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As the number of positive COVID-19 cases in Minnesota 

, the highest concentration of cases per capita isn’t in the Twin Cities — it’s in a rural southern Minnesota county.

Martin County — home to just under 20,000 residents —has become 

a hotspot of the coronavirus outbreak in Minnesota for its increasing number of positive cases

 of COVID-19. As of late Tuesday morning, the Minnesota Department of Health reported that 25 people in the county have tested positive for the disease caused by the new coronavirus, and two people have died from it.

The two patients who died were men in their 80s. One of the men had been living at a long-term assisted care facility, according to county human services director Chera Sevcik. Both had been hospitalized.

The highly infectious disease has taken a swift toll on the largely rural Martin County, which now has the highest number of positive COVID-19 cases in relation to its population, according to an analysis of health department data. It has more than twice as many confirmed cases per capita as the next-highest county, Le Sueur. 

Public health officials say limited testing has made it hard to understand how widespread the virus truly is, so the numbers of confirmed cases is an imperfect metric, but one of the few available.

“We’re taking it day by day, week by week,” Sevcik said. 

The first two cases of COVID-19 in Martin County were reported on March 18. Officials haven’t yet been able to establish a common thread linking the positive cases, Sevcik said, but they’re concerned about the extent of the community transmission.

Here’s what they do know: Cases have likely been present in the community longer than test results were coming in. And, according to the Martin County Sheriff’s Office, the patients with confirmed cases of COVID-19 range in age from mid-20s to 95.

“What we know is that it’s likely been in the community for a while, with the extensive numbers that we have,” Sevcik said. “We don’t know how it got here. I think everybody was a little late to the game across the United States in preparing for anything like this to happen.”

Much of the testing in the county has been done by private community providers like the Mayo Clinic health system’s hospital in Fairmont, Sevcik said. She doesn’t know the exact rate of testing, but said she believes that it’s not different than that in other parts of the state.

Sevcik’s department — which serves both Martin and Fairbault counties — has been advising local health care providers on strategies for slowing the spread of the virus. They regularly check in with community health providers, and county department agencies to make sure they have enough protective equipment such as masks and gloves.

Individual providers within the county have put restrictions on the amount of visitors they allow into their buildings, and the county human services department is advising on other approaches, such as screening staffers for potential symptoms.

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Tim Langer has been working to get information out to communities in Martin County and neighboring Faribault County about social distancing, washing hands and limiting travel unless for essentials like grocery shopping.

“We are concerned about the cases,” said Langer, who serves as health inspector for the counties’ joint human services department, and is leading the agency’s public information efforts during the coronavirus outbreak.

“One of our goals in this scenario is to get the word out that this is serious, and need to take it as such. Our hope is that our campaign will be helpful, but that remains to be seen. I’m sure we will be seeing more cases.”

Growing concerns about community transmission have county law enforcement working with neighboring agencies to enforce safety measures for deputies and the public.

Gov. Tim Walz’s two-week statewide “stay at home” order went into effect over the weekend, and since then, Martin County Sheriff Jeff Markquart has been closely observing the county’s rhythms.

So far, he said, most people seem to be heeding state officials’ pleas to stay home.Traffic in the county seat of Fairmont has been relatively low since Saturday, he said — in part because Sunday church services have been temporarily canceled or moved online — and he hasn’t gotten many complaints about people hosting parties or get-togethers.

“It’s difficult for everybody ... to stay home and not have that personal touch with people,” he said. “We all have families, we have children, we have grandchildren and stuff that we want to be with — and this is difficult.”

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For the most part, he said, people seem to be taking social distancing orders seriously, despite the challenge. His deputies, though, still have to work — so he’s supplied them with gloves and masks to protect them in their day-to-day duties.

It’s likely, given the high number of cases already confirmed in the county, that Markquart’s deputies or other first responders will encounter people who have confirmed cases of COVID-19 who are quarantining at home — or people who have encountered those patients, and are self-isolating.

“We don’t know where those addresses are and we are not given those addresses,” Markquart said. He is relying on the public — those who are self-isolating and those who are showing possible symptoms of COVID-19 — to be clear with first responders when they encounter them.

“If they open your door up, and they’re standing there, tell them right away if you are a positive case,” Markquart said. “Step back and give each other some space, so that we can make plans before we’re too close.”

Countering the spread of COVID-19 in southern Minnesota has several logistical challenges. Roughly a quarter of Martin County’s population is over 65. Three nursing homes and six senior living communities operate in towns across the county. Some have already begun restricting “nonessential” visitors. 

Lakeview Methodist Health Care Center in Fairmont said in a Facebook post that it has started hosting Skype calls for residents to connect with virtual visitors without making direct physical contact, and have arranged for other virtual call options. Residents at nursing homes and senior living communities are especially vulnerable to the coronavirus.

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Kris Ehresmann, Minnesota’s infectious disease director, said in a daily COVID-19 news conference over the weekend that “one of the things we’re very focused on right now ... are the cases we are seeing in our congregate care settings,” adding that the group is at the highest risk of dying from COVID-19.

Most of the coronavirus deaths in Minnesota have been in those group care facilities, which remain a primary concern for state health officials. Jan Malcolm, the state health commissioner, said Monday that 31 such facilities statewide now have at least one case of COVID-19 confirmed.

“It brings forth a whole host of new challenges and things that no exercising or no pre-planning can really prepare you for,” Sevcik said.

Health officials for weeks have been increasingly raising the alarm over the spread of the novel coronavirus in the United States. The disease is transmitted through respiratory droplets, coughs and sneezes, similar to the way the flu can spread.

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Government and medical leaders are urging people to wash their hands frequently and well, refrain from touching their faces, cover their coughs, disinfect surfaces and avoid large crowds, all in an effort to curb the virus’ rapid spread.

The state of Minnesota has temporarily closed schools, while administrators work to determine next steps, and is requiring a temporary closure of all in-person dining at restaurants, bars and coffee shops, as well as theaters, gyms, yoga studios and other spaces in which people congregate in close proximity.

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Martin County officials worry about how to tamp down community transmission, when they don’t know why the coronavirus has spiked in their county in the first place.

Morning Edition host Cathy Wurzer talked with Chera Sevick, the executive director of Human Services of Faribault and Martin counties about how Martin County has become a hotspot of coronavirus spread.

Minnesota's COVID-19 hotspot isn’t in the metro — it’s in one southern Minn. county

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