State health officials will be encouraging people protesting the death of George Floyd to seek COVID-19 testing — regardless of whether they feel sick — due to the increased risk of the disease spreading at mass gatherings.

A surge in COVID-19 cases among protesters isn't a given — many are wearing masks, and protests are outside, which can diffuse the virus. But health officials on Monday said they are expecting that the gatherings will counteract some progress.

"Concentrated gatherings and loud talking, singing, yelling, you know, all of those loud vocal expressions, exacerbate the risk of spread," said Jan Malcolm, state health commissioner, though it is "mitigated ... by the fact that this is outdoors."

Minnesota reported 361 COVID-19 lab-confirmed cases on Monday, which was the first day since April 28 when the daily count was below 400. The number was likely deflated by the lower reporting that has happened on most Mondays in this pandemic, and by the closure over the weekend of the state's public health lab, which didn't contribute results on Monday.

And yet this also coincided with the Covid Exit Strategy website changing Minnesota's status in the pandemic from "trending poorly" to "making progress" — based largely on the reduction in the growth in cases over the past two weeks. Ten deaths reported on Monday brought the state's total to 1,050 but also was the lowest single-day count in two weeks.

The threat of a new wave of cases among protesters prompted state health officials to recommend COVID-19 testing for all of them. One reason for concern is that 80% of infected people suffer mild or no symptoms, meaning protesters could spread the novel coronavirus that causes COVID-19 without knowing they have it.

The Minnesota Department of Health will soon issue guidance about asymptomatic testing of protesters, because until now it had asked doctors to prioritize testing supplies for patients with symptoms.

A key recommendation will be when asymptomatic protesters should seek testing, because the incubation period of the virus following infection is around five days — with a range of two to 14 days. Testing too soon could miss developing infections, Malcolm said.

Masks have been common, but not universal, at demonstrations, as some protesters wore them for protection while others used them to conceal their identities.

"Obviously, it's something to be nervous about and thoughtful of," said Jessica Tomann of St. Louis Park, who wore a mask at a memorial on Monday for Floyd. "It's also like there's two viruses fighting this nation right now, and it's like, 'What's more important?' It's a double-edged sword, but you've got to pick the justice you really are going to fight for, you know?"

Maria Smith drove with her daughter to E. 38th Street and S. Chicago Avenue on Monday so that her daughter, a jingle dancer, could perform with others. COVID-19 is a risk, but the memorial "is taking a little more precedence than that," said Smith, who wore a mask while standing shoulder to shoulder with other women at the event.

Stocking clinics

Social distancing and a 51-day statewide stay-home order, which ended May 18, had been credited with slowing the growth of COVID-19 in Minnesota, which is one reason health officials believed the pandemic was still peaking here compared with other states.

Modeling by University of Minnesota and state health researchers showed that adherence to the order had reduced disease transmission by 55%, though initially they had predicted a reduction of 80%. But no modeling accounted for the death of George Floyd during an arrest by Minneapolis police officers — and the outrage that sent people crowding into the streets.

Upon learning of the likely protests, the state Department of Health made sure masks were available through community clinics and partners if protesters wanted them, said Kris Ehresmann, state infectious disease director.

Studies have shown that cloth, nonmedical-grade masks reduce the chance that wearers spread the coronavirus to others. These masks don't protect the wearers from being infected by others, though, unlike fitted N95 masks that are being largely held in reserve for hospitals treating COVID-19 patients.

State health authorities will make sure that clinics are well-stocked with collection kits for COVID-19 tests of asymptomatic protesters, said Dr. Ruth Lynfield, state epidemiologist.

Protesters can help by monitoring their own health and calling their doctors right away if they experience dry cough, difficulty breathing, fever, loss of taste or other classic COVID-19 symptoms, she added.

When it comes to the infection risk at a protest, "being outdoors is better than being in a very closed, confined indoor-type of setting," Lynfield said. "However it is hard to maintain a 6-foot distance at a rally."

Toll on black community

The potential spread of cases among protesters could be a double whammy, even though many of them are in the younger age demographic that has seen far fewer severe COVID-19 cases. Minnesotans 30 and under make up 74% of known infections but only six total deaths.

Further, many of the protesters are black, and people in this racial demographic suffer higher rates of chronic disease, which raises the likelihood of severe or even fatal COVID-19 cases. An initial state analysis showed that 23% of COVID-19 hospitalizations involved black people, even though they make up 6% of Minnesota's population.

Another problem is that black people make up a substantial share of the workforce in long-term care facilities — and residents of these facilities have suffered 855 of the COVID-19 deaths so far.

An outbreak late last month of COVID-19 in Minneapolis' largely black Cedar-Riverside neighborhood showed how infection risks work together. Health officials believe the outbreak was sparked by long-term care workers bringing the virus from work to friends and relatives in that community.

Assessing the impact of the protests on the pandemic in Minnesota will be challenging, because it is coming at the same time as other changes in state policies and restrictions. That includes the allowance as of Monday for restaurants and bars to resume outdoor dining service, and for salons to offer limited appointments at 25% of their usual capacities.

Contact tracing by state health investigators will be challenging as well when identifying sources of COVID-19 infection for people who participated in mass protests.

Finding the sources of infections for sick individuals is only one purpose of contact tracing, though, Ehresmann said. The other is to identify their close contacts around the time they developed symptoms, so that those contacts can quarantine themselves and avoid spreading the virus further.

Staff writer Matt McKinney contributed to this report.

Jeremy Olson • 612-673-7744