App text formatting test

This article is updated multiple times a day and is available for free to non-subscribers as a public service. Please consider subscribing to the Star Tribune.

As the pandemic spreads, we've asked readers what they most want to know. Our reporters have talked to the experts and answered some of the most pressing and popular questions. For daily updates, sign up for our newsletter.

- Minnesota considers mail-in voting, other changes for 2020 with COVID-19 outbreak.

- Gov. Tim Walz's "stay at home" order begins at midnight Friday. What you need to know about the order. Read the complete text.

- REDDIT AMA: Today from 12-1 p.m. C.T., Star Tribune health care reporter Glenn Howatt will answer reader questions about the coronavirus pandemic in Minnesota live on Reddit. Learn more here.

- Minnesota House, Senate vote to approve an additional $330 million to fight the coronavirus pandemic and help people and businesses.

- Minnesota reports 59 new cases of COVID-19, bringing the state total to 346. In addition, a second person has died and 31 are hospitalized.

- More than 10,000 Minnesota health care workers filed for unemployment in past 10 days.

- Sen. Amy Klobuchar said her husband has checked out of the hospital and is recovering at home after COVID-19 diagnosis.

- Minneapolis to close some parkways so runners, walkers can spread out.

- What 'stay at home' means for Minnesota outdoor sports, recreation, fishing, hunting.

- Stores around the Twin Cities are banning reusable bags and putting up shieldsto keep workers safe.

- Updated: 75 Twin Cities takeout/delivery restaurant options suggested by our food critic.

Minnesota has documented 346 cases of COVID-19, with 59 new cases reported Thursday, along with the state's second death. State officials say that these numbers are based on limited testing and are likely an undercount of cases in the state. Thirty-one patients are currently hospitalized. Two people in Minnesota has died of COVID-19. The map below shows a county-by-county breakdown, which is updated as information becomes available. (It may lag behind news reports due to the release of incomplete information.) The state is posting some updates online and has a phone hotline: 651-201-3920.

READ: Details about Minnesota's COVID-19 case.

Around the world, there have been more than 542,000 confirmed cases and more than 24,300 deaths. The United States has at least 83,381 cases in all 50 states, with more than 38,987 cases in New York. The U.S. death toll climbed to at least 1,271 this week, with 432 in New York and 151 in Washington state.

The New York Times is tracking U.S. cases, including a state-by-state breakdown of totals and how the illnesses were contracted. Johns Hopkins University has a real-time interactive dashboard following the spread of COVID-19 across the U.S. and the world.

The drug known chemically as chloroquine has been available for decades to treat the mosquito-borne illness malaria. Technically, doctors can already prescribe it to patients with COVID-19, a practice known as off-label prescribing. But, at a Thursday press conference, President Trump falsely suggested that the FDA had just cleared the drug specifically for the viral pandemic. That would mean that the drug had met the FDA's standards for safety and effectiveness.

Minutes later, FDA Commissioner Dr. Stephen Hahn emphasized that the drug still needs testing to determine if it can help patients. He said chloroquine would have to be tested in "a large pragmatic clinical trial to actually gather that information."

Drug trials typically require hundreds or thousands of patients and, even when accelerated, take weeks or months to complete. In his remarks, Hahn reflected on his background as a cancer doctor and warned against giving patients "false hope" before drugs are fully vetted.

While chloroquine has shown promise in preliminary laboratory studies, some experts are skeptical it will prove effective in human testing.

The FDA reiterated in a statement that there are "no FDA-approved therapeutics or drugs to treat, cure or prevent COVID-19."

The drugs Trump was referring to are for treatment in patients already infected. That doesn't prevent spread of the virus. One study is testing chloroquine to try to protect health care workers at highest risk of infection, because a vaccine is likely a year or more away.

"Flattening the curve" is an expression used to explain how slowing the exponential growth in a disease's spread can allow a country's health system to better cope with the surge in cases so that it isn't overwhelmed.

While the novel coronavirus pandemic might eventually infect a majority of people in the United States, the speed at which the outbreak spreads makes a huge difference in health outcomes. What epidemiologists fear is that the U.S. health system would become overwhelmed by a sudden surge that requires more people to be hospitalized than can be handled, both from a personnel and equipment standpoint. In a scenario of uncontrolled growth, more people would die simply because there might not be enough doctors, nurses, hospital beds or ventilators for people who need them.

"If you look at the curves of outbreaks, they go big peaks, and then come down. What we need to do is flatten that down," said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Flattening the curve means that the social distancing measures being deployed in places like Italy and South Korea and now in the United States aren't so much about preventing illness but rather slowing down the rate at which people get sick, according to Vox.

Without any measures to slow it down, COVID-19 will spread exponentially for months. An interactive simulation by the Washington Post shows how the spread can be slowed by use of "social distancing," avoiding public spaces and large group gatherings that can increase the rapid spread of COVID-19.

READ: Amid outbreak, Minnesota parents are working at home, making it work.

READ: How Minnesota's pets are handling their humans' work-from-home routine.

COVID-19 is a respiratory disease, much like influenza, and while there's not a vaccine for it, there are ways to cope. The precautions used to fight influenza are the same ones that people should be using to stave off coronavirus and other respiratory diseases, said Timothy Brewer, a professor of epidemiology and medicine at UCLA's Fielding School of Public Health.

The CDC recommends washing with soap and water for at least 20 seconds after using the bathroom, before eating and after blowing your nose or sneezing. It also advises to avoid touching your eyes, nose and mouth and to frequently clean objects and surfaces you touch often.

READ: Tough coronavirus prevention advice: Don't touch your face

Infectious disease doctors, epidemiologists and officials from the CDC are in agreement on this one: If you are not sick, there is no reason to wear a mask.

Common surgical masks block droplets coming out of a sick person from getting into the air, but they are not tight enough to prevent what's already in the air from getting in.

There are specialized masks — known as N95 masks because they filter out 95% of airborne particles — that are more effective, but the masks are difficult to use without training. They must be fitted and tested to work properly. The same goes for exam gloves, which can get contaminated just like our hands. There's no need for them if you're washing your hands properly and often.

PODCAST: What you need to know about the coronavirus pandemic now.

READ: One Minnesota nurse's story of trying to find protective masks

Washing your hands with soap and water is the most effective way to protect yourself, according to the Centers for Disease Control and Prevention. "But if soap and water are not available, using a hand sanitizer with at least 60% alcohol can help you avoid getting sick and spreading germs to others," the agency says on its website. Sanitizers do not eliminate all types of germs and they are less effective if your hands are visibly dirty or greasy.

State officials are working with businesses to encourage them to prepare now for the eventuality that they could be short-handed in a pandemic outbreak. "In particular with essential services and infrastructure, identify what are your core activities and make sure that you have cross-trained so that everything doesn't rely on one person that pushes that one button," said Kris Ehresmann, director of infectious disease for the Minnesota Health Department.

The general public should also prepare in case some retail locations are closed or have limited hours. "We want people to start to gradually prepare to have an adequate supply of nonperishable food items at home," she said. That would be especially helpful if you or your family became sick and could not leave home. At the same time, authorities discourage panic buying. "We certainly don't want people to think that we are asking them to plan for Armageddon."

READ: Got a small business in Minn. that closed due to COVID-19? Do this next.

On Tuesday, Minnesota's public health lab announced it is restricting criteria for COVID-19 testing after a surge of testing activity that taxed its supply of kits and chemical reagents needed to confirm the presence of the coronavirus that causes the illness. The Minnesota Department of Health announced the change after a two-day surge in testing.

Testing for now will be restricted to hospitalized patients, health care workers, residents of long-term care facilities, and others at highest risk for spreading the virus or suffering the worst complications from it. Testing capacity in Minnesota is expected to expand as private labs develop their own capacity to perform the test.

Like any medical test, there has to be a clinical reason to perform the procedure. In the case of COVID-19, someone must have symptoms of the disease like fever, coughing and shortness of breath. Travel to an area with active transmission of COVID-19 is also a factor, as well as close contact with someone who is sick or had travelled. The Minnesota Department of Health said it has asked doctors to test their patients for other respiratory illnesses before submitting a COVID-19 test. "At present we do not recommend testing for those that do not have symptoms," said Dr. Mark Sannes, an infectious disease physician at Park Nicollet. It can take anywhere from two to 14 days for COVID-19 symptoms to develop and until they do the test won't pick up signs of the disease. "It is more about making sure that you identify whether someone that has exposure develops disease or not," said Sannes. "Testing them early on in their incubation period doesn't help settle that question." Even those who have been asked to quarantine often will not be tested until they have symptoms.

The COVID-19 test, which involves a nose or a throat swab, can detect the disease but it cannot tell doctors how severe the case will become.

"We want people to keep in mind that we have the capacity to test but we want to make sure that those tests are used in the best way possible," said MDH infectious disease director Kris Ehresmann. "At the state and national level we don't have unlimited supplies. We want to focus on individuals who are in a high risk situation."

COVID-19 arrived during peak cold and flu season, and many of the symptoms are the same: fever, cough and sneezing. So based on symptoms alone, it is hard to tell. But this new coronavirus has been known to severely impact the lungs. When we hear someone has shortness of breath, we will have more concern and they will need to be seen, said Dr. Jeff Dichter, a critical care physician at M Health Fairview.

Doctors say that dehydration from vomiting or diarrhea, a severe headache and progressively worsening symptoms also are warning signs. If you have a chronic medical condition that makes you more susceptible to complications from any type of viral infection, such as pneumonia, it is important to seek medical care. One suggestion is to call your clinic to get advice on how to proceed. Many clinics have a nurse who will triage cases, and you will most likely be asked about travel history and symptoms. If the clinic suggests that you see a doctor, staff might meet you at the front door and provide you with a mask to help prevent infecting others.

If COVID-19 does take hold in Minnesota, the health care system is likely to prioritize care for those who are the sickest. The health care system is extremely full right now and always runs close to capacity, said Dr. John Hick, emergency physician and medical director for emergency preparedness at Hennepin Healthcare. Be prepared for longer waits and potentially non-traditional approaches to care. The focus of the health care system will be on taking care of those with severe disease that may require prolonged and intensive care.

READ: Is it the flu, a cold or the new coronavirus?

The Minnesota Hospital Association (MHA) says it is making plans for a possible surge of COVID-19 patients, and is anticipating that 15% of them will need hospital care and 5% will need intensive care. As it stands, the system is already seeing high demand, with more than 95% of beds occupied on one or more days in the Twin Cities metro area last week, said Dr. Rahul Koranne, MHA chief executive.

Based on its planning, the hospital group has said there could be a need for more intensive care beds, ventilators, masks and other protective equipment for health care workers, as well as for staffing, phone banks to help triage patients, and training on COVID-19. "If there was a challenge to our capacity, hospitals would have to look at constructing additional space for those," said Wendy Burt, MHA spokeswoman. Hospitals and health care systems are working with the Minnesota Health Department to coordinate information about resources.

A novel coronavirus is a new coronavirus that has not been previously identified. Coronaviruses are a large family of viruses. According to the CDC, the virus causing this outbreak is not the same as the coronaviruses that commonly circulate and cause mild illness, such as the common cold. Some coronaviruses cause illnesses in people; others cause viruses in animals such as cattle, camels and bats. Rarely, animal coronaviruses can spread to people. This happened with SARS-CoV and MERS-CoV. The virus that causes COVID-19 likely also originated in an animal and spread to humans, according to the CDC.

The Centers for Disease Control says that it is not yet known whether weather and temperature impact the spread of COVID-19. Some other viruses, like the common cold and flu, spread more during cold weather months but that does not mean it is impossible to become sick with these viruses during warm weather.

Communities in warmer places appear to have a comparative advantage in slowing the transmission of coronavirus infections, according to an early analysis by scientists at the Massachusetts Institute of Technology.

The New York Times published news of the MIT study along with two others that have drawn similar conclusions. But none of the studies have been peer-reviewed by other scientists, and the MIT study's author acknowledged that factors such as travel restrictions, social distancing measures, variations in the availability of tests and hospital burdens might have affected the number of cases in different countries.

The most common method of catching COVID-19 illness is by inhaling respiratory droplets created when an infected person sneezes or coughs, especially through close contact over a sustained time period. "We know that your highest risk is in being close contact with another person who is in their acute phase of infection," said Dr. Alison Peterson of Allina Health's United Hospital. "If a [sick] person coughs into your face that is high risk." However, it is possible that the novel coronavirus could be on surfaces, such as door handles, elevator buttons and other things that get touched frequently. That is why health officials are emphasizing the importance of washing your hands and not touching your face.

"It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads," according to the U.S. Centers for Disease Control.

Ultimately, researchers can't prove that surfaces are totally safe, which is why they ask people to take some precautions for protection from COVID-19 as well as other diseases such as influenza and the common cold. The risk is even lower for packages that are shipped weeks ago or from long distances. "In general, because of poor survivability of these coronaviruses on surfaces, there is likely very low risk of spread from products or packaging that are shipped over a period of days or weeks," according to the CDC. It is good practice to clean surfaces at home using products containing bleach or 70% alcohol. "Wipe down commonly touched surfaces. Use appropriate precautions in your home that would do with the common respiratory illnesses," said Peterson. The Environmental Protection Agency has guidelines for which products to use against SARS-CoV-2.

COVID-19 and other coronaviruses can live on surfaces for a few hours or up to several days, according to the World Health Organization, depending on the type of surface and the temperature and humidity. One recent study, which has not yet been reviewed by other scientists, found the novel coronavirus was viable up on copper up to 4 hour, up to 24 hours on cardboard and two to three days on plastic and stainless steel.

READ: No, you can't kill coronavirus by drinking warm water. Debunking that viral Facebook post.

Because COVID-19 is still a relatively new human infection, researchers are still learning more about it. "Based on more common circulating coronaviruses, there is some evidence that people can be infected more than once over subsequent years," said Dr. Susan Kline at M Health Fairview. "But I don't think we know yet with this COVID-19." In the 2003 SARS outbreak, which was also caused by a type of coronavirus, there was evidence that the virus was still present in respiratory secretions, blood, urine and tissue "going into three weeks of illness, sometimes even longer among people who are more seriously ill."

While the elderly or those susceptible to pneumonia are encouraged to get that vaccine, it won't protect you against the viral pneumonia that is associated with COVID-19. "The pneumonia vaccine just protects against pneumococcal pneumonia," which is a bacterial infection, said Dr. Susan Kline, infection prevention medical director for M Health Fairview. "But it can't protect against all pneumonia and it does not protect against viral pneumonias."

This week, Gov. Tim Walz issued an executive order asking Minnesotans to stay in their homes unless absolutely necessary, for at least two weeks beginning at midnight Friday. "What our objective is now is to move the infection rate out, slow it down and buy time," the governor said, adding that "the place we cannot go to is when someone cannot get that ICU care."

Last week, the U.S. State Department issued a Level 4 "Do Not Travel" alert and advised U.S. citizens to avoid all international travel due to the global impact of COVID19. The broad warning states: "If you choose to travel internationally, your travel plans may be severely disrupted, and you may be forced to remain outside of the United States for an indefinite timeframe." In countries where commercial departure options remain available, U.S. citizens who live in the US should arrange for immediate return. The State Departmen says it has also suspended routine visa service in most countries.

In addition, many countries have introduced mandatory quarantines and travel restrictions, in some cases stranding U.S. citizens, including Minnesotans, who were living or traveling abroad.

Within the United States, the CDC recommends that people cancel or postpone in-person events that consist of 50 people or more for the next eight weeks. The CDC is advising older adults and people with severe medical conditions such as heart, lung or kidney disease to "stay home as much as possible" and avoid crowds. It urges those people to "take actions to reduce your risk of exposure," but it doesn't specifically address flying.

This week, the federal government said it is postponing the deadline for obtaining REAL ID-compliant identification cards because of the coronavirus. Travelers would have been required to present REAL ID cards to board U.S. flights starting on Oct. 1. The new deadline has not yet been announced.

The CDC assesses the coronavirus risk in countries worldwide.

Metro Transit is cutting service on buses and light-rail trains by 40% starting Wednesday as the agency responds to the rapidly spreading coronavirus that led to a steep drop in ridership over the past week.

Service will operate on schedules that are often used on days following major holidays such as Thanksgiving, Christmas and New Year's Day, said spokesman Howie Padilla.

Metro Transit says buses, trains and facilities are being regularly disinfected. Customer service information is available at 612-373-3333 between 6:30 a.m. and 9 p.m. weekdays and 8 a.m. and 4:30 p.m. on weekends. Riders are encouraged to use the Show My Bus feature on mobile or desktop websites.

Metro Transit also encourages its customers to help prevent the spread of infection by: covering your cough, washing your hands, avoiding touching your face and staying home when you are sick.

"Metro Transit maintains contingency plans for all types of emergencies, including pandemics," said Metropolitan Council spokeswoman Terri Dresen.

COVID-19 is more fatal than the seasonal flu, but not as deadly as some other viruses. "We've certainly seen infectious diseases in fairly recent memory that are much more lethal than COVID-19 at this point," said Minnesota Health Commissioner Jan Malcolm.

Ebola, which primarily has affected African countries, had a fatality rate of 50%. COVID-19 is the name of the illness caused by exposure to the SARS-CoV-2 virus. Recent estimates have suggested a fatality rate between 1.4% and 3.4%. The flu's death rate is about 0.1%. By comparison, two other coronavirus-type outbreaks were more fatal: 10% for the 2003 SARS outbreak, which also started in China, and 30% for the 2012 MERS outbreak, which was confined to the Arabian Peninsula.

The COVID-19 fatality rate was determined by a study of nearly 45,000 patients conducted by China's disease control agency. That number is likely to change as other studies are conducted and more is known is about the number of mild cases. However, like the flu, the elderly and those with chronic health conditions that affect their ability to fight off infection have higher mortality rates. According to the Chinese study, 81% of cases were mild, while 14% had more severe infections and 5% needed intensive hospital care, a group that saw higher death rates. "When the disease is severe, it can be quite severe," Malcolm said.

The CDC offers guidance to those who are at risk for serious illness with COVID-19, including older adults and those with heart disease, diabetes or lung disease. In addition, if you have another chronic health problem, cancer or are immune-compromised, doctors suggest extra caution. The State Department said U.S. citizens, particularly the elderly or those with underlying health conditions, should not travel on cruise ships.

Not everyone with the virus will exhibit symptoms, and about 80 percent of people with the virus do not end up needing hospitalization, health experts say.

It is unclear if COVID-19 can be spread through residential or office ventilation systems. "We know that your highest risk is in being close contact with another person who is in their acute phase of infection," said Dr. Alison Peterson at Allina's United Hospital. The water droplets formed when an infected person coughs or sneezes are thought to be the main method of transmission.

"We haven't heard of any case that has come from ventilation," she said. Some viruses, such as measles, float in the air for a while and have been documented to travel through ventilation systems. Most notably, in 1991 the measles virus was passed through the Metrodome's ventilation system, infecting 16 people at a Special Olympics event. The COVID-19 virus is thought to be heavier and eventually will sink to the ground.

In a hospital, as a precautionary measure, most people who are seriously ill with a viral infection are placed in a hospital room with specialized ventilation equipment that will direct the air outside the building and not circulate it internally.

Janet Moore contributed to this report. This article also includes information from the Washington Post and Associated Press.