Fourth, fifth cases of COVID-19 confirmed in Minnesota

State health officials are readying for a new phase of the COVID-19 outbreak in Minnesota, where five people have tested positive for the illness — including an Olmsted County individual who went to work while symptomatic and may have spread the virus that causes the illness.

While all five people were likely infected during travel outside of Minnesota, the odds of community transmission of the virus within the state are increasing, said Kris Ehresmann, infectious disease director for the Minnesota Department of Health. That might mean the cancellation of mass gatherings to prevent the spread of the coronavirus, she said, but it definitely means that people need to stay home when suffering fever and respiratory illness.

"What is concerning … is the fact that people are not staying home when they're sick. Even with one of these cases, the individual was symptomatic at work," she said. "What we really need is for people to stay home when they're sick so we don't have the potential for unnecessary spread."

The five positive cases were identified out of 222 COVID-19 tests, including roughly 100 that the state's public health lab processed just Tuesday. Once people have tested positive, Ehresmann said, they have complied with isolation orders and received support from county public health workers to remain comfortably at home.

The fourth and fifth cases were discovered through testing Tuesday and involved a Ramsey County resident in the 30s age range, and the Olmsted patient in the 50s age range. Both are recovering.

Minnesota's third case involves an Anoka County resident in the 30s age range who remains hospitalized in critical condition.

Health officials in Olmsted are now working with the infected individual in that southeast Minnesota county to identify co-workers who might have been in close enough contact to now be at risk for COVID-19.

The individual first experienced symptoms March 5 and went on March 9 to the Mayo Clinic emergency room in Rochester, said Graham Briggs, director of public health for Olmsted County.

The risk pool appears small, despite the individual going to work, he added.

"Some investigations are tougher than others," he said. "In this particular situation, we've got some things on our side. The person lives alone. We don't have some other concerns we might have of being out in public areas, big meetings, big congregant settings. For those who were exposed, it's a small, limited number."

Co-workers who were just in the same building are at low risk and simply need to monitor their health. Co-workers who were within 6 feet of the infected patient for at least 10 minutes will be deemed at moderate risk and required to quarantine themselves at home for 14 days.

COVID-19 is caused by a coronavirus that emerged in China in December and spread worldwide. Studies suggest it takes up to 14 days for symptoms to emerge after infection. Health officials believe people are at greatest risk for spreading the virus once they have symptoms.

One group of Minnesotans waiting for that 14-day quarantine clock to start consists of travelers on the Grand Princess cruise ship. After cases were discovered, the ship docked in Oakland, Calif., but passengers were not allowed to disembark. Their quarantines won't start until they are off the ship.

"We are incredibly frustrated with this whole process," said Lynn Fuchs of Big Lake, who is healthy but stuck on the ship with her husband. "If we have to spend another night on this ship, I don't know what will happen."

As many as 42 Minnesotans are on that cruise, but it is unclear if some have been moved to quarantine centers on land. The Fuchses have watched busloads of other passengers from Canada and California leave already.

While 80% of COVID-19 cases result in only mild symptoms, health officials are concerned because nobody has immunity to the coronavirus and no vaccine exists.

Ramsey County now has two confirmed but unrelated cases. Both involved people who stayed home while symptomatic, then called ahead when they got sick before going to health care facilities for testing. As a result, health officials do not believe they exposed others to the virus.

The second case was reported in Carver County and resulted in three high-risk and 15 medium-risk contacts being quarantined because of their exposure levels to the infected person. The severity of illness for the Anoka patient made that contact investigation more challenging, but health officials recommended home quarantines for two people because of their high levels of interaction.

Minnesota has not had any cases of COVID-19 in which one person in the state passed the coronavirus to another. Ehresmann said the state is still pursuing a containment strategy to prevent such community spread or slow the introduction of the coronavirus into Minnesota — which in turn will help the state's hospitals and clinics manage any surge in infected patients.

However, Ehresmann said the state needs to gradually transition toward a mitigation strategy of reducing the impact of the virus once it is here. That could include the cancellation of mass events or other community measures.

"We want to start turning the dial," she said, "and start preparing to move into that community mitigation mode."

The state is not yet in a position to cancel events such as the World Cup Nordic race that will draw cross-country skiers from across the globe to Minneapolis this weekend. Ehresmann said that event at least has the advantage of being outdoors, which reduces the threat of virus transmission.

An additional $21 million in state funding has been secured for the public health response to COVID-19. The White House also announced Wednesday that Minnesota is receiving $10.5 million in additional federal aid.

Globally, there have been more than 120,000 COVID-19 cases. Studies show higher death and complication rates for people who are older, but Ehresmann said the Anoka case of a person in critical condition is the "outlier" that warns everyone to take precautions.

"It's important for people to recognize that our recommendations for staying home when you're sick, and things like that, are not just for individuals that are in the high-risk group," she said. "That's for everyone."

Staff writers Glenn Howatt and Reid Forgrave contributed to this report.