVID-19 case rate to 12 per 100,000 residents, above the threshold of 10 indicating substantial viral spread.

Even with the increase, Minnesota's case rate remains far below the peak of 246 per 100,000 residents in the week ending Jan. 11. The Centers for Disease Control and Prevention also considers all Minnesota counties at low COVID-19 risk, meaning none have recommendations for broad, public indoor mask-wearing to reduce viral transmission.

People are eager to move on from the pandemic, but the trends suggest they should still take precautions such as staying up to date with vaccinations and wearing masks on public transportation — whether mandated or not, said Dr. Dimitri Drekonja, an infectious disease specialist with the Minneapolis VA Medical Center.

"[The] message needs to shift from 'we're moving on' to 'we're better off but still at risk and can be better,'" he said.

The divergent state and federal risk levels reflect their differing definitions. The state high-risk measure is a warning that viral spread has reached a point where it could grow exponentially. The federal low-risk designation indicates the current pressure COVID-19 is placing on Minnesota's hospital capacity. The guidance also reflects some confusion about where the pandemic is going and whether subsequent waves will be milder and send fewer infected people into hospitals.

COVID-19 hospitalizations in Minnesota already increased in response to the turnaround in infection numbers from 183 on April 10 to 215 Wednesday. However, only 24 of those hospitalizations required intensive care, and that number has been declining since mid-December.

"We all hope to see the decoupling of cases and hospitalizations, but no one thinks we're there yet," Drekonja said. "I expect that hospitalizations will rise as cases rise, and deaths will rise a little bit, but probably not as much as before."

Minnesota reported three more COVID-19 deaths Thursday, but death numbers have not increased in response to the latest increase in infections. Vaccinations and unprecedented infections during the January omicron COVID-19 wave have left many Minnesotans with at least temporary immunity, reducing the risk of severe illness.

Reinfections also have increased over the past two weeks, indicating that immunity might be waning. There were 119 reinfections identified from samples collected April 13 — more than 1 in 10 of the COVID-19 cases identified on that date. Overall, Minnesota's more than 1.4 million known infections include 64,260 reinfections. The state's overall COVID-19 death toll is 12,482.

A BA.2 coronavirus subvariant remains responsible for the small but steady increase in COVID-19 activity in Minnesota this month. BA.2 was found in 84% of positive COVID-19 specimens that were analyzed through genomic sequencing in the week ending April 9, according to the Minnesota Department of Health. The rate a week earlier was 61%.

COVID-19 vaccination activity has increased in Minnesota, where 71,962 doses were administered in the week beginning April 10 — an increase from 17,511 in the week beginning March 20.

However, the state remains stuck at 49% in its rate of Minnesotans 5 and older who are up to date with COVID-19 vaccination — meaning they have recently completed the initial series or received scheduled boosters to maintain immunity.

The increase in vaccine administration is mostly among people receiving second boosters, which were OK'd by federal authorities late last month. Second boosters are permitted for people 50 and older, have weakened immune systems or received only the less-effective Johnson & Johnson vaccine.