Minneapolis contact tracer Luisa Pessoa-Brandao finds that residents don’t always connect their own runny nose or sore throat to COVID-19. 

“Because I’m so immersed, I will think COVID immediately. I’m always surprised at the people that say … ‘I thought it was nothing,’” she said. 

It’s getting harder for contact tracers to keep up. In the course of a single week in November, Minneapolis’ positive cases went from 70 per day to more than 300 per day. 

Pessoa-Brandao, who manages the city’s epidemiology, research and evaluation unit, said 37% of people recently diagnosed with COVID-19 (between Oct. 18 and Nov. 14) don’t know the source of infection. Of these people who said in interviews they don’t know how they contracted the virus, 25% reported that they had eaten inside restaurants or bars, and 23% had attended some sort of community event, such as a family gathering or religious service. 

“It seems like every-other interview that we’re doing over the last couple weeks, someone attended a Halloween party or a Halloween gathering,” she said. 

For those who report contact with another case as their exposure, the majority are household contacts, she said. 

Since late September, Minneapolis has been faring better than the state in terms of the new daily cases per 100,000 population. But in recent weeks, Minneapolis’ rate has started mirroring the statewide trajectory, moving straight up into the “red zone.” 

More than 18,000 people in Minneapolis have recovered from COVID-19 since the beginning of the pandemic. More than 1,600 have been hospitalized, and 284 have died. Senior living buildings have been hit particularly hard, accounting for about half of the city’s deaths where COVID-19 was a contributing factor, according to Minnesota Department of Health (MDH) data. 

Impacted senior buildings in Southwest Minneapolis include Walker Methodist Health Center, where state data indicate that 18 people have died, Jones-Harrison Residence, where 18 people have died, Mount Olivet Careview Home, where 11 have died, the Villa at Bryn Mawr, where six have died, and Redeemer Residence & Rehab, where five have died.

The Lyndale neighborhood has seen the highest case rate in Southwest Minneapolis; 7% of residents have reported a positive test result. Lyndale is followed by Whittier at 6.4%; Cedar-Isles-Dean, 5.8%; East Harriet, 5.3%; Stevens Square, 5.2%; Lowry Hill East, 5.1%; Windom, 4.9%; Kenwood, 4.1%; South Uptown, 3.8%; West Maka Ska, 3.3%; Kingfield, 3.1%; ECCO, 3%; East Isles, 2.8%; Tangletown, 2.7%; Bryn Mawr, 2.6%; Lowry Hill, Lynnhurst and Armatage at 2.5%; and Kenny, Linden Hills and Fulton at 2.3%. 

“Some of the fault lines of inequities are highlighted even more during this pandemic,” said Mayor Jacob Frey, speaking about food relief during a Nov. 13 Council meeting. 

Minneapolis’ population is 19% Black, but Black residents represent 25% of cases and 28% of deaths. Hispanic residents, 10% of the population, represent 19% of cases and 7% of deaths. White residents, 64% of the population, represent 44% of cases and 60% of deaths. Cases are currently increasing among all ages and ethnic groups.

The first vaccine doses may arrive as soon as mid- to late-December, Minneapolis Health Commissioner Gretchen Musicant said at the city’s Public Health & Safety meeting on Nov. 5. Minneapolis is preparing for mass vaccine distribution, creating a communications plan and ordering cold storage. 

The first vaccines will go to staff working at hospitals and long-term care facilities, followed by first responders. The second phase of distribution will reach high-risk populations, including seniors and essential workers. Last will come availability to the general public. The federal government will determine Minnesota’s allocation of doses, and the state will determine the allocation at the local level.

“The entire outbreak for 1918 in cities occurred usually within 6-10 weeks, from start to finish. We are now in our ninth month,” said Dr. Michael Osterholm, a University of Minnesota epidemiologist named to the president-elect’s COVID-19 advisory board, at a Nov. 13 briefing. “This is our COVID year. … With the advent of the vaccine, and the availability of that vaccine I believe starting in the first quarter of next year, if we can just hold out until then, we can save so many lives, so much suffering.”

The governor’s current shutdown targets social gatherings, gyms, sports and indoor dining, while leaving salons and retail stores open. 

Data guiding the dial-back order include contact tracing, which found 223 outbreaks totaling 3,589 cases at restaurants and bars since June, including one in November at Cowboy Slim’s, now temporarily closed. The state currently defines an “outbreak” as five unrelated cases from five households who told contact tracers they visited only that restaurant or bar in the month prior to symptoms or a positive test. The true source of infections is unknown, however. 

Since June, 41 people with COVID-19 have reported a Southwest Minneapolis restaurant or bar with an outbreak as the only establishment they visited, according to state data. The state reported outbreaks at the Pourhouse Uptown, Stella’s Fish Café and Uptown Tavern in July. 

“We’re only capturing the tip of the iceberg, but it makes us pretty confident that transmission was occurring in that environment,” said Doug Schultz, an MDH spokesperson. “We know for example that with salmonella, for every one case that we identify, there are 29 more that go unidentified. … The same thing is true with COVID, especially now that we know people can be asymptomatic spreaders. For every case in a bar, there are untold numbers of other cases.”

From June 1 to Nov. 19, the state documented 254 outbreaks at sports events, 111 at weddings, 72 at social gatherings, 48 at gyms, 33 at churches, 25 at funerals and five at salons.

“Minnesota is now well over a case rate of 120 cases per 100,000 across Minnesota and a positivity rate of over 15%. This means at this point in the pandemic, wherever people gather there is a [significant] likelihood that infectious people are among them,” Dan Huff, MDH assistant commissioner for health protection, wrote in an email.

Although it might be easier to distance from others at salons and retail stores, there isn’t yet conclusive data, said Ryan Demmer, associate professor at the University of Minnesota’s Division of Epidemiology and Community Health.

“It’s one thing to take people who end up getting tested and have a positive result and ask them where they’ve been. It’s another thing to go out and randomly sample people and get a better sense of the true infection rates,” he said. 

It’s clear that the virus spreads easiest at indoor gatherings, he said, where there are close contacts and no masks over long durations of time. In large groups, it’s more likely at least one person is infected and can spread it to others.

And while kids get very sick at far lower rates, he said, they are just as likely to get infected and spread the virus, especially at high school age. 

“I think that they’re really powerful pieces of the infection chain and, in part, an explanation for why things have really changed this fall,” he said, noting other factors like the cold weather and pandemic fatigue.

Minnesota is rolling out an app, COVIDaware MN — developed in a rare partnership between Apple and Google — that allows phones in close contact to exchange numbers via Bluetooth. Users who test positive can opt to anonymously alert other app users who have come within 6 feet for more than 15 minutes during the infectious period.

“If you don’t have symptoms and you got that notification, we want you to stay home for 14 days, stay out of circulation so that you aren’t a potential source of infection and transmission to other people,” Kris Ehresmann, the state’s infectious disease director, said at a Nov. 23 briefing.

The state’s IT commissioner said the app does not access personal information, track GPS or send data to the state.

MDH recommends getting tested if you have symptoms or were in close contact with someone with COVID. During the dial-back period, health officials are asking people to stay home and lay low, reserving community testing sites for people working outside the home in sectors like health care, child care, public safety and retail.

Saliva testing sites are now open daily at the Minneapolis Convention Center and Terminal 1 at the airport; people are eligible for testing regardless of whether they show symptoms. The Whittier Clinic tests patients on weekdays, serving people in the order of arrival until capacity is reached. Axis Medical Center tests both symptomatic and asymptomatic patients by appointment. The Southside Medical Clinic tests symptomatic patients by appointment on weekdays. 

Minnesota also offers free, at-home COVID-19 saliva testing for people who believe they need to be tested, with or without symptoms at learn.vaulthealth.com/state-of-minnesota.

Pessoa-Brandao said the quarantine period is 14 days for a reason — that’s the incubation time when someone can test positive and develop symptoms, so no one can truly test out of quarantine. 

“Go and get tested,” she said.