As the coronavirus surges, it is reaching into the nation’s last untouched areas

Then came October. Three residents tested positive, knocking Petroleum off zero-case lists, forcing the county’s lone school to close for a week and proving, as Sheriff Bill Cassell put it, that “eventually we were going to get it,” and that the virus “ain’t gone yet.”

That is a lesson people in many other wide-open places have been learning as the coronavirus surges anew. Months after it raced in successive waves along the nation’s coasts and through the Sun Belt, it is reaching deep into its final frontier — the most sparsely populated states and counties, where distance from others has long been part of the appeal and this year had appeared to be a buffer against a deadly communicable disease.

In Montana, which boasts just seven people per square mile, active cases have more than doubled since the start of the month, and officials are warning of crisis-level hospitalization rates and strains on rural health care. In Wyoming, which ranks 49th in population density, the National Guard has been deployed to help with contact tracing. Those two states, along with the low-density states of Idaho, North Dakota and South Dakota, now have some of the nation’s highest per capita caseloads. Even Alaska, the least-crowded state, is logging unprecedented increases, including in rural villages.

“People here make the joke that we’ve been socially isolating since before the state was founded,” said Christine M. Porter, an associate professor of public health at the University of Wyoming. “In terms of the reason this happened now and it didn’t happen before, it was essentially luck-slash-geography. It’s a disease that spreads exponentially once it’s taken root, unless you take severe measures to stop it.”

The bulk of these states’ cases are clustered in their relatively small cities, but infections are fanning out. In Montana, about 55 percent of cases were in population centers by mid-month, down from nearly 80 percent over the summer. And although the caseloads may look low, they loom large for local public health officials and facilities.

Sue Woods directs the Central Montana Health District, a Massachusetts-sized area that includes Petroleum and five other rural counties. The district has about 120 active cases, and Woods is working 10- to 12-hour days, mostly on contact tracing.

“The numbers of cases that we see are so small compared to large population centers, but when you take our population into account, we’re right in the same percentages,” Woods said. “Two of us are doing the bulk of the patient contacts. It is overwhelming.”

Some officials point to the positive side of being hit by the coronavirus later in the pandemic. It gave jurisdictions and health-care facilities the opportunity, they say, to collect personal protective equipment, ramp up testing and learn more about the virus and how to treat covid-19, the disease it causes.

“Up until a few weeks ago, we had been very successful in limiting transmission,” said Alexia Harrist, Wyoming’s state health officer and state epidemiologist. “It did buy us very important time to

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