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Gov. Tim Walz lauded Minnesota on Monday for reaching its “moonshot” testing goal to closely track the spread of COVID-19, but he warned that everything from mask-wearing in public to social distancing in bars will be needed to see the state through this pandemic.

While Minnesota isn’t seeing the rapid growth in COVID-19 occurring right now in other states, Walz said he is concerned because of the recent outbreaks related to crowded bars and the gatherings over the upcoming holiday weekend that could spread the coronavirus that causes the infectious disease.

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“We’re going to have to learn to live with and manage COVID-19 for quite some time,” he said.

The personal and economic sacrifices Minnesotans made over the past four months to prepare the state for COVID-19 cannot be undermined by a lack of compliance now, Walz said, and he is considering requiring face masks given the increasing evidence that they work — as well as sanctions if bars fail to protect customers by keeping them spread out so they don’t infect one another.

“At some point in time, the carrot turns to the stick to stop this thing,” said Walz, who encouraged bar owners to follow social distancing rules and customers to help by spreading out and wearing masks.

Cases traced back to virus transmission in bars — since they were allowed to reopen at limited capacities June 10 — have now reached 200 in Mankato and 100 in Minneapolis, said Jan Malcolm, state health commissioner.

Crowding in indoor bars is a “proven recipe for spread” of the virus, she said. “It’s up to all of us, our collective individual decisions, whether we are able to achieve these goals of managing the epidemic, the pandemic, which is here and will be here for a long time.”

Reaching a testing capacity of 20,000 per day was a key step in the strategy. Minnesota had barely conducted 2,000 tests per day — due largely to global shortages in collection supplies and chemicals — when Walz announced his “moonshot” goal on April 22.

A $36 million partnership with the University of Minnesota and Mayo Clinic helped the state reach that goal, which has allowed for the state’s universal testing of staff and residents at long-term care facilities with outbreaks and the free testing of people involved in the protests after the killing of George Floyd.

The capacity also allowed the Minnesota Department of Health to expand its guidelines last week to allow people to seek testing even if they don’t have respiratory symptoms if they believe they have been exposed to the virus. Initially, shortages required that testing be used only on symptomatic patients, health care workers and long-term care residents at greater risk of severe COVID-19 due to their ages or underlying health conditions.

The state also will be directing testing resources to areas with flare-ups of COVID-19 cases, including free testing announced Monday in response to a rising case count in Madelia and Watonwan County.

The state on Monday reported a total of 35,861 known cases and 1,435 deaths related to COVID-19 — including 1,129 deaths of residents of long-term care or assisted-living facilities.

Daily case counts had been falling since late May but recently started to rise, particularly among young adults. People younger than 29 now make up 31% of all known COVID-19 cases, but only two in that age range have died. People 70 and older account for 11% of known cases but 81% of the state’s COVID-19 deaths.

More than half the states in the country had been rated as “trending better” or “making progress” by the COVID Exit Strategy website until late May, when the relaxation of state restrictions on businesses and social interactions was followed by an increase in cases. Now, 36 states, including Minnesota and Wisconsin, are rated as “trending poorly.”

The hopeful news in Minnesota is that hospitalizations have reached their lowest levels in two months. The state on Monday reported that 278 patients with COVID-19 were hospitalized — including 140 who needed intensive care.

Comparative websites place Minnesota in the top 10 or 15 on per capita measures of diagnostic testing, though the state was partly helped on that front when it switched its official count from the total number of people tested to the total number of tests performed. Many people have had more than one COVID-19 test, and Minnesota health officials said many other states were reporting their numbers by tests rather than individuals.

Malcolm said the rising number of tests is good news, but so is the low rate of about 4.4% of tests turning up positive for COVID-19. A high test count and a low positive rate is the goal, she said.

The U and Mayo Clinic have been heavily involved in the development of serological antibody tests, which examine blood serum to detect when people have recovered.

One sampling of antibody test results in health care workers and some Twin Cities residents showed that 4 to 5% had previously been infected, said Dr. Timothy Schacker, the U medical school’s vice dean for research. Serological testing could help determine the actual spread of the virus given that the majority of infections produce little or no symptoms.

The U.S. Centers for Disease Control and Prevention last week estimated that every one positive diagnostic test actually represented another 10 people who had been infected but did not know it.

Malcolm said it is possible that 10% of the state’s population has already been infected.

Malcolm encouraged holiday revelers to gather outside, given the growing research that the coronavirus transmission is less likely outdoors.

Young adults might not be as worried about COVID-19, but they can quickly spread the virus to others, she said. More than 9 in 10 COVID-19 deaths in Minnesota have involved the elderly or people with underlying health problems such as obesity, diabetes, asthma and diseases of the heart, lungs, kidneys and immune system.

Malcolm said she hoped bars would comply with social distancing guidelines to help reduce the spread of the virus, but that her department does have punitive authority if bar-related cases continue to rise.

“We have preferred to take an educational approach first,” she said, “but we are taking it very seriously, seeing numbers like this.”