![7 days to die motorcycle 7 days to die motorcycle](https://i.ytimg.com/vi/fabgd9vEMHs/maxresdefault.jpg)
Overall, 64 (74%) patients were symptomatic, including 39 (76%) of 51 patients with a primary case and 25 (71%) of 35 patients with secondary and tertiary cases. The median interval between specimen collection and interview was 3 days (range = 1–13 days). Four patients were hospitalized, and one died ( Table). This investigation identified 86 cases, including 51 (59%) primary event-associated cases,** 26 (30%) confirmed secondary and tertiary cases, and nine (10%) likely event-associated secondary or tertiary cases. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy. Phylogenetic relationships, including distinct clustering of viral whole genome sequences, were inferred based on nucleotide differences via IQ-TREE † using general time reversible substitution models ( 3) as a part of the Nextstrain § workflow ( 4).
![7 days to die motorcycle 7 days to die motorcycle](https://www.onrpg.com/wp-content/gallery/W101-2/Wizard101-Screenshot-9.jpg)
To investigate genomic similarity among COVID-19 cases, available SARS-CoV-2 RNA-positive clinical specimens were obtained from clinical laboratories, and whole genome sequencing was conducted at the MDH Public Health Laboratory on 38 specimens using previously described methods ( 2). Likely event-associated tertiary cases were confirmed infections in patients who had contact with persons who had a likely event-associated secondary case during their infectious period. Likely event-associated secondary cases were confirmed infections in patients who had contact with a person who had symptoms of COVID-19 and had attended the motorcycle rally but who were not tested. Tertiary cases were laboratory-confirmed cases in persons who had contact with a person who had a secondary case during their infectious period. Confirmed secondary cases were defined as laboratory-confirmed infections in persons who did not attend the rally but who received SARS-CoV-2–positive test results after having contact with a person who had a primary case during their infectious period. Secondary and tertiary cases were identified from case interview data. During August–September 2020, MDH and local health department staff members interviewed >80% of patients with a confirmed SARS-CoV-2 infection. MDH or local public health department staff members interviewed patients with confirmed SARS-CoV-2 infection to identify exposures and persons who might have been in contact with patients during their infectious period (2 days before through 10 days after symptom onset).* To assess exposures, interviews included questions about travel and being in specific settings, such as bars or restaurants, schools, health care facilities, or events or social gatherings in the 14 days before symptom onset. All confirmed cases among Minnesota residents were reported to MDH. Reverse transcription–polymerase chain reaction testing for SARS-CoV-2, the virus that causes COVID-19, was used to confirm cases.
![7 days to die motorcycle 7 days to die motorcycle](https://i.ytimg.com/vi/MBJcumA0YKM/maxresdefault.jpg)
A primary, event-associated case was defined as an illness in a person who reported attending the rally or who traveled to western South Dakota by motorcycle during August 7–16 and who had symptom onset or specimen collection before August 30 (within 14 days after the end of the rally). On August 21, 2020, MDH identified confirmed COVID-19 cases in persons who reported attending the motorcycle rally in the neighboring state of South Dakota. Furthermore, although these findings did not capture the impact of the motorcycle rally on residents of other states, they demonstrate the rationale for consistent mitigation measures across states. These findings support current recommendations for mask use, physical distancing, reducing the number of attendees at gatherings, isolation for patients with COVID-19, and quarantine for close contacts to slow the spread of SARS-CoV-2 ( 1). Genomic sequencing supported the associations with the motorcycle rally. Approximately one third (34%) of 87 counties in Minnesota had at least one primary, secondary, or tertiary case associated with this rally. Fifty-one primary event-associated cases were identified, and 35 secondary or tertiary cases occurred among household, social, and workplace contacts, for a total of 86 cases four patients were hospitalized, and one died. During August–September 2020, the Minnesota Department of Health (MDH) investigated a coronavirus disease 2019 (COVID-19) outbreak associated with the rally in Minnesota residents. During August 7–16, 2020, a motorcycle rally was held in western South Dakota that attracted approximately 460,000 persons from across the United States to numerous indoor and outdoor events over a 10-day period.