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Minnesotans are dying from COVID-19 in greater numbers than at any time during the pandemic, with average fatalities per day more than doubling since the start of November.

Hospitals across the state remain packed just ahead of the Thanksgiving holiday, and Sunday marked the third consecutive day in which the average number of tests given to detect COVID surpassed 50,000 — a high-water mark.

New state guidelines recommend testing if you have symptoms, or a known exposure at least in the past five days. Dr. Mark Sannes, an infectious disease physician with HealthPartners, said people should seek immediate care if they feel they’re “getting worse by the minute.”

Minnesota has seen more than 270,000 confirmed cases of COVID since March 5, including more than 13,000 added to the tally over the weekend, according to Minnesota Department of Health statistics.

Sunday saw 40 deaths, bringing the state’s total to 3,241, including one new fatality in a person under 55. But death statistics are clumpy. Using a seven-day average to smooth out day-to-day trends, the number of daily deaths rose to 48 on Sunday, up from 18 at the start of the month.

Record-shattering trends across the state and Midwest are also spurring strong interest in getting tested for COVID before the holiday — so strong that Health Department officials are modifying their prior advice for asymptomatic people to get tested.

On Friday, the Health Department recommended testing for three groups: people actively having symptoms, those with a known exposure to COVID five days prior, and anyone working in critical industries like health care, retail, law enforcement and child care.

As of Monday, Minnesota has 20 semi-permanent free public testing locations scattered around the state in National Guard armories, convention centers, schools and vacant retail locations. The sites all have different days and hours of operation, and reservations are encouraged. Details are at mn.gov/covid19.

Separately, Minnesota has hundreds of private health care providers that can do the tests, sometimes in a “drive-through” setting. Those tests are often reserved for people who are symptomatic.

The state’s latest guidelines don’t explicitly say asymptomatic Minnesotans ages 18-35 should get tested before Thanksgiving, as was advocated earlier this month.

Health Department Assistant Commissioner Dan Huff said Friday that it still remains a “good idea” for asymptomatic college students returning home for Thanksgiving to get tested, as his son did. But testing must be used in combination with isolation before and after to reduce risks the most.

“Don’t substitute a test for good judgment,” Huff said.

The changes in guidance were prompted partly by the fact that people honoring a four-week statewide “lay low” period that began Friday shouldn’t pose a transmission risk to the community, so their need to get tested is lower, Huff said.

He noted that for residents who are laying low but still need to get tested, the state is now offering at-home testing. Those tests can be ordered by residents at the state’s COVID website and take a day or two to arrive. The test requires a person to spit into a tube while on a Zoom call.

The new guidance is also supposed to cut down on crowds at the public testing sites, where test positivity rates have ranged between 11 and 24%. Lines can grow long during peak times, making it challenging to socially distance while waiting.

State officials say anyone feeling “moderate to severe” symptoms should call their doctor or clinic, or go to the hospital.

Symptoms of COVID include fever, chills, coughing, headache, sore throat, muscle pain, and loss of test or smell. Less common symptoms include upset stomach, vomiting or diarrhea.

The CDC says people should seek emergency medical attention if they see warning signs including trouble breathing, persistent pain or pressure in the chest, inability to wake or stay awake, bluish lips, or new onset of confusion.

Symptoms often appear within five days of exposure but can take as long as 14 days. About 40% of people with COVID have no symptoms, though they can still transmit the virus.

In Hennepin County, a gathering of 10 people has an estimated 36% chance of having at least one positive COVID case in the room, according to an analysis of trends by researchers at the Georgia Institute of Technology. In Polk County, along the North Dakota border, the risk grows to 66%.

“There is no way to guarantee a COVID-free holiday,” said Dr. Darria Long Gillespie, an author and clinical assistant professor at the University of Tennessee who appears frequently on CNN and other media.

An executive order from Gov. Tim Walz last week limits all social gatherings in Minnesota to people from one household until Dec. 18. Walz has also said, “We are not going into someone’s home and arresting them on Thanksgiving.”

For those choosing to gather in groups, Gillespie advised a multilayered risk-reduction strategy, including wearing masks while indoors, staying distant from others, and minimizing party size. She advised running kitchen and bathroom exhaust fans and using separate tables for different households.

Gillespie recommended commercial at-home specimen-collection kits, including one from a company called Everlywell, where she’s an outside adviser. That kit costs $109 up front and may be reimbursed by insurance later. Minnesota’s at-home test program has no cost to the user.

“Because people so often have to break isolation to get a test, I highly recommend using a mail-in test kit,” she said.