The pace of the spread of COVID-19 had slowed across America. Increases in daily fatal and confirmed cases are still about half what they were seven weeks ago. Nevertheless, 561,775 Americans have died, which is about 20% of the world’s total. Confirmed cases have reached 31,056,277, or about 23% of the global number. Hospitalizations, which were over 100,000 a day during the peak wave, dropped into the thousands. However, the U.S. Department of Health & Human Services reports they have begun to rise again in more than half the states.

The pace of the spread of the disease remains in part a race between vaccinations and the rising number of potentially dangerous variants. So far, 33% of the adult population has received at least one dose of vaccine and 19% are fully vaccinated. While the Pfizer and Moderna vaccines require two shots, the one from Johnson & Johnson requires just a single dose. According to The New York Times, 219,194,215 doses have been delivered in the United States and 168,592,075 of them have been administered.

Variants of the disease are among the dangers epidemiologist and public health officials worry about. At least one, first identified in the United Kingdom, could soon account for most new U.S. cases. This variant also could be more deadly. The Centers for Disease Control and Prevention (CDC) currently tracks three variants for the public. They have been found in all 50 states, and a number of other variants have emerged that the CDC does not report on to the public.

Additionally, much of the country has “opened up,” which has caused worries that there will be a fourth wave of the disease. Just two weeks ago, the nation’s newspapers were filled with reports of large college parties in Florida with hundreds of people in close proximity without masks. More people flew over the Easter weekend than any other weekend since the start of the pandemic. This kind of activity has led to public health officials predicting that fourth wave.

Measuring cases per 100,000 people allows easier comparisons from place to place because it adjusts for population size. By the measure, the deadliest county in America is Edwards County, Texas, where the 14-day average death rate is 6.95. This county is west of San Antonio, toward the Mexican border. According to the U.S. Census Bureau, it has a population of 1,932. About 55% of the population is Hispanic and just over 42% is white. Edwards County is relatively poor. Its median household income is $40,766, which is more than $20,000 below the national average. The 20.7% poverty rate is nearly double the national number.

Based on the 14-day death rate per 100,000, Edwards County is followed by Glacier County, Montana, at 5.21. Its population is 13,699. Foard County, Texas, is next at 5.07. It has a population of 1,408. Lac qui Parle County, Minnesota, is at 4.22, and its population is 6,773. Rounding out the top five, the figure for Knox County, Texas, is 3.83. The population there is 3,733.

Among other things, the data show just how hard America’s rural counties have been hit recently.

Click here to see which states have the most COVID-19 cases.

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