Minnesota health officials are expressing new alarm about the spread of COVID. Today they announced opening a second supplemental hospital care site in Brainerd. 

The daily death toll also topped 40 for only the fifth time since January.

State Health Commissioner Jan Malcolm says there are a range of factors contributing to the rise. 

"It’s the combination of a waning immunity among some of those first vaccines that we were just talking about. It's the relaxation of mitigation by a lot of people and a lot of circumstances — a lot more circulating going on without masking and so forth. Cold weather. More indoors. There just are some anomalies to this virus that we just don't fully understand yet."

Malcolm and Infectious Disease Director Kris Ehresmann urged Minnesotans to think about taking extra precautions at — if not outright avoiding — some of the holiday gatherings that will start with Thanksgiving, now just 15 days away.