Minnesota reported 159 deaths from COVID-19 in July, the lowest full-month tally since the state started seeing losses from the coronavirus pandemic in late March.

Health officials credit better control of the virus in long-term care facilities as well as better treatments for the disease, but say recent jumps in the number of cases could bring increased death counts in coming months.

Health officials last week noted a worrisome sign involving cases among workers in long-term care facilities, and there are concerns the virus might spread faster as schools start to reopen. "Now is not the time to be complacent," said Dr. Timothy Schacker, vice dean for research at the University of Minnesota Medical School. "A lot of people have COVID fatigue, but things have the potential to become a lot worse."

On Saturday, the Minnesota Department of Health reported six new deaths, including three among residents of long-term care and assisted living facilities. Statewide, 1,606 people have died from the virus, including 1,226 deaths in long-term care or assisted living residents.

After reporting 12 deaths in March and 331 deaths in April, the state's one-month count peaked in May at 696 deaths from COVID-19. In June, the state reported 402 deaths.

More testing of long-term care patients and staff, as well as improved efforts to isolate cases and control the spread in the facilities, help explain the relatively low number of COVID-19 deaths in July, Jan Malcolm, state health commissioner, said during a Friday call with reporters. But Kris Ehresmann, the state's director of infectious disease, said recent increases in confirmed cases are troubling.

The Health Department reported Saturday a net increase of 731 new coronavirus infections, taking the seven-day average for new cases to about 700 per day. During the second half of June, the state was averaging fewer than 400 new cases per day.

Testing volumes have increased over the time period, but by a smaller amount.

"We knew with opening up things there would obviously be some transmission, but the volume that we're seeing is really high and we think, to a large extent, it's because ... people are really disregarding the social distancing guidance," Ehresmann said. "If we keep seeing more cases, we're going to have to be thinking about how open we are."

Cases surge among young

Minnesota has seen a surge of cases in June and July among people age 20 to 29. While the risk of death and serious illness in that group is relatively low, they have the potential to spread it to others who are more vulnerable, Ehresmann said.

A related concern, she added, is last week's one-day increase of 83 cases in long-term care facilities, including 64 cases among health care workers. That's troubling, she said, because those workers might unknowingly be bringing the virus into facilities that have worked hard to control the spread.

On Friday, the Health Department reported the number of long-term care facilities with at least one confirmed case had increased to 170, up from 159 the previous week. The numbers had been trending down the previous two weeks.

"It's concerning to us that we have that many more facilities that are having to be on alert because of an exposure," Ehresmann said.

The state passed a milestone in testing capacity last week as the total number of coronavirus tests completed surpassed 1 million, Malcolm said Friday.

As cases have surged this summer in Sun Belt states and elsewhere, supply problems have emerged that have slowed the turnaround time for test results. Still, Malcolm urged Minnesotans to get the test when it's recommended by doctors and public health workers, since results help with efforts to control the spread.

"Really, the entire globe is challenged for having enough COVID testing available to manage the pandemic," Dr. William Morice, chairman of laboratory medicine and pathology at Mayo Clinic, told reporters. "So, we feel that here in Minnesota, but we'll continue to work to make the test available."

The coming school year brings the potential for more cases, which could put further strains on the state's capacity to test for the virus, Schacker said. Some students, if not all, will be returning to campus at many colleges and universities, and while much instruction will be online, "you'll still have dorms with people in them," he said.

"As people move back inside and as we open things up a little bit more, I think the concern is that there will be more cases," Schacker said.

Saturday's data release showed 317 patients in the hospital, an increase of five from Friday; 149 patients required intensive care, down two from the previous day.

Daily tallies for hospitalized patients in Minnesota have been on the rise in recent weeks, although they remain well below peaks of more than 600 hospitalized patients and about 260 in the ICU in late May.

"That's what we've seen around the country and around the world — as cases go up, then hospitalizations go up and deaths go up trailing both of those," said Dr. Tim Sielaff, chief medical officer at Allina Health System, which operates 11 hospitals in Minnesota and western Wisconsin.

"Every single good decision that we make about exposing ourselves or exposing others to potential risk is what adds up to fewer cases, fewer hospitalizations and fewer deaths," he added.

COVID-19 is a viral respiratory illness caused by a new coronavirus that was found circulating late last year. Since the first case was reported in Minnesota in early March, hospital stays have been required in 5,208 cases, although most patients don't need that level of care.

The illness usually causes mild or moderate sickness. Studies suggest that up to 45% of those who are infected won't have symptoms.

People at greatest risk from COVID-19 include those 65 and older, residents of long-term care facilities and those with underlying medical conditions ranging from lung disease and serious heart conditions to obesity and diabetes.