The cities of Minneapolis and St. Paul, along with several businesses, will keep mask requirements in place even though Gov. Tim Walz signed an executive order Friday ending the statewide mask mandate.
For the near future at least, Minnesotans are likely to face a patchwork of different rules about mask-wearing, making the face covering still an essential item to carry in cars, pockets, purses or backpacks when needed to gain entry beyond the "Masks are required" sign.
At a time when case growth, test positivity rates and hospitalization rates have been decreasing but remain above cautionary levels set by state health officials, the removal of mask mandates could set the stage for more infections in those places where masks are few and far between.
"Our steady but quite gradual reduction in these rates has continued for several weeks but still do indicate that we have a lot of virus circulating in our communities," Minnesota Health Commissioner Jan Malcolm said.
While new vaccinations are increasing but "not as quickly as we would like," Malcolm said, "we're hopeful that those favorable trends are more powerful than the added risks that we know exist when more interaction happens."
Health equity advocates are concerned that removing the mask mandate will negatively affect the Black, Indigenous and Hispanic communities, where vaccination rates are among the state's lowest.
Schools will need to follow masking guidelines until the end of the school year, while salons and barbershops can go without them, unless they are in a city that still mandates their use.
Under federal law, face masks must still be worn on buses, trains, airplanes and at transit hubs. But Duluth said Friday that it would end its requirements while Edina, where a mandate expired last year, said it would not enact a new one.
Walz announced Thursday the end of the statewide mandate just hours after federal health officials abruptly announced that fully vaccinated people can drop the masks given evidence that shows minimal risk of COVID-19 infection and transmission.
"From a scientific perspective, ending the mask mandate makes sense," said Dr. David Boulware, an infectious disease specialist at the University of Minnesota Medical School.
"The accumulated data suggest that vaccinated persons are at a very low risk of transmission, even if they have infection present without any symptoms."
Those with weakened immune systems, including some with cancer or taking immunosuppressant drugs, should continue to social distance and wear masks, Boulware said.
Officials at the Centers for Disease Control and Prevention said that those who are not fully vaccinated should continue to wear masks indoors and adhere to social distancing.
Minnesota health officials said their recommendations for unvaccinated or partially vaccinated residents remain the same as the CDC's, except there will no longer be a mandate.
Some states, such as Illinois, announced Thursday that they would remove the mandate for vaccinated residents but keep it for others.
Malcolm said that option would be unworkable in Minnesota.
"We certainly did discuss that. I think it really comes down to a matter of how you operationalize it and what are the practical effects of such a bifurcated mandate," she said. "We've heard from a lot of local public health colleagues that they would find such a mandate impossible to enforce."
Under the order signed by Walz on Friday, cities, counties and other local governments would be free to keep or implement mask mandates.
"We always support their right of local jurisdictions to set public health standards that are higher than the state minimum," Malcolm said.
Speaking before the Minneapolis City Council on Friday, Minneapolis Health Commissioner Gretchen Musicant said the decision to keep the mask mandate was based on low vaccination rates among communities of color.
The state's initial vaccine rollout had the practical effect of limiting access for minority groups, she said.
As a result, 71% of white city residents have gotten at least one dose, but only 28% of Blacks and 35% of Hispanics have started vaccinations. Asian and Indigenous populations have fared better, with one-dose vaccination rates above 50%.
"The questions of how shall we proceed rests on a goal we have as a city to lead with the notion of equity and to protect our populations equitably," Musicant said.
Statewide, vaccination disparities still exist for racial and ethnic groups, despite recent efforts to improve access and education.
While 56% of white Minnesotans have received at least one dose, the rates for Indigenous, Black and Hispanic residents range from 38% to 42%, according to state data.
Dr. Nathan Chomilo, COVID-19 vaccine equity director for the Minnesota Department of Health, said the removal of the mask mandate will present challenges for communities of color.
"Having this and other public health measures no longer mandated does present different risk to different communities," he said.
Minnesota's per capita case growth rate is second in the country, according to the CDC.
On Friday, health officials announced 1,306 new COVID-19 infections, bringing the state's pandemic total to 592,750.
COVID-19 hospitalizations have fallen, with 464 patients in the state's hospitals Thursday, a one-week drop of 17%.
Although the average age of patients has fallen, many of the new cases don't require hospital-level care because a large share of new cases are among younger Minnesotans, who don't develop serious complications compared with the elderly.
Another nine deaths were announced Friday, including three among long-term care residents. The pandemic has cost 7,283 Minnesota lives, including 139 deaths reported in May.
Health care and long-term care facilities will still require mask usage.
"M Health Fairview currently has over 100 patients hospitalized with COVID, and the vast majority of them are unvaccinated," said Dr. Abe Jacob, chief quality officer. "We will continue to mandate masking for staff and visitors to protect the most vulnerable, in particular the immunocompromised."
While 2.3 million Minnesotans have completed the COVID-19 vaccine series, another 3.3 million are either unvaccinated, partially vaccinated or not yet eligible for a dose because they are too young.
"I have some concerns frankly," said Dr. Susan Kline, an infectious disease physician with the University of Minnesota Medical School.
"My worry is that the fact that people won't be wearing masks will make some people more vulnerable to getting infected."
"I think people are still trying to figure out what these new guidelines mean," she said. "I think that puts people in kind of a quandary knowing what is the best thing to do."
State infectious disease director Kris Ehresmann said "when in doubt, wearing a mask is just fine." But most importantly, the best protection is to get vaccinated, she said.
"The ultimate mitigation measure is vaccination."
How Minnesota ranks nationally
• 2nd per 100,000 population in coronavirus cases
• 8th per 100 inpatient beds in coronavirus hospitalizations
• 13th per 100,000 population in coronavirus deaths
Source: White House COVID-19 State Profile Report, week ending May 6
Glenn Howatt • 612-673-7192