A two-day spike in confirmed COVID-19 cases last week was just enough to land Minnesota on New York’s travel restriction list.

New York Gov. Andrew Cuomo on Tuesday added Minnesota and three other states to the list due to their rising levels of COVID-19 activity, meaning that travelers from those states must fill out health forms and voluntarily quarantine themselves for 14 days upon arriving in New York.

The announcement surprised health officials in Minnesota, where COVID-19 case growth has been moderate for more than a month and daily death and hospitalization totals have been declining. The number of Minnesotans hospitalized for COVID-19 declined Tuesday to 236 — including 107 people needing intensive care. Those are the lowest daily figures since mid-April.

“We are looking into this as it does not jibe with our data,” Kris Ehresmann, the state infectious disease director, said of New York’s decision.

New York’s approach is to restrict travelers from any state in which the seven-day average of new cases exceeds 10 per 100,000 people per day — or in which the positivity rate of COVID-19 tests is above 10%. The state was among the earliest to see a big spike in cases and remains one of the hardest hit overall in the United States.

“Rising cases around the country continue to threaten our progress, which is why four new states have been added to New York’s travel advisory,” Cuomo said.

Minnesota’s COVID-19 numbers stayed below New York’s thresholds through June and the first week of July. However, the state reported confirmed COVID-19 case counts of 806 and 715 on Saturday and Sunday, respectively.

Even with lower counts of 499 on Monday and 403 on Tuesday, that put the state’s seven-day average at about 583 cases per day.

To stay below New York’s threshold for travel restrictions, Minnesota needed a seven-day average of fewer than 564 per day.

Minnesota Gov. Tim Walz said travel restrictions will be “detrimental” to commerce but he doesn’t fault New York.

“When you have the lack of a federal cohesive strategy, you see a 50-state strategy,” he said. “And I think, New York, what they went through — keep in mind it wasn’t all that long ago we were seeing 400 and 500 deaths a day in New York City. And I think the hard-earned gains that they made, they are very nervous about backsliding, just like we are.”

Travelers could face fine

Minnesota’s COVID-19 response page shows the state below both New York thresholds — with a case rate of 6 per 100,000 and a positive testing rate of only 3%. However, the page is based on case data through July 8, and doesn’t reflect the spike this past weekend.

New York’s analysis is based on updated figures maintained by the COVID Tracking Project, a national journalist-led organization that started tracking the disease in the absence of a unified federal source.

Minnesota health officials said the tracking project monitors cases by report date, but that the state Health Department uses specimen collection dates to calculate daily COVID-19 rates. This results in some differences in the daily case rates, but probably wouldn’t have prevented Minnesota from ending up on New York’s travel restriction list.

Iowa and Wisconsin are also among the 22 states on New York’s list.

Travelers entering New York are required to complete screening forms or pay $2,000 fines. Those coming from restricted states will be asked to voluntarily quarantine themselves for 14 days — the amount of time during which a coronavirus infection would be expected to produce symptoms.

The quarantines are voluntary, though travelers from restricted states must agree to receive texts or calls from New York contact tracers.

New Jersey and Connecticut are enforcing the same restrictions, but they do not apply to people passing through the states in 24 hours or less — such as those on airport layovers — or to a broad list of essential workers such as health care providers.

New York reviews states’ COVID-19 rates every Monday, meaning Minnesota could be removed from the restriction list in a week.

The city of Chicago also has enacted travel restrictions, but with a higher threshold for anyone traveling from states with case rates of 15 per day per 100,000 people.

Minnesota’s total COVID-19 case count reached 43,170 Tuesday, including 37,749 people who have recovered to the point that they are no longer considered infection risks.

The state on Tuesday also reported six COVID-19 deaths, bringing its total in the pandemic to 1,510.

Median age dropping

COVID-19 case reporting has followed a cycle in Minnesota — with high totals on weekends reflecting tests conducted during the workweek. While the numbers reported this past weekend might have been artificially high — and pushed Minnesota onto New York’s travel restriction list — state health officials aren’t writing them off as anomalies.

Minnesota has seen COVID-19 case growth since mid-June, largely due to infections involving young adults and teenagers.

Only two COVID-19 deaths in Minnesota have involved people 29 or younger, even though they make up more than 35% of the state’s known cases. By comparison, people 70 and older make up 10% of the state’s cases, but 81% of the deaths.

While some growth in confirmed cases is likely due to more diagnostic testing over the last week, state health officials are concerned that the recent increase in Minnesota could mimic the pattern in many Southern and Western states.

Arizona, Texas, Florida and others saw initial increases in infections among young adults and teens. They later saw an increase in hospitalizations and deaths when those young adults spread the virus to people who are at greater risk due to their age and underlying health conditions.

California on Monday again ordered the closure of bars, restaurants and other public gathering places due to a rise in COVID-19 cases.

Walz said he isn’t considering quarantines on travelers entering Minnesota, because they aren’t the primary source of COVID-19 cases for the state. Travel in the early spring was the top source of COVID-19 cases in Minnesota — with the virus first emerging in China and spreading globally — but now makes up only 6% of the state’s total transmissions.

Walz is expected to decide later this week whether to join more than 20 other states in requiring that people wear masks in public settings to reduce transmission of the virus.

Staff writer Jessie Van Berkel contributed to this report.