– Three people have died from a coronavirus outbreak at an assisted living center in Duluth, the first Duluth-area deaths in the pandemic.

There have been 17 confirmed cases of COVID-19 among the 138 residents of St. Ann's Residence as of Thursday, executive director Scott Johnson said. Five remain hospitalized.

Among the three deaths was the first person at St. Ann's to test positive for the respiratory infection several days ago.

"They went into the hospital with unrelated events and had the sniffles," Johnson said. "The virus hits fast ... the horror of 'I'm fine' to 'I'm not.' "

The Minnesota Department of Health said Thursday that a man in his 70s was the first person in St. Louis County to die from COVID-19, and on Friday confirmed a fourth person had died in the county. The state relies on an explicit mention of COVID-19 as a cause of death for its count.

"This is a very somber day for us," said Amy Westbrook, the county's public health director. "To a certain extent, we knew we likely would see deaths from COVID-19 here, but it is still heartbreaking to have it confirmed."

A woman walked towards the front door of St. Ann’s Residence in Duluth with flowers in hand on Thursday morning. .

Last week, there were a dozen cases confirmed in all of St. Louis County. Confirmed cases have nearly doubled in the past two days.

Westbrook said her department is not predicting how many deaths COVID-19 will cause in the state's geographically largest county or when cases will peak.

"Up until now we've had cases reported a little more sporadically, but I anticipate we'll see more cases daily now," she said, indicating an increase in spread rather than an increase in testing, though many infections remained linked to travel or other confirmed cases.

"We're continuously preparing for the worst-case scenario," said Dr. Rajesh Prabhu, infectious disease physician at Essentia Health in Duluth. "There's prediction models and then there's reality. So we're preparing for the worst."

St. Ann's Residence, adjacent to Duluth's downtown medical district, now has a health department staffer on site to assist with infection control and is receiving backup from Essentia and St. Luke's employees.

"We're an assisted living facility, not a nursing home — we don't have the staffing or supplies a nursing home would," Johnson said.

St. Ann's can't control the movement of its residents to better stem the spread of the virus. Some neighbors have raised concerns about seeing residents outside the complex.

"They're all individual apartments, and the messaging is their rooms are the safest place they can be," Johnson said. "But you deal with different levels of dementia, and you can't stop someone who wants to get groceries."

Some residents have been taken home by their families, which poses risks because the long incubation period could mean they are infected without yet showing symptoms.

Johnson said the residence is doing everything it can to control the infection and "flatten our internal curve."

"My residents need to know we've turned over every resource to take care of them," he said.