Minnesota has given COVID-19 vaccine to nearly a third of its priority group of 500,000 health care workers and long-term care residents — putting the state at an average pace nationally as it prepares to offer shots to the next wave of people who are elderly or have critical front-line jobs.

The state ranked 23rd nationally on Monday for its rate of COVID-19 vaccine shots per 100,000 people, according to the U.S. Centers for Disease Control and Prevention, and has administered 157,245 of 422,450 distributed doses. Minnesota ranks behind the Dakotas and Iowa but ahead of Wisconsin.

The comparison isn't entirely fair, because some states have received more of their distributions and have a head start while others await shipments, state Health Commissioner Jan Malcolm said. However, Minnesota is pushing providers to offer more vaccine on weekends to get more shots in arms quickly.

"We are a competitive bunch and hope and intend to improve in those state-by-state comparisons," Malcolm said.

Minnesota health officials said there is urgency to vaccinate against the novel coronavirus that causes COVID-19, even though the current pandemic wave has declined in the Upper Midwest.

The Health Department reported four COVID-19 deaths on Monday — the lowest single-day total since October — and 980 diagnosed infections, bringing Minnesota's totals to 5,711 deaths and 437,552 infections. However, the positivity rate of diagnostic testing increased from 4.7% on Dec. 24 to 7.1% on Dec. 31 — underscoring concerns about holiday gatherings fueling more viral transmission.

The number of COVID-19 patients in Minnesota hospital beds also crept up from 666 on Saturday to 686 on Sunday — though that remains below the peak of 1,864 on Nov. 29.

A more infectious variant of the COVID-19 virus also has been found through genomic sequencing in samples from five Minnesota patients, amplifying the need for vaccine, said Sara Vetter, assistant director of Minnesota's public health lab. "Getting as many people vaccinated as possible will be critical in the control of spread of this variant and the emergence of other variants."

Minnesota stuck closely to guidance from the CDC's Advisory Committee on Immunization Practices by prioritizing limited initial doses of the Pfizer and Moderna vaccines. Health care workers were prioritized due to their infection risks. Long-term care residents were selected because they are at greater risk of severe illness, and make up 64% of Minnesota's COVID-19 deaths.

Sixteen states deviated from the guidance for this first phase, according the Kaiser Family Foundation, a Washington D.C.-based health policy group. South Dakota added police officers and corrections workers, while Florida added anyone 65 or older.

While that made sense given the elevated risk of COVID-19 deaths for older people, it created numerous problems because the elderly population in Florida far exceeds the vaccine supply, said Michael Osterholm, executive director of the University of Minnesota's Center for Infectious Disease Research and Policy.

"Look what happened in Florida by deviating without having a detailed plan," he said. "It's been chaos."

Osterholm serves on the COVID-19 advisory committee to President-elect Joe Biden, who has pledged to expand access to vaccine by releasing a federal stockpile that currently guarantees on-time second doses of the two-dose vaccines.

While that creates risks if second doses aren't available on schedule, Osterholm endorsed the move. There is enough redundancy in manufacturing to ensure continued delivery of second doses even if one plant had problems and had to shut down, he said.

"Do we need to reserve half of all vaccine to cover that second dose?" Osterholm said. "The answer is no."

Some states with higher vaccination rates were less active in a federal program through which chain pharmacies such as Walgreens and CVS vaccinate long-term care residents.

West Virginia did not participate at all because it doesn't have as many chain pharmacies, which have been slowed in part by staffing shortages. The state has the nation's second-highest rate of COVID-19 vaccination.

Minnesota participated heavily in the federal program, which controls 124,000 vaccine doses allocated to the state. Among 369 nursing homes in Minnesota, only 84 opted for local distribution of vaccine rather than the national program.

Hospitals are providing more progress. The majority of Sanford Health workers in northern Minnesota have received first doses, though some have declined, said Matt Webb, Sanford Bemidji's pharmacy director.

"The expectation was about 60 to 70 percent of staff would get this vaccine on the first go-round when it became available," he said, adding that many declined for scheduling reasons earlier on and are now making appointments.

Most hospitals in Minnesota have received the Pfizer vaccine, which comes in a five-dose vial and must be used in a few hours after it is thawed.

Sanford, Allina Health and Mayo Clinic leaders said they have avoided wasting doses by finding other health care workers on hand if others canceled vaccine appointments.

As more workers are vaccinated, there are fewer available as backups, though, making it harder to use up leftover doses, Webb said. "That's kind of the big question coming up here at the end, as we wind down on this first priority group."

Mayo last week created a standby list of people who could come in on a moment's notice for vaccination with leftover doses, but with mixed results, said Dr. Melanie Swift, a co-lead of Mayo's COVID-19 vaccine allocation work group.

"When we actually call them at 7:30 p.m. at home, they don't really want to come back in because they've already got their appointments," she said.

A state advisory group met Monday to plan for distribution of vaccine to the next priority wave of more than 1 million people in Minnesota who are 75 or older, or workers such as teachers, police officers and power plant workers in front-line critical industries.

The Kaiser analysis showed even more variation, with 30 states breaking from the federal guidance on this next wave. Many states are lowering the age range.

Swift said she supports prioritizing vaccine for these high-risk workers, though it will be a struggle for doctors and nurses to know if their patients are in jobs that qualify.

"It's not our 75-year-olds that are out in the community contributing to spread," she said. "These are the folks out there being exposed and potentially exposing others [to the virus] and they can't help it. They can't stay home. We need them to do their jobs."

Jeremy Olson • 612-673-7744