COVID-19 cases in American have reached 17,702,516, up 176,253 yesterday. Fatal cases have hit 318,499, up by 2,160. The spread of the disease has been uneven. Some parts of the country, like New York, were hit hard early. Others, like North Dakota, were battered more recently. One of the best measures of places that have taken the brunt of the disease is cumulative case rates since the start of the pandemic.

The New York Times keeps the cumulative case rates by city. The city with the highest measure is Bismarck, North Dakota. It has had 18,587 confirmed cases, against a population of 133,179. That translates to 139.6 per 1,000. To show how hard North Dakota has been hit, three of the top seven cities based on this measure are in the state. The others are Grand Forks with a figure of 120.8 and Minot at 119.3.

Bismarck is the state capital. It has been one of the fastest-growing cities in America for decades. Most recently, the entire state had a surge of residents as the fracking industry exploded. This also kept the jobless rate as one of the lowest in the nation.

Bismark’s median household income, according to the Census, stands at $64,444, slightly below the national average. The poverty rate of 9.2% stands well below the national number. Almost 90% of the residents are White. Native Americans make up about 4% of the population while Blacks account for about 3%.

As is the situation with many small state capitals, the state is the largest employer. It employs about 4,600 people in Bismarck. Sanford Health employs another 3,300. The local school system employs 2,200.

Active cases of COVID-19 have started to drop in North Dakota. It has begun to get early shipments of the vaccine. The number of rapid tests for COVID-19 has increased sharply.

However, the state and Bismarck spreads might have been largely avoided. The state government did little to check the disease. Gov. Doug Burgum did not order that masks be worn or limit the size of gatherings until one month ago. By then, it was too late.

The ordeal is not over, for Bismarck, the State of North Dakota, or most of the U.S. The Institute for Health Metrics and Evaluation (IHME) at the University of Washington’s School of Medicine, which has a well-followed model for the rise in COVID-19 cases and deaths, forecasts U.S. fatal cases will reach 502,000 by April 1, if social distancing and mask wearing do not improve.

This is the most dangerous county for COVID-19.

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