It took 28 days for Minnesota to lose 121 people to COVID-19. It took just seven more for the count to double.

State health officials announced 23 more deaths Saturday, pushing the statewide total to 244 since the first Minnesotan to die from the virus was reported March 21. People living in long-term care facilities accounted for all but one of the fatalities announced Saturday and three-quarters of all deaths in the state thus far.

A concentrated testing effort in Nobles County in southwestern Minnesota after an outbreak of COVID-19 at a pork plant in Worthington resulted in a sharp spike in case numbers there over the past several days. Nobles now ranks second to Hennepin County among all Minnesota counties in known cases and has more than Ramsey County, which has more than 20 times the population.

Gov. Tim Walz called Nobles County a "hot spot" in an executive order issued Saturday night that will allow out-of-state nurses and doctors to help with the pandemic response across the state without obtaining a Minnesota license. The Minnesota Nurses Association quickly responded by saying the order raises "serious concerns."

While COVID-19 clusters connected to meat processing represent an ongoing challenge, other indicators — such as case counts and hospitalizations — suggest state policies limiting social interactions are helping to control the spread, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

"It's been a very slow, steady climb in cases — it's not been this rapid acceleration that has been seen in many other locations," Osterholm said. "All the indications are that this is still, Number 1, a significant problem in Minnesota. But, Number 2, the case numbers surely have been reduced over what we feared they might be."

The number of known cases in Minnesota increased Saturday from 3,185 to 3,446.

A total of 288 people currently require hospitalization, compared with 278 on Friday, the Health Department said. There are 109 patients in the ICU, compared with 111 intensive care patients Friday.

Earlier this month, Walz extended a "stay-at-home" order to slow the spread of the virus and buy time to build up scarce health care resources. Recent data suggest the state's push is helping to control the growth of those who need hospital care, according to University of Minnesota researchers.

Within 14 days of the stay-at-home order, total hospitalization growth rates in the state started to significantly slow from earlier levels, said Soumya Sen, a researcher at the Carlson School of Management.

"The stay-at-home order is likely having its desired positive effect, suggesting that continued enforcement is necessary for some time," researchers wrote in a summary of data provided this month to the Star Tribune. The summary was written by Sen; Pinar Karaca-Mandic, a health economist at the U, and Archelle Georgiou, chief health officer at Starkey Technologies.

The numbers are one of several indicators that suggest stay-at-home has provided more to prepare the state's health care system, said Kris Ehresmann, the state's director of infectious diseases. She cautioned that hospital totals could increase with the large number of confirmed cases among those in long-term care.

Limited testing supplies have made it impossible to precisely document the virus spread, but state officials announced last week a significant boost to the testing efforts.

The increase in testing, however, doesn't explain why there were so many deaths last week, Ehresmann said.

"These are most likely individuals who tested positive earlier and have since died," she said.

Some long-term care facilities have reported staffing shortages as workers fall ill with COVID-19. Walz cited that, among other reasons, in explaining his executive order Saturday, which allows health care professionals to practice in Minnesota based on licensure in another state or the District of Columbia. Before caring for patients, those doctors and nurses must be engaged with a health care system or provider already working in Minnesota.

Physicians and nurses who specialize in intensive and critical care, as well as respiratory therapists, are needed for an increasing number of COVID-19 patients, the Minnesota Hospital Associaiton said in a statement. The order helps "alleviate workforce concerns," the group said.

But the Minnesota Nurses Association said the move for out-of-state workers comes as "hundreds of Minnesota RNs will begin receiving unemployment checks due to furlough." Hospitals have refused nurse requests to work in a different facility while furloughed, the MNA said, adding that nurses from other states may not have the same high level of training.

The Health Department is trying to help long-term care facilities keep the virus out and limit its spread. It's doing the same with meat-processing facilities.

More than a week ago, union officials reported an outbreak at the JBS pork plant in Worthington, which employs more than 2,000 workers. While the company announced last week it had closed the facility indefinitely, case counts in Nobles County continue to rise — jumping from 258 known cases Friday to 325 cases Saturday. The county has seen one death.

Jennie-O Turkey Store, a unit of Hormel Foods, said Friday it was indefinitely closing two processing plants in Willmar after 14 workers tested positive for COVID-19. The confirmed case tally for Kandiyohi County jumped from 12 Friday to 28 Saturday, the Health Department said.

"We've been focusing on meat processing, but the same elements are going to be true of other types of plants," Ehresmann said. "We know there are other situations where vegetable canning is done, where other plants that have a situation where workers — they're essential, they're working and there are many of them working together."

Ehresmann said the increase in testing will continue to generate more confirmed cases.

"The goal is to get to the point where every care provider can get symptomatic patients tested really promptly," Jan Malcolm, state health commissioner, said last week. "We're hoping that we can achieve that within the next four weeks — that every symptomatic person is able to get a test."

COVID-19 is a respiratory illness caused by a new coronavirus that surfaced in China late last year. Since the first case was reported in Minnesota on March 6, 797 people have been treated in hospitals. Most patients don't need to be hospitalized, however. The illness usually causes mild or moderate sickness, the Health Department says, and does not require a clinic visit.

Public health officials say the reported case count in Minnesota dramatically understates the number who've been infected and sickened, adding that each confirmed case might represent 100 actual cases.