Community transmission continues throughout the country, and the risk of infection remains high regardless of destination in the US. From Oct. 15-21, risk of infection was highest in the north-central states of North Dakota, South Dakota, Wisconsin, Montana, Idaho, and Nebraska.

At the nationwide level, authorities report an overall increase in cases since early September, in part due to the resumption of in-person education in some states, as well as easing of business and movement restrictions. Continued population movement will likely create new localized outbreaks of infection in areas where transmission was previously decreasing.

Authorities have identified a total of 8,312,667 confirmed and presumptive positive cases of COVID-19, according to US CDC data through Oct. 22. The incidence rate of COVID-19 (cases per 100,000 people, a better indicator of infection risk than case count alone) indicates the risk of infection during this outbreak overall is highest in Louisiana, Mississippi, Florida, Alabama, Arizona, Georgia, North Dakota, New York City, South Carolina, Tennessee, and Iowa. In line with this data, the incidence rates are as follows according to US CDC data through Oct. 22:

Incidence rate more than 3,479 cases per 100,000:


  • North Dakota
  • South Dakota
  • Louisiana
  • Mississippi
  • Alabama
  • Florida
  • Tennessee
  • Iowa


Incidence rate 2,922-3,371 cases per 100,000:


  • Arkansas
  • Wisconsin
  • South Carolina
  • Georgia
  • Arizona
  • Idaho
  • Nebraska
  • Utah
  • Nevada
  • Oklahoma
  • Texas


Incidence rate 2,326-2,816 cases per 100,000:


  • Illinois
  • Rhode Island
  • Missouri
  • Kansas
  • New Jersey
  • Delaware
  • North Carolina
  • Washington, D.C.
  • Montana


Incidence rate 1,816-2,283 cases per 100,000:


  • Maryland
  • Indiana
  • Minnesota
  • California
  • Massachusetts
  • New York
  • Kentucky
  • Virginia
  • New Mexico
  • Connecticut


Incidence rate 965-1,705 cases per 100,000:


  • Wyoming
  • Michigan
  • Ohio
  • Alaska
  • Colorado
  • Pennsylvania
  • Washington
  • West Virginia
  • Hawaii
  • Oregon


Incidence rate fewer than 731 cases per 100,000:


  • New Hampshire
  • Maine
  • Vermont



Background and Analysis
Additional cases may be added to this list at any time as disease surveillance and testing continues. Significant increases in case counts are expected as laboratory test results become available. Older individuals and people with chronic medical conditions or otherwise compromised immunity should consider postponing nonessential travel, including domestic travel, and take precautions to avoid becoming ill, especially where sustained community transmission of COVID-19 has been identified. All individuals should monitor their health and limit interactions with others for 14 days after returning from travel.

Older individuals and those with chronic illness are more susceptible to infection and are at increased risk for severe complications. Human-to-human transmission does occur, primarily through respiratory droplets from infected individuals or contact with contaminated surfaces or objects.

Coronavirus disease 2019 (COVID-19) is a viral respiratory disease caused by infection with the SARS-CoV-2 virus. Symptoms occur 1-14 days following exposure (average of 3-7 days). These symptoms typically include fever, fatigue, and dry cough; less common symptoms include headache, diarrhea, loss of taste or smell, reddening of the eyes, skin rash, or discoloration of the fingers or toes. Symptoms may worsen to difficulty breathing, pneumonia, and organ failure - especially in those with underlying, chronic medical conditions.

Emphasize basic health precautions, especially frequent handwashing with soap and water, or an alcohol-based hand sanitizer if soap and water are unavailable. Practice good coughing/sneezing etiquette (i.e., covering coughs and sneezes with a disposable tissue, maintaining distance from others, and washing hands). There is no evidence that the influenza vaccine, antibiotics, or antiviral medications will prevent this disease, highlighting the importance of diligent basic health precautions.


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