Residents in four Minnesota long-term care facilities are being tested for COVID-19 after some tested positive and others reported symptoms, sparking concerns that the coronavirus has been circulating within medically vulnerable populations.

“We have said from the beginning that we know that congregate living settings especially among our elderly are going to be very important to react to very quickly,” said state Health Commissioner Jan Malcolm. “We are taking a very proactive approach to working with those facilities.”

The four cases in long-term care are among the 235 cases that have so far been confirmed statewide. A total of 66 new cases were announced Monday by state health officials.

It was another record-setting day for confirmed cases, as health officials have consistently said more infections were expected to be discovered. The number of Minnesota cases has doubled since Friday, when there were 115 people testing positive.

“At this point with confirmed community spread we know that there are more cases in Minnesota,” Malcolm said.

Minnesota is also seeing more severe cases, with five people now in hospital intensive care units and another seven receiving general inpatient care. Another nine patients have been discharged so far.

Altogether, 50 health care workers have tested positive for COVID-19. Although some were still being interviewed, so far most have picked up the infection through travel or community spread.

“We do not have any confirmed case as yet from patient care,” Malcolm said in a Monday afternoon news briefing.

A shortage of protective equipment, including masks and gowns, has nurses and even some health care systems asking the public for donations in a bid to keep those on the front lines safe.

Gov. Tim Walz issued an executive order Monday that all health care systems, as well as any business, that has health care protective gear, ventilators, respirators and anesthesia machines must disclose their inventories to the state. Construction companies, research firms and universities must comply.

The data, which will not be made public, will be used to help put resources where they are needed in case some health care facilities are critically short.

Joe Kelly, Minnesota’s emergency management director, said the state was also building a system to track all the offers of goods and services that are being made.

The pandemic virus has now been detected in 31 Minnesota counties, with Big Stone, Lac qui Parle and Sherburne counties seeing their first detected cases with one each. Fifteen other counties also saw an increase from the most recent testing round. Hennepin County has 89 cases and Ramsey has 24.

Minnesota health officials have identified long-term care residents as a high-risk group that should get priority testing because they are more likely to succumb to the coronavirus complications, including pneumonia, either because of age or underlying health issues.

At this time of year, facilities are typically on high alert because of seasonal influenza, which so far has resulted in 101 confirmed outbreaks in long-term care.

The confirmed COVID-19 cases have been discovered in two assisted-living facilities, a skilled-nursing home and a memory-care facility. Other residents in each facility reported upper respiratory symptoms.

“We are working aggressively with those facilities on infection control practices and testing all of the residents of those facilities,” Malcolm said.

Patti Cullen, executive director of Care Providers of Minnesota, said discovery of a case typically prompts visits from the state Department of Health, which investigates the affected patient’s contacts and makes recommendations on containment. Depending on the severity of the case, not all infected residents would be removed.

“You don’t want to overwhelm the hospital system with someone who doesn’t need [that level of] care,” she said. “That is why some of them remain.”

Last week, based on guidance from the U.S. Centers for Disease Control and Prevention, facilities shut down group activities and group dining rooms where social distancing recommendations could not be maintained.

Awareness about the dangers to long-term care residents was heightened after many residents at a nursing home in Kirkland, Wash., were sickened or died from COVID-19.

“We have learned a lot from what happened in Washington,” Cullen said. “Unfortunately somebody had to be first, and we learned the lesson.”