State health officials on Thursday stopped short of calling for cancellation of K-12 classes but encouraged schools to practice social distancing and other measures to reduce the threat from COVID-19, the respiratory illness caused by a new coronavirus that has spread to nine Minnesotans.

The decision comes in contrast to decisions by the University of Minnesota and other institutions to suspend in-person classes and switch to online instruction.

The coronavirus hasn't been a significant problem in children worldwide, and school closures could be disruptive and force urgently needed health care workers to stay home with their children, said Kris Ehresmann, state infectious disease director.

"There are concerns about access to nutrition and other important school services," she said. "And closing schools means that a large number of parents need to stay home with their children, and many parents are health care providers. So closing schools also has an impact on our health care system."

The latest round of testing identified four new cases of COVID-19 in Minnesota — with Hennepin, Dakota and Stearns counties seeing their first cases. Ramsey County now has three cases. All nine cases in the state involve people who were infected while traveling or who were infected through contact with others who had traveled, Ehresmann said.

Minnesota so far has not identified a case of transmission from one person to another within the state — which would signal that the virus has gained a firm foothold here and that stronger measures might be needed to reduce its spread.

"Minnesota is not at a point where you are seeing community transmission," Ehresmann said.

Minnesota's public health lab has so far tested saliva or nasal samples from 316 patients. The state doesn't have unlimited testing capacity and is trying to make sure it tests samples from people at greatest risk or who have the greatest likelihood of infection based on travel history and other factors, Ehresmann said.

The relative amount of testing doesn't affect the underlying public health message to Minnesotans to stay home if they are sick, she said. "Certainly having more testing is something the whole country aspires to, but at this point, if you stay at home when you are sick, that will have the biggest impact."

Whether infected with the coronavirus, flu or some other pathogen, people should make efforts to stay away from others. No vaccine or specific medicine exists for COVID-19, so patients with respiratory symptoms could receive the same treatment regardless of their diagnosis.

Hospital leaders urged public compliance with these state health recommendations in order to prevent infections and slow the rate of spread and keep health care facilities from being overwhelmed. While 80% of COVID-19 cases appear to cause little or no symptoms, others can lead to pneumonia and severe respiratory infections that require intensive care and even mechanical ventilation.

As of Thursday morning, only 5% of the state's intensive care hospital beds were unused, and roughly 3% of the medical-surgical beds were unused, according to the Minnesota Hospital Association.

"We don't ever want to get to the point where we have completely exhausted our resources," said Dr. Caitlin Eccles-Radtke, an infectious disease expert at Hennepin Healthcare in Minneapolis. "We know that could happen, which is why we are pushing people now."

Hospitals are still pressed by the influenza season, though it may have crested. The 263 influenza-related hospitalizations in the first week of March was a decline from the prior week, though the state health department in its latest flu report Thursday listed a third flu-related pediatric death this winter.

Eight of Minnesota's COVID-19 patients are recovering at home. One remained hospitalized in critical condition.

Globally, there have been more than 128,000 COVID-19 cases, mostly in the Wuhan region of China, where the coronavirus emerged. Cases have been declining in China, though, even as they increase in the United States and Europe.

The outbreak has been harsher on the elderly and people with underlying health problems. Doctors have been surprised by the low infection rate among children. One study in China found only 2% of cases involved patients 19 and younger.

That lower incidence rate influenced state health and education authorities' decision not to shut schools for now.

Ehresmann said schools should cancel large gatherings and take actions to limit student interaction such as staggering recess, lunch and dismissal times. Schools with adequate resources could consider regular health or temperature checks of students and staff.

Recommendations that limit the daily lives and routines of adults might be forthcoming as well, as the state transitions from a strategy of containment and limiting the emergence of the outbreak in Minnesota, to mitigation of its impact once the virus begins to spread.

"We are leaning forward into this area of community mitigation," she said. "These are things that we're doing together to protect our community, and they may impact our lives even if we are healthy. Our goal is to protect people who are most vulnerable."

The Fairview and HealthPartners health systems responded Thursday by waiving costs for patients to use their OnCare or Virtuwell online clinic systems, respectively, to determine if their symptoms merit testing for COVID-19.

"Social distancing, or the act of modifying your behaviors to put physical space between you and other people, will become increasingly important," said Theresa Havalad, a nurse practitioner and care delivery manager for Virtuwell. "Beyond our assessment, Virtuwell and telehealth services can help people avoid potential situations that can increase the spread of infectious disease, COVID-19 or otherwise."

Staff writer Glenn Howatt contributed to this report.

Jeremy Olson • 612-673-7744