The first wave of the pandemic hit New York, and other cities with dense populations. As hospitals were overwhelmed with patients and struggled to access enough personal protective equipment and ventilators, the midwest and south were largely spared the worst of COVID-19. Then, the came the fall. COVID-19, the disease caused by SARS-CoV-2, started disrupting families and ravaging lives far from the metropolitan counties, especially in the southern and midwestern states such as Texas, North Dakota, South Dakota, and Wyoming.