This article is updated multiple times a day and is available for free to non-subscribers as a public service. Please consider subscribing to the Star Tribune.
As the pandemic spreads, we've asked readers what they most want to know. Our reporters have talked to the experts and answered some of the most pressing and popular questions. For daily updates, sign up for our newsletter.
- Three Minnesota nursing homes with COVID-19 outbreaks cited for serious infection-control violations.
- Minnesota churches open for first time since March 18.
- St. Paul to require face masks inside businesses, city buildings.
- Gov. Tim Walz sticks to dining restrictions for Minnesota restaurants.
- The United States surpassed a jarring milestone today in the coronavirus pandemic: 100,000 deaths.
- Minnesota has an executive order that stops evictions. Here's how it works.
- Thirty-three more deaths and 510 additional confirmed COVID-19 cases were announced, bringing the total number of known infections in Minnesota to 22,464.
- Suspect cures and price gouging have become a game of Whac-a-Mole for state and federal regulators during the COVID-19 pandemic.
- Officials say public compliance key as virus enters "volatile phase" in Minnesota.
- Minnesota cities testing new plans to expand outdoor dining during coronavirus.
- Sherbune County jail detainees plan hunger strike for release because of COVID-19.
- Joe Biden will deliver keynote address at Minnesota DFL Party's virtual convention.
- Faith groups suing Gov. Walz say order allowing 25% to congregate still violates religious liberties.
- Dangerous blood clots pose a perplexing coronavirus threat.
- Have you lost a loved one to COVID-19 in Minnesota? We need your help telling their story.
- What are the symptoms of COVID-19?
- Minnesota COVID-19 survivor: "There's this narrative that it's just the flu. It's not."
- How should I clean and store my cloth face mask?
- Virus risk factors show who is most likely to land in the hospital.
How many cases are there in Minnesota?
Minnesota reported 504 new cases of COVID-19 and 33 new deaths Wednesday. The state's total number of confirmed cases so far is 22,464 — with 932 total deaths.
The map below shows a county-by-county breakdown, which is updated daily. (It may lag behind news reports due to the release of incomplete information.) The state is posting updates online and has created a phone hotline: 651-201-3920.
How many cases are there in the world? The United States?
Around the world, there have been more than 5.6 million confirmed cases and more than 354,000 deaths. The United States has more than 1.7 million cases, with more than 368,000 diagnosed in New York. The cumulative U.S. death toll climbed to more than 100,243 this week.
The New York Times is tracking U.S. cases, including a state-by-state breakdown of totals and how the illnesses were contracted. Johns Hopkins University has built an interactive dashboard tracking the spread of COVID-19 across the U.S. and the world.
What's the best way to prepare?
COVID-19 is a respiratory disease, much like influenza, and while there’s not a vaccine for it, there are ways to cope. The precautions used to fight influenza are the same ones that people should be using to stave off coronavirus and other respiratory diseases, said Timothy Brewer, a professor of epidemiology and medicine at UCLA’s Fielding School of Public Health.
- Wash your hands regularly
- Cover your nose and mouth when you sneeze
- Stay home from work or school when you’re sick
- Drink lots of fluids
The CDC recommends washing with soap and water for at least 20 seconds after using the bathroom, before eating and after blowing your nose or sneezing. It also advises to avoid touching your eyes, nose and mouth and to frequently clean objects and surfaces you touch often.
Should I be wearing a mask on my face?
Guidance from the Centers for Disease Control encourages people, especially in areas hit hard by the spread of the coronavirus, to use coverings such as homemade masks, bandannas or T-shirts for their faces while outdoors.
Simple cloth masks that cover the mouth and nose can prevent virus transmission from individuals when they are out buying groceries or seeking medical care.
The guidance, a change from the CDC's previous recommendation, came as states continue to cope with critical shortfalls of N95 masks and other personal protective equipment and raised concern that it could cause a sudden run on masks.
Trump and other administration officials sought to minimize any burden by stressing the recommendations did not amount to requirements and that a variety of homemade coverings were acceptable.
However, some individual cities, businesses and health organizations are requiring homemade masks or face coverings for people to enter.
Federal officials said that surgical masks and N95 respirator masks should be reserved for those on the front lines of fighting the spread of the infection. N95 masks must be fitted and tested to work properly. The same goes for exam gloves, which can get contaminated just like our hands. There’s no need for them if you’re washing your hands properly and often.
Is hand sanitizer effective against COVID-19?
Washing your hands with soap and water is the most effective way to protect yourself, according to the Centers for Disease Control and Prevention. “But if soap and water are not available, using a hand sanitizer with at least 60% alcohol can help you avoid getting sick and spreading germs to others,” the agency says on its website. Sanitizers do not eliminate all types of germs and they are less effective if your hands are visibly dirty or greasy.
“It is very important when you use hand sanitizer that you use an adequate amount and you cover all of the surfaces of your hands,” said Dr. Alison Peterson, vice president of medical affairs at Allina Health’s United Hospital in St. Paul. Also, let your hands dry before touching anything. Apart from cleaning your hands, remember not to touch your face, something that is often easier said than done.
What is "flattening the curve" and how does social distancing help?
“Flattening the curve” is an expression used to explain how slowing the exponential growth in a disease’s spread can allow a country’s health system to better cope with the surge in cases so that it isn’t overwhelmed.
While the novel coronavirus pandemic might eventually infect a majority of people in the United States, the speed at which the outbreak spreads makes a huge difference in health outcomes. What epidemiologists fear is that the U.S. health system would become overwhelmed by a sudden surge that requires more people to be hospitalized than can be handled, both from a personnel and equipment standpoint. In a scenario of uncontrolled growth, more people would die simply because there might not be enough doctors, nurses, hospital beds or ventilators for people who need them.
“If you look at the curves of outbreaks, they go big peaks, and then come down. What we need to do is flatten that down,” said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
Flattening the curve means that the social distancing measures being deployed in places like Italy and South Korea and now in the United States aren’t so much about preventing illness but rather slowing down the rate at which people get sick, according to Vox.
Without any measures to slow it down, COVID-19 will spread exponentially for months. An interactive simulation by the Washington Post shows how the spread can be slowed by use of “social distancing,” avoiding public spaces and large group gatherings that can increase the rapid spread of COVID-19.
What happens if workers at power plants, water treatment facilities, grocers, etc., get sick?
State officials are working with businesses to encourage them to prepare now for the eventuality that they could be short-handed in a pandemic outbreak. “In particular with essential services and infrastructure, identify what are your core activities and make sure that you have cross-trained so that everything doesn’t rely on one person that pushes that one button,” said Kris Ehresmann, director of infectious disease for the Minnesota Health Department.
The general public should also prepare in case some retail locations are closed or have limited hours. “We want people to start to gradually prepare to have an adequate supply of nonperishable food items at home,” she said. That would be especially helpful if you or your family became sick and could not leave home. At the same time, authorities discourage panic buying. “We certainly don’t want people to think that we are asking them to plan for Armageddon.”
TESTING, HEALTH CARE
When is COVID-19 most contagious? When are you no longer considered contagious?
People sickened by COVID-19 are most infectious when they are showing symptoms, including fever, coughing and shortness of breath, according to the Centers for Disease Control and Prevention.
But new research confirms that those without symptoms are playing a significant role in spreading the virus. A study of cruise ship passengers found that nearly 18 percent of them tested positive and had no symptoms. State of Minnesota and University of Minnesota researchers modeling the pandemic’s effects now estimate that one infected person is spreading it to as many as four others. That’s up from two to three transmissions per infected person, reflecting the greater role of asymptomatic transmission, according to Minnesota Health Commissioner Jan Malcolm.
That’s why public health officials recently changed guidelines on masks to suggest that people who are out in public should wear a homemade mask to lower the chances that they will make someone else sick.
The virus is still thought to be primarily transmitted by breathing in the respiratory droplets released by an infected individual.
“Person-to-person transmission occurs when an individual with the infection emits droplets containing virus particles while coughing, sneezing, and talking,” according to a recent article published on the Journal of the American Medical Association website.
The virus can also exist on surfaces. “Survival of the virus on innate surfaces has been an important topic of discussion. While there are few data, the available evidence suggests that the virus can remain infectious on inanimate surfaces at room temperature for up to 9 days,” the JAMA article said. That’s why it is important to wash your hands and try to avoid touching your face.
After a person recovers, it is unclear how long they remain contagious. Genetic material of the virus may be detectable up to two weeks after infection, but that “does not necessarily mean that infectious virus is present,” according to the CDC.
Is there an average length for COVID-19 illness to run its course?
It really depends on how bad the symptoms are and whether any serious complications develop. “About 80% are mildly to moderately symptomatic,” said Dr. Timothy Sielaff, chief medical officer at Allina Health. “That can mean fever, cough, muscle aches and lethargy, which last a few days and improve over several more; typically 2 weeks or so.”
These mild cases can recover at home because there is no treatment for COVID-19.
When complications develop, such as pneumonia, hospital care may be needed so doctors can monitor symptoms and provide support to stabilize the situation and hopefully keep things from getting worse.
“Severe illness can last longer especially if hospitalization or intensive care is needed; on the order of 3-6 weeks,” said Sielaff.
What is the criteria is to be listed as "recovered?" Do they assume if your fever and cough is gone you're recovered?
The Minnesota Health Department so far has kept in contact with all people who have tested positive. Each case differs, so recovery depends on the guidance provided by a doctor or a public health official. But generally, people are considered recovered when the symptoms go away.
“If you are sick, we are asking people to stay home for at least seven days and you need to be fever free for at least three days without the aid of fever reducing medications,” said Kris Ehresmann, infectious disease director at the Health Department.
The World Health Organization considers two negative COVID-19 tests taken 24 hours apart to be part of its official definition of recover, but a shortage of tests makes that difficult.
“It will be useful to the individual and the community to have negative testing to confirm, but we do not have enough tests available right now,” said Dr. Timothy Sielaff, chief medical officer at Allina Health.
Should I get tested for COVID-19?
Health officials recommend that anyone with fever and a cough or shortness of breath should get tested, as well as those in high-risk groups, including the elderly, those will underlying health conditions, health care and other essential workers as well as those who have been in contact with known cases.
To find out where you can be tested, contact your medical provider or visit the state's new web page to assess your testing needs and to find places near you that are offering testing.
A sample will be taken from your nose or mouth and sent to the laboratory, which runs a test that looks for the genetic material of the virus that causes COVID-19. If the test result is positive, a diagnosis of COVID-19 is confirmed. Negative results, however, don’t guarantee that you aren’t infected. The test might not be able to detect the virus if you have no symptoms, even if you are infected. Also, if the sample is taken incorrectly, there might not be enough material for the test to recognize the infection.
The speed of test results will vary based on how many samples are in the pipeline or if the sample is sent to a lab outside the state.
The University of Minnesota and the Mayo Clinic are working with other health care systems in the state to expand testing capacity with the goal of doing 20,000 tests per day.
If someone gets sick, when should I suspect COVID-19?
COVID-19 arrived during peak cold and flu season, and many of the symptoms are the same: fever, cough and sneezing. So based on symptoms alone, it is hard to tell. But this new coronavirus has been known to severely impact the lungs. When we hear someone has shortness of breath, we will have more concern and they will need to be seen, said Dr. Jeff Dichter, a critical care physician at M Health Fairview.
Doctors say that dehydration from vomiting or diarrhea, a severe headache and progressively worsening symptoms also are warning signs. If you have a chronic medical condition that makes you more susceptible to complications from any type of viral infection, such as pneumonia, it is important to seek medical care. One suggestion is to call your clinic to get advice on how to proceed. Many clinics have a nurse who will triage cases, and you will most likely be asked about travel history and symptoms. If the clinic suggests that you see a doctor, staff might meet you at the front door and provide you with a mask to help prevent infecting others.
If COVID-19 does take hold in Minnesota, the health care system is likely to prioritize care for those who are the sickest. The health care system is extremely full right now and always runs close to capacity, said Dr. John Hick, emergency physician and medical director for emergency preparedness at Hennepin Healthcare. Be prepared for longer waits and potentially non-traditional approaches to care. The focus of the health care system will be on taking care of those with severe disease that may require prolonged and intensive care.
Does Minnesota have hospital bed capacity to handle cases that would require acute care in the event of an outbreak?
The Minnesota Hospital Association (MHA) says it is making plans for a possible surge of COVID-19 patients, and is anticipating that 15% of them will need hospital care and 5% will need intensive care. As it stands, the system is already seeing high demand, with more than 95% of beds occupied on one or more days in the Twin Cities metro area in recent weeks, said Dr. Rahul Koranne, MHA chief executive.
Based on its planning, the hospital group has said there could be a need for more intensive care beds, ventilators, masks and other protective equipment for health care workers, as well as for staffing, phone banks to help triage patients, and training on COVID-19. “If there was a challenge to our capacity, hospitals would have to look at constructing additional space for those,” said Wendy Burt, MHA spokeswoman. Hospitals and health care systems are working with the Minnesota Health Department to coordinate information about resources.
What is a novel coronavirus?
A novel coronavirus is a new coronavirus that has not been previously identified. Coronaviruses are a large family of viruses. According to the CDC, the virus causing this outbreak is not the same as the coronaviruses that commonly circulate and cause mild illness, such as the common cold. Some coronaviruses cause illnesses in people; others cause viruses in animals such as cattle, camels and bats. Rarely, animal coronaviruses can spread to people. This happened with SARS-CoV and MERS-CoV. The virus that causes COVID-19 likely also originated in an animal and spread to humans, according to the CDC.
Will warm weather stop the outbreak of COVID-19?
The Centers for Disease Control says that it is not yet known whether weather and temperature impact the spread of COVID-19. Some other viruses, like the common cold and flu, spread more during cold weather months but that does not mean it is impossible to become sick with these viruses during warm weather.
Communities in warmer places appear to have a comparative advantage in slowing the transmission of coronavirus infections, according to an early analysis by scientists at the Massachusetts Institute of Technology.
The New York Times published news of the MIT study along with two others that have drawn similar conclusions. But none of the studies have been peer-reviewed by other scientists, and the MIT study's author acknowledged that factors such as travel restrictions, social distancing measures, variations in the availability of tests and hospital burdens might have affected the number of cases in different countries.
Can the coronavirus live on surfaces outside the body, things like canned goods, packaging, mail?
The most common method of catching COVID-19 illness is by inhaling respiratory droplets created when an infected person sneezes or coughs, especially through close contact over a sustained time period. “We know that your highest risk is in being close contact with another person who is in their acute phase of infection,” said Dr. Alison Peterson of Allina Health's United Hospital. “If a [sick] person coughs into your face that is high risk.” However, it is possible that the novel coronavirus could be on surfaces, such as door handles, elevator buttons and other things that get touched frequently. That is why health officials are emphasizing the importance of washing your hands and not touching your face.
“It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads,” according to the U.S. Centers for Disease Control.
Ultimately, researchers can’t prove that surfaces are totally safe, which is why they ask people to take some precautions for protection from COVID-19 as well as other diseases such as influenza and the common cold. The risk is even lower for packages that are shipped weeks ago or from long distances. “In general, because of poor survivability of these coronaviruses on surfaces, there is likely very low risk of spread from products or packaging that are shipped over a period of days or weeks,” according to the CDC. It is good practice to clean surfaces at home using products containing bleach or 70% alcohol. “Wipe down commonly touched surfaces. Use appropriate precautions in your home that would do with the common respiratory illnesses,” said Peterson. The Environmental Protection Agency has guidelines for which products to use against SARS-CoV-2.
COVID-19 and other coronaviruses can live on surfaces for a few hours or up to several days, according to the World Health Organization, depending on the type of surface and the temperature and humidity. One recent study, which has not yet been reviewed by other scientists, found the novel coronavirus was viable up on copper up to 4 hour, up to 24 hours on cardboard and two to three days on plastic and stainless steel.
If you are diagnosed with the virus and recover, are you immune?
Because COVID-19 is still a relatively new human infection, researchers are still learning more about it. “Based on more common circulating coronaviruses, there is some evidence that people can be infected more than once over subsequent years,” said Dr. Susan Kline at M Health Fairview. “But I don’t think we know yet with this COVID-19." In the 2003 SARS outbreak, which was also caused by a type of coronavirus, there was evidence that the virus was still present in respiratory secretions, blood, urine and tissue “going into three weeks of illness, sometimes even longer among people who are more seriously ill.”
Does the pneumonia vaccination help fend off pneumonia-like symptoms with coronavirus?
While the elderly or those susceptible to pneumonia are encouraged to get that vaccine, it won’t protect you against the viral pneumonia that is associated with COVID-19. “The pneumonia vaccine just protects against pneumococcal pneumonia,” which is a bacterial infection, said Dr. Susan Kline, infection prevention medical director for M Health Fairview. “But it can’t protect against all pneumonia and it does not protect against viral pneumonias.”
TRAVEL, GETTING AROUND
What travel restrictions are in place?
Gov. Tim Walz is extending a statewide stay-at-home order to May 18 to buy time to allow hospitals to stock up on supplies and researchers to develop tests and treatments against the new coronavirus.
In the United States, President Trump's federal social distancing guidelines expired April 30. Many states and local governments have stiffer controls in place on mobility and gatherings.
Earlier, the U.S. State Department issued a Level 4 "Do Not Travel" alert and advised U.S. citizens to avoid all international travel due to the global impact of COVID19. The warning states: "If you choose to travel internationally, your travel plans may be severely disrupted, and you may be forced to remain outside of the United States for an indefinite timeframe."
The CDC is advising older adults and people with severe medical conditions such as heart, lung or kidney disease to “stay home as much as possible” and avoid crowds.
The federal government has postponed the deadline for obtaining REAL ID-identification cards for one year. Travelers will not be required to present REAL ID cards to board U.S. flights starting on Oct. 1, 2021.
Gov. Tim Walz on March 28 signed a bill that grants an extension for Minnesotans whose driver’s licenses or ID cards expire during the stay-at-home order. The law says any expiring driver’s license, instruction permit, provisional license, operator permit, limited license, or farm-work license will remain valid for two months after the emergency ends.
What is the status of Metro Transit service?
In an effort to curb the spread of the coronavirus, Metro Transit suspended nighttime light rail service beginning April 18.
Service on the Green and Blue lines was suspended between 9 p.m. and 6 a.m. in an effort to also address “operational challenges.” Evening trips on light rail that begin before 9 p.m. will complete their trips, Metro Transit said.
The Blue Line airport shuttle between Terminal 1 (Lindbergh) and Terminal 2 (Humphrey) at the Minneapolis-St. Paul International Airport will continue to operate overnight.
Regular bus service will continue to be suspended between 11 p.m. and 4:30 a.m. And earlier this week, Metro Transit suggested that passengers wear a mask or face covering while aboard all buses. Only 10 bus passengers will be permitted on 40-foot buses, and 15 on 60-foot buses.
Metro Transit advises that public transportation should be used for essential purposes only.
Metro Transit says buses, trains and facilities are being regularly disinfected. Customer service information is available at 612-373-3333 between 6:30 a.m. and 9 p.m. weekdays and 8 a.m. and 4:30 p.m. on weekends. Riders are encouraged to use the Show My Bus feature on mobile or desktop websites.
“Metro Transit maintains contingency plans for all types of emergencies, including pandemics,” said Metropolitan Council spokeswoman Terri Dresen.
MORTALITY RATES, RISK FACTORS
What is the mortality rate compared with influenza? What segment of the population is most at risk?
A report from the U.S. Centers for Disease Control and Prevention examined more than 7,000 U.S. cases of COVID-19 and reaffirmed the risks to the sick and elderly. People with at least one underlying condition, such as diabetes, represented 37% of overall COVID-19 patients, but 78% of those needing intensive hospital care. Just being older than 65 was a risk factor for needing intensive care.
According to the U's Center for Infectious Disease Research and Policy, a team from the United Kingdom published a new case-fatality rate estimate of 1.4%, based on all available data on deaths in and outside of China.
COVID-19 is more fatal than the seasonal flu, but not as deadly as some other viruses. “We’ve certainly seen infectious diseases in fairly recent memory that are much more lethal than COVID-19 at this point,” said Minnesota Health Commissioner Jan Malcolm.
Ebola, which primarily has affected African countries, had a fatality rate of 50%. COVID-19 is the name of the illness caused by exposure to the SARS-CoV-2 virus. Recent estimates have suggested a fatality rate between 1.4% and 3.4%. The flu’s death rate is about 0.1%. By comparison, two other coronavirus-type outbreaks were more fatal: 10% for the 2003 SARS outbreak, which also started in China, and 30% for the 2012 MERS outbreak, which was confined to the Arabian Peninsula.
The COVID-19 fatality rate was determined by a study of nearly 45,000 patients conducted by China’s disease control agency. That number is likely to change as other studies are conducted and more is known is about the number of mild cases. However, like the flu, the elderly and those with chronic health conditions that affect their ability to fight off infection have higher mortality rates. According to the Chinese study, 81% of cases were mild, while 14% had more severe infections and 5% needed intensive hospital care, a group that saw higher death rates. “When the disease is severe, it can be quite severe,” Malcolm said.
The CDC offers guidance to those who are at risk for serious illness with COVID-19, including older adults and those with heart disease, diabetes or lung disease. In addition, if you have another chronic health problem, cancer or are immune-compromised, doctors suggest extra caution.
Not everyone with the virus will exhibit symptoms, and about 80 percent of people with the virus do not end up needing hospitalization, health experts say.
Are residents of large buildings at risk because of the ventilation systems?
It is unclear if COVID-19 can be spread through residential or office ventilation systems. “We know that your highest risk is in being close contact with another person who is in their acute phase of infection,” said Dr. Alison Peterson at Allina’s United Hospital. The water droplets formed when an infected person coughs or sneezes are thought to be the main method of transmission.
“We haven’t heard of any case that has come from ventilation,” she said. Some viruses, such as measles, float in the air for a while and have been documented to travel through ventilation systems. Most notably, in 1991 the measles virus was passed through the Metrodome’s ventilation system, infecting 16 people at a Special Olympics event. The COVID-19 virus is thought to be heavier and eventually will sink to the ground.
In a hospital, as a precautionary measure, most people who are seriously ill with a viral infection are placed in a hospital room with specialized ventilation equipment that will direct the air outside the building and not circulate it internally.
ASK A QUESTION
Do you have coronavirus questions?
Janet Moore contributed to this report. This article also includes information from the Washington Post and Associated Press.
Journalism that matters.