BISMARCK — The North Dakota Department of Health confirmed four more known cases of COVID-19, the illness caused by coronavirus, on Tuesday, March 17.

Two new cases announced Tuesday afternoon are a Cass County woman in her 20s and a Ward County man in his 60s. The department announced two more cases Tuesday night from Burleigh County — a man in his 50s and a woman in her 20s. All of the people had "a history of travel to impacted areas."

Public health investigations continue in both cases, but State Health Officer Mylynn Tufte said one of the people had recently returned from Germany.

The announcements of the new cases mean the state now has five confirmed cases of the disease that has caused a global health crisis.

Cass County is the state's most populous county with about 177,000 residents, most of whom live in or near Fargo. Burleigh County is the second most populous with about 95,000 residents, most of whom live in or near Bismarck. Ward County is home to about 69,000 people, most of whom live in or near Minot.

The state's first positive test, a different Ward County man in his 60s, was announced last week. The man, who had recently traveled to the East Coast, is recovering at home, and health officials do not suspect he transmitted the virus to anyone else in his community.

The state has reported 253 tests for the virus as of Tuesday afternoon, with 248 coming back negative. The department no longer lists pending tests on its website because private providers don’t need to get permission to send tests to the state lab.

Despite the small number of positive tests, Burgum said it's "very likely" that more North Dakotans have contracted COVID-19 but have not been tested for it. While health officials don't suspect the disease was spread through North Dakota communities by the current known cases, Burgum said Tuesday officials "can assume that community spread may have already arrived" in the state.

Every state now has at least one confirmed case of the illness, and some states like Washington, New York and California have more than known 500 cases.

On Tuesday, Minnesota reported it had 60 known cases of COVID-19, while South Dakota reported 11 cases. Nationwide, the number of cases topped 5,000 by Wednesday afternoon, with more than 95 deaths.

Burgum announced the five-day closure of the state's 175 public and private school districts Sunday in an effort to increase "social distancing" by limiting situations in which the virus can spread easily between people. Hundreds of public events and meetings in North Dakota, including the high school state basketball tournaments and the Fargo Marathon, have been canceled or postponed to prevent mass gatherings during the epidemic.

State and national health officials have repeatedly said taking these kinds of actions could help prevent a sudden outbreak of COVID-19 that overwhelms the health care system.

People can help protect themselves from the spread of the virus by diligently practicing preventative behaviors, like avoiding crowds, covering coughs and sneezes, washing hands frequently with soap and water and cleaning commonly touched surfaces.

Symptoms of COVID-19 in those who have been exposed can include fever, cough and shortness of breath. The symptoms may appear in as few as two days or as long as 14 days after exposure.

Reported illnesses have ranged from people with few to no symptoms to people becoming severely ill and dying. People who think they may have COVID-19 should call their health care provider first before going to the clinic, unless it’s an emergency.

Older adults and people with underlying medical conditions, like heart disease, diabetes or lung disease, are at a greater risk of suffering a serious illness or death from the illness, according to the Centers for Disease Control and Prevention.

Burgum said Tuesday residents who are traditionally "North Dakota tough" and work through illnesses on the job now have to be "North Dakota smart" and stay home when sick.

For questions related to COVID-19, the public can call the Health Department hotline at 866-207-2880 from 7 a.m. to 7 p.m. Monday through Friday. Individuals who need medical advice should contact their health care provider.

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