“We thought it was horrible then, but when you look at it from this perspective, they were fairly low,” said Kimberley Shoaf, an expert in public health crises at the University of Utah, reflecting on her state’s caseload in the spring. Now, for the first time, Utah is consistently seeing more than 1,000 new daily infections, according to STAT’s Covid-19 Tracker.

“Our health care system is almost at a breaking point,” Shoaf said…

The fact that the epidemic is now hitting states like the Dakotas and Montana so hard reflects what experts envisioned at the outset of the U.S. crisis. The virus would spread the most at first in dense cities that received a high number of imported cases, and from there would travel to other cities, and then trickle to more rural areas.

“Slowly, day after day, you’ve seen the gap in the infection rates decline” between metropolitan areas and rural areas, said Fred Ullrich, a program director at the University of Iowa’s College of Public Health. It might be a combination of a better handle on the virus in cities or a more lax approach in rural areas, “but we’re seeing it all over the Midwest, and all over the United States.”