The Midwest has seen higher levels of COVID-19 activity in recent weeks, and that includes both South and North Dakota.
Health officials say all parts of the region need to be mindful of community spread. The Dakotas now top the nation for new coronavirus infections, based on their seven-day averages per 100,000 people.
Shelly Ten Napel, CEO of Community HealthCare Association of the Dakotas, said that's a more important measuring tool than just the raw numbers for each county.
"You see some of the more rural counties really being the hardest hit," Ten Napel explained. "And so, I think that per-population number is really important, because it shows the true spread of the epidemic."
Ten Napel said rural America needs to get past the mindset that only larger cities are affected by the virus, as was the case last spring.
She said examining different metrics can better inform health agencies and residents about where surges are happening and how best to respond.
Meanwhile, a new report from a group of economists said more than 250,000 COVID cases in multiple states are likely linked to the Sturgis motorcycle rally in August.
Dhaval Dave, professor at Bentley University and co-author of the report, said they estimate those cases resulted in $12 billion in public health costs. He explained how they came up with those case numbers.
"We used anonymized smartphone data to sort of measure nonresident inflows into Sturgis and surrounding areas and mobility patterns into establishments," Dave said.
That phone data, available to the public, was then traced back to various states after the event.
Gov. Kristi Noem has resisted issuing policies such as mask mandates. She criticized the report, noting that it hasn't been subject to peer review. Some local leaders in Sturgis have issued similar responses to the findings.