As COVID-19 cases in Minnesota continue to surge, some Minnesota hospitals and health care providers are asking employees with "higher-risk" exposure to the disease to return to work before their quarantines end.

The requests are forcing health care workers to choose between following the state guidance of quarantining for 14 days after virus exposure or going back to the job sooner than that. State officials say isolating for two weeks is highly recommended, but voluntary.

"The deck just seems stacked against us," said Mary Turner, an intensive-care nurse at North Memorial Health Hospital and president of the Minnesota Nurses Association.

The Minnesota Department of Health on Sunday added 5,908 newly diagnosed infections of the coronavirus that causes COVID-19 — an all-time daily high and the second total above 5,000 in three days.

Overall, the state has had 180,862 cases of the viral respiratory illness.

The rise in cases is not just a reflection of increased testing — the share of tests that were positive grew to 13% Sunday. In the last week of October, more than 10% of all tests resulted in positive readings, double the rate from a month earlier. Test positivity peaked in May at about 15%, weekly data from the state show.

On Sunday, the Health Department reported 31 new deaths from COVID-19, bringing Minnesota's tally of pandemic fatalities to 2,656. The youngest fatalities were two people in their 40s.The deaths included 18 residents of assisted-living and long-term care facilities.

A study published by the CDC late last month analyzed 3,580 workers in Minnesota on state-monitored quarantine after exposure to COVID-19 between March and early July. It found 57% were asked to return to the job early, and slightly more than 48% did so.

The trend continued in September, state health officials say, with 56% being called back to work and 49% returning.

The data show the pressure to return to work early was more evident in congregate care settings such as skilled-nursing and assisted-living centers than in hospitals and outpatient centers. But the requests, which continue, were made by employers in all of the health care sectors measured.

COVID-19 case growth in Minnesota in October and November has set records, far exceeding peak case counts last May. The recent spike has put pressure on hospitals and surgery centers, which at this time of year are filled with patients seeking care before insurance deductibles reset on Jan. 1.

As a result, demand for health care services is peaking as greater numbers of health care workers exposed to COVID-19 are going into quarantine.

One registered nurse who works with COVID-19 patients at an Essentia Health facility said she struggled last month when her employers told her — rather than asked her — to report to work two days before her quarantine ended. The Health Department recommended she not work, but she said she felt she had no choice.

"If you are asking me to come to work when I should be on quarantine for a high-risk exposure, you are asking me to go against the oath that I swore when I became a nurse," said the woman, who asked that she not be identified for fear of reprisal from Essentia. "You are asking me to go against the integrity of the person that I am, and you're making me question whether I could be potentially infecting patients."

Leaving a 14-day quarantine early is allowed under CDC guidelines for asymptomatic health care workers during staffing shortages. But there are conflicting opinions about whether an employer in Minnesota can force a worker to return to the job against their wishes.

The state Health Department urges health care workers to abide by 14-day quarantines and will check in daily with workers who are being monitored. The state may also give workers letters that remind employers that state law forbids firing or penalizing workers under quarantine or isolation.

"The isolation and quarantine law does say that people cannot lose their job for following the public health guidance," state infectious diseases director Kris Ehresmann said.

That hasn't stopped employers from applying pressure.

"State or county health department guidance does not override Essentia Health's Workability team guidance about returning to work," said three chief medical officers at Duluth's Essentia Health in an Oct. 9 staff memo obtained by the Star Tribune.

A spokesman for the health system said "critical staffing shortages" have prompted difficult choices, including modifying quarantines to allow workers to return before 14 days. Those employees must remain free of symptoms, wear an N95 respirator at all times, and take two COVID tests.

"These are not decisions we make lightly," the health system said in a statement. "However, they are ones we have to consider if the alternative is a staffing shortage that would compromise patient care."

Modified quarantines

The CDC's current guidance says workers who go without face masks or goggles for more than 15 minutes while close to someone with COVID-19 must stay home for 14 days from last exposure.

However, a footnote says it may not be possible to honor asymptomatic quarantines if hospitals or nursing homes have staffing shortages. The modified rules say such workers can return with protections such as masking, symptom screening and, potentially, testing.

Many health care organizations across the country have been following the CDC rules on modified quarantines, said Dr. Laura Breeher, Mayo Clinic's medical director of occupational health.

"These individuals are able to work if critical staffing needs exist and if they're asymptomatic, with universal masking, and with serial PCR testing every few days to ensure they are free of infection," she wrote in an e-mail.

Workers, however, remain skeptical.

Chris Rubesch, a registered nurse with Essentia Health and director with the Minnesota Nurses Association, said he has not seen evidence that hospitals in staffing crises are cutting back on elective procedures, rather than calling workers out of quarantine.

"Calling back nurses before they are done with quarantine, because of PPE use in the hospital, may be a low risk for people in the hospital. But it's not no-risk," Rubesch said. "So let's do absolutely everything we can to make it as safe as possible."

Staff writer Jeremy Olson contributed to this report.