Only a select few may have been close enough, long enough, to President Donald Trump to be infected by the coronavirus he is carrying, but health officials urge people who attended Wednesday's campaign events in Minnesota to watch for symptoms.

The president was far enough from the crowd at a Duluth rally that it's unlikely he spread the virus to his fans, but the environment also presented the risk of attendees infecting one another, said Amy Westbrook, St. Louis County's public health director. The city of Duluth had warned that the setup could be problematic and lamented in a statement Friday that "the campaign chose not to comply with state guidelines" for social distancing and mask-wearing.

"With an estimated attendance of at least 3,000 people at the rally, there's a pretty good likelihood that some of the attendees had the virus and were contagious," Westbrook said. "So as we would with any event, we strongly encourage participants to quarantine, monitor themselves for symptoms and consider getting tested."

The spread of COVID-19 appears to have accelerated recently in Minnesota, where state health leaders Friday reported another 10 deaths and 1,184 infections — bringing the state's totals to 2,059 deaths and 101,366 infections. Hospitalizations for the infectious disease have increased — with 358 admissions for COVID-19 in the seven-day period ending Tuesday.

A key state metric, the seven-day positivity rate of diagnostic testing, has risen from 4.4% two weeks ago to 5.3%. That suggests a broader spread of the virus, even though testing activity has increased over the past month and has likely identified more mild infections that might previously have been missed.

Large group events have helped fuel the increase in transmission, state health officials said, with an outbreak at a Martin County church and funeral last month contributing to communitywide spread. The Sept. 9 funeral has been linked to 41 infections, and 15 others have been tied to funeral attendees who likely spread the virus at church services four days later in Fairmont and Truman, and at a local hair salon.

The state on Friday released its first list of outbreaks in schools in which five or more students or staff members were in the buildings while infectious — and three of the seven were in Martin County.

St. Louis County has seen rising community spread of COVID-19 as well — with infections increasing from 409 on Aug. 1 to 1,840 now, and deaths increasing from 18 to 46. That development, combined with the lack of compliance with COVID-19 mitigation strategies by the Trump campaign, raises the risk that infections did occur at the rally, state infectious disease director Kris Ehresmann said.

"People may not have been socially distant, they may not have been masking and obviously it was a large group," Ehresmann said.

The state Health Department advises anyone who has been in close contact with the president or staff members who have tested positive to consider quarantining and limiting contact with others. Any contacts meeting the definition for moderate exposure risk — meaning people who spent 15 minutes within 6 feet of the president — are advised to seek testing and remain quarantined for 14 days regardless of test results.

Several Minnesota Republican leaders announced voluntary quarantines Friday due to their varying levels of contact with the president and his staff this week.

Ehresmann said the state has not received an attendance list for the Duluth rally that it could use to conduct contact tracing to find any high-risk exposures, and a statement from Hennepin County Public Health said it has not received an attendance list from a Trump Shorewood fundraiser for contact tracing either.

Gov. Tim Walz sent a letter earlier this summer to the presidential campaigns of Trump and Joe Biden, asking them to follow state guidelines that encouraged social distancing, limited the size of group gatherings and required indoor mask-wearing.

Ehresmann said she didn't know whether state officials responsible for enforcing COVID-19 safety requirements would take action regarding lapses at the latest rally.

Trump's infection reflects the ease with which the coronavirus that causes COVID-19 can spread, said Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy.

The White House strategy of COVID-19 prevention through frequent testing was never going to be an effective barrier compared to "assuming that everyone is infected and taking the steps necessary to assure that they don't infect someone else," he said.

"I'm concerned about his exposure to the individuals at the fundraiser in Shorewood as well as the team's contact — not just him — but the team's contact with people in Duluth," Osterholm added. "There clearly were infected, and likely infectious, people at that time."

Trump's age and weight increase his risk for severe COVID-19, but even in that demographic, "the majority still end up coming through OK," said Dr. John O'Horo, an infection prevention and control specialist at Mayo Clinic in Rochester. The early detection and wealth of medical resources available to the president will make his outcome difficult to compare with that of someone in the general public, he said.

The broader lesson is that anyone spending so much time close to other people is going to be at elevated risk and that it takes a combination of masking, social distancing, washing hands and other steps to reduce risk, he said.

"For the rest of us, we still have a chance" of avoiding infection, he said. "We just have to make sure we're not completely reliant on any one layer of protection — since any one layer can fail."

Staff writers Katie Galioto and Christopher Snowbeck contributed

to this report.

Jeremy Olson • 612-673-7744