The first confirmed case of COVID-19 in Minnesota was announced on March 6 three months after China told to the world that patients in Wuhan were sick with pneumonia of unknown cause.

That first case was an older Ramsey County resident who had disembarked from the COVID-stricken Grand Princess cruise ship before it was quarantined. By the next week, a Carver County resident who had been in Europe was confirmed to have the virus. So was an Anoka County resident who had been traveling for work.

All three cases were in the Twin Cities metro area, which was the first place to be hit hard by the virus. Soon, medium-sized cities started to see coronavirus activity, as well as some rural parts of the state, particularly those with food processing outbreaks. But even months after the virus was first detected in the state, some rural parts of the state still saw low numbers of officially confirmed cases of the virus.

Thats started to change in recent weeks. Now some Greater Minnesota counties that had previously seen little confirmed coronavirus activity have started to see upticks in cases. And as of last weekend, with a confirmed case in Lake of the Woods County, every county in Minnesota has at least one case of COVID-19.

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The novel coronavirus first appeared in the United States big cities, with a major outbreak in New York City back in April. In Minnesota, Hennepin and Ramsey counties were early centers of the outbreak.

Carrie Henning-Smith, an assistant professor in the University of Minnesotas School of Public Health said this may have given parts of rural America a false sense of security about the virus.

We know that COVID started in the U.S. as a distinctly urban phenomenon. We were first hearing about it in Seattle and New York and New Orleans,she said.

[Since] this took a long time to spread into some rural communities, I think that false sense of security may have become heightened. I think people looked around and said Im not sick, none of my neighbors have gotten sick lets move on and move back to life as normal, Henning-Smith said.

That may be changing in some areas now. Mahnomen County, in northern Minnesota, saw new cases per capita double between the second and third weeks of July, from 5.4 cases per 10,000 residents to 10.9 the same number of cases per capita as Hennepin County. In Koochiching County, on the Canadian border, new cases went from 10.3 per 10,000 people the week of the Fourth of July to 15 per 10,000 people the following week.

Source: Minnesota Department of Health

The county had seen some coronavirus activity prior to July, but really saw an increase from 3.3 new cases per 10,000 residents to 11.1 per 10,000 residents after the Fourth of July, according to Minnesota Department of Health data. In the most recent week of data, the number of new confirmed cases had slowed slightly, to 9.5 per 10,000 residents.

Our initial surge was a group of early 20-year-olds, Borgen said. Once the restrictions were released and folks were out at the bars, sporting events, recreation leagues, that kind of was the start of it for us.

Despite that cases had been present prior, hospitalizations had been few until recently, Borgen said. As of this week, four people were hospitalized with COVID-19 in Beltrami County.

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Up until now, I think people felt a little more like If I get sick, Im not going to get very sick, Borgen said.

Some of the hospitalizations weve had were of people who were fairly young and healthy and its a small enough community that people learn pretty quickly whos in the hospital, even if we do our best to prevent any of that from coming through formal channels, she said.

While some in the community may not have seen COVID-19 as a big problem locally before, people are realizing this maybe is something that could impact me and my loved ones, Borgen said.

Before South Central Minnesotas Watonwan County saw an outbreak of COVID-19 last month, Community Health Services Manager Julia Whitcomb noted some belief in the community that the virus wasnt a concern in the area.

We did see some of those beliefs thinking its not here, so why do I need a mask or why do I need to follow social distancing, she said.

Concern heightened when cases climbed, but Whitcomb says some resumed lax mask-wearing behavior before the statewide mask order took effect on Saturday.

While geography is one factor that separates some Greater Minnesota residents feelings about the virus from others in the state, its not the only factor. The pandemic and the states handling of it has also become highly politicized, with people on the right side of the political spectrum tending to downplay the seriousness of the virus and the utility of interventions like face masks, while those on the left assume the opposite position.

Ahead of a public discussion of a local mask mandate in Alexandria that was scheduled before Gov. Tim Walzs mask mandate and took place this week, city officials said 286 people contacted the council in favor of a citywide mask mandate, while 463 people told the council they opposed such requirements.

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Many who opposed the local mask mandate cited low case counts as rationale.

Its not necessary as we have very few cases in our city. I think it will just cause tension between people, wrote one who opposed a potential local mandate.

But politics also came into play.

One employee of a senior living center in town wrote in using their work email addresses opposing the mask mandate on political grounds: This pandemic has become more political than anything because it is forcing Americans to submit to rules/regulations that do not support the constitution that this great country was built on.

But as cases climb again nationally and public health officials initially often opposed to masks on the grounds of limited supplies of medical-grade ones come to a general consensus that they are effective in slowing the virus spread, that may be changing, too.

In a Harvard/Harris poll released this week, 79 percent of respondents said they supported a national mask mandate. A Fox poll of Minnesota residents released this month found the majority of respondents, 85 percent, felt strongly or somewhat favorable towards Minnesotans who wore face masks.

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Particularly in summer, Greater Minnesota plays host to tourists from all over the state and country. Some residents worry about what that means when it comes to the accuracy of case counts in their areas.

Jen Sumption lives in Longville, Minnesota, home to the Woman Chain of Lakes, a big summer tourist destination in Cass County, where there have been 54 confirmed cases of COVID-19, according to MDH data, up from 12 a month ago.

Last week, she submitted a question to local radio station KAXE during a discussion with Lt. Gov. Peggy Flanagan to express concern about how case numbers are reported.

In rural Minnesota weve experienced an increase in cases as we saw an increase in out of town visitors, also the fishing opener and the Fourth of July weekend, she wrote.

If she were a Twin Cities or out-of-state resident who had been traveling up to lake country for generations, she said shed look at the states case map and might be likely to think Oh wow, Cass County, pretty consistently low, low-risk. Lets do it, she told MinnPost.

But she says that map isnt an accurate reflection of everyone whos been in Cass County: if people travel north and get sick, whether theyre tested in Cass County or back home, their result is associated with their home county.

Sumption told MinnPost that in a trip to town this week, she watched cars go by on Highway 84, the main drag through the town of 150.

I would say there were at least 20 to 25 cars that passed by where I could see their tags, and half were out-of-state, she said.

Shes concerned these travelers might see the low numbers in Cass County and let their guard down when they visit, believing the virus isnt in the community.

I think its a very false sense of security because the numbers dont actually represent the number of people who are really infected here, she said.

Walker Orenstein contributed to this report.

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COVID-19 has arrived in Greater Minnesota - MinnPost