Rising COVID-19 case counts, especially in rural hot spots, have Minnesota health officials concerned that the infectious disease will infiltrate back into long-term care facilities where it can be particularly severe.

The Minnesota Department of Health on Friday reported 14 COVID-19 deaths, 12 of which involved residents of long-term care. The list of such facilities with at least one confirmed infection in a resident or worker in the past 28 days has grown from 239 on Sept. 1 to 341 now.

“While over the summer we were seeing very low numbers of new cases in staff and residents, we added 77 new cases today,” said Kris Ehresmann, state infectious disease director. “We’ve gone from 20s to 30s to 50s to now we have days when we’re adding over 100 cases a day.”

A larger proportion of infections in these facilities involve workers, when compared with this spring. Ehresmann said that suggests that rapid testing and isolation protocols are limiting the transmission of the virus from workers to vulnerable residents — who have made up 72% of the state’s 2,121 COVID-19 deaths.

However, the hard lesson learned this spring is that community transmission of the virus makes it difficult to prevent the spread in long-term care facilities forever, she said. And Minnesota’s infection rate per the COVID Exit Strategy website has risen to 190 per million people per day, with rates in neighboring Wisconsin and the Dakotas above 400 and worst in the nation.

The Health Department on Friday reported 1,401 newly lab-confirmed infections with the novel coronavirus that causes COVID-19, bringing Minnesota’s total to 109,312.

Friday’s high infection count was fueled by 31,857 tests reported by the state, but even that came with a troubling sign, state Health Commissioner Jan Malcolm said.

More testing should theoretically reduce the positivity rate of results if the virus is diminishing. Instead, the state’s rate has hovered around 5% for the past month.

“The fact that we’re still finding a consistent percentage of cases as we test more, rather than seeing a lower percentage, just means the viral load that’s out there, the amount of virus circulating, is not decreasing,” she said.

Test numbers have increased in part through Minnesota’s investment in new saliva-based diagnostic tests and test sites. Saliva samples are easier to obtain than nasal or throat samples. The first collection center in Duluth has already obtained saliva samples from 7,000 people. The second center was announced Friday at the Winona Mall and will be offering free testing on select hours from Wednesday through Sunday each week.

Ehresmann said the spread of the virus has flipped in Minnesota from concentrations in the metro areas to pockets in the rural areas. Test positivity rates in Martin and Pipestone counties have been above 10% in the past week.

The infections reported Friday came from 81 of the state’s 87 counties. The number of counties with low enough COVID-19 rates to recommend all in-person classes has dropped from 48 at the start of August to five, while the rate of counties in which all online learning is advised has increased from zero to nine.

The median age of known infections had declined over the seven-month course of the pandemic to 35 in Minnesota, but it has increased to 36.

“Even though we had a significant … shift age-wise, demographically, to younger people contracting the virus, in recent weeks we have expected and are now seeing that secondary and tertiary transition into older and higher-risk parts of the population,” Malcolm said.

More than 80% of the COVID-19 deaths in Minnesota have involved people 70 or older. The share of deaths involving long-term care residents has declined from 80% in the spring to 72% now. However, 12 of the 14 deaths reported Friday involved long-term care residents.

The state’s revised COVID-19 dashboard showed that 471 people were in Minnesota hospitals on Thursday due to COVID-19, and that 133 required intensive care because of breathing problems or other complications.

When including patients with COVID-19 and any other medical problems, 1,090 of the state’s 1,495 immediately available ICU beds were filled. Another 408 ICU beds could be readied within 72 hours.

ICU utilization varies by region, with 95% of beds full in the metro area — though Malcolm said that isn’t uncommon this time of year. She said health officials are monitoring ICU use and any signs of rising pressure caused by more admissions of Minnesotans and also patients from border states where infection numbers have been higher.

State health officials also continue to monitor any spread of COVID-19 from President Donald Trump’s recent rallies in Bemidji and Duluth, where mask-wearing and social distancing recommendations were not widely followed. Nine infections have been associated with people at the Bemidji rally. Two of those people were hospitalized and one required intensive care.