Gov. Tim Walz faces a key decision this week about whether to lift a stay-at-home order for a COVID-19 pandemic that is proving most deadly for long-term care residents, gumming up food production and spreading at a rate that nobody yet comprehends.

The death toll from COVID-19 reached 286 in Minnesota on Monday, but 223 involved long-term care facilities residents — who remain at greatest risk from the coronavirus infection due to age and existing health problems. Half of the COVID-19 deaths have been reported in the last seven days.

In deciding whether to extend the stay-at-home order beyond May 4, Walz will need to balance the rising death and COVID-19 case counts against the economic damage caused by the pandemic and the stay-at-home order — with more than 500,000 Minnesota workers applying for unemployment insurance benefits this spring.

How much longer Minnesotans can stick to the restrictions will be a factor as well, said Jan Malcolm, state health commissioner. “Our ability to keep moving forward is going to hinge significantly on people continuing to really keep the stay-at-home message in the forefront.”

COVID-19 is caused by a novel coronavirus, for which there is no vaccine or proven treatment, that has caused about 980,000 confirmed infections and more than 50,000 deaths in the U.S., according to the COVID Tracking Project.

The state order was designed to reduce face-to-face contact and opportunities for transmitting the virus by 80%. Cases in Minnesota have increased, but not exponentially — which state leaders attribute to success in social distancing.

Signs of restlessness are showing, though. Car traffic levels statewide were 28% below normal on Sunday, but had been 39% below normal on the prior Sunday, and 68% below normal on the Sunday before that. SafeGraph’s shelter-in-place index — which uses mobile device data to determine how often people leave their homes — worsened every day in Minnesota from April 15 to April 23. The state’s index has fallen below the national rate.

How Minnesota is faring in its relative fight against the pandemic depends on the data. With 3,816 lab-confirmed cases, the state’s per capita rate of COVID-19 is one of the lowest in the country. On the other hand, 7.5% of Minnesota’s lab-confirmed cases have died, and that is one of the worst rates in the nation.

State officials stressed that the actual death rate is much lower, because there are as many as 100 unconfirmed infections for every one lab-confirmed case in Minnesota. And due to a supply shortage, the state’s testing strategy focused largely on hospitalized patients and long-term care residents. That inflated the per-case death rate.

There have been 61,268 diagnostic tests performed in Minnesota. Malcolm said she is hopeful that a $36 million deal with Mayo Clinic and the University of Minnesota will provide a clearer picture of how much the disease has spread in Minnesota by increasing diagnostic testing up to 20,000 per day.

Testing has increased to more than 2,000 in each of the last four days.

Discovering that the infection has already spread more widely than known would be comforting in one way, Malcolm said. “There’s maybe a piece of good news ... that there is a higher level of disease burden in the community that isn’t overwhelming the health care system.”

The U and Mayo also have pledged thousands of antibody tests to identify people who have already recovered from infections with the coronavirus. Mayo reported on Monday that it had conducted about 12,000 antibody tests — from blood samples of its own patients and health care workers, and from samples sent from around the country to its national reference lab — and that 22% turned up positive.

That doesn’t necessarily mean one-fifth of the population already recovered from the infection, though. Some of those tests were given to patients who already had positive diagnostic tests, making their positive antibody results extremely likely.

Surveillance testing of people throughout Minnesota is planned to assess how widely the virus has spread.

The pandemic has gripped Minnesota’s food production industry, though, with outbreaks among workers temporarily shutting down the JBS pork plant in Worthington and two Jennie-O turkey facilities in Willmar.

As of Monday, the state had lab confirmation of infections among 175 meatpacking workers. Health officials held a conference call with vegetable canning companies, which will be ramping up production soon and will have similar risks of outbreaks.

Smaller meat-processing facilities are helping amid the large plant shutdowns but can’t keep up with the total demand — meaning that some animals are having to be euthanized, said Thom Petersen, state agriculture commissioner. Farmers are trying to help by reducing feed for pigs so they aren’t ready for market as quickly.

Minnesota’s food supply will remain stable but experience occasional disruptions, Petersen added. “There could possibly be higher prices for some of the things they are seeing at the stores.”

Health officials are eyeing difficult decisions about moving long-term care residents around so that those with suspected infections live in a cohort and do not expose others, said Kris Ehresmann, the state infectious disease director.

“We want to be mindful of recognizing the impact and the stress that that would have on people,” she said.