As the weather cools and socializing moves inside, the U.S. has set new records for coronavirus spread. In September, the U.S. averaged roughly 41,000 new cases per day. In October, that number has exploded to 58,000. Only three counties have reported zero COVID-19 cases.

In this third wave, case numbers and hospitalizations are climbing everywhere. Twenty states have more than 70 percent of their ICUs currently occupied. And 18 million people live in counties that have hospitals but no ICU.

The virus hit cities first – of the first 100,000 COVID-19 deaths, only about one-fifth occurred outside urban areas – but it has since spread to all corners of the United States. The “rural wave” of the pandemic has low-density states like Wyoming, Idaho, North Dakota and South Dakota reporting some of the nation’s highest per capita caseloads.

Rural populations are at a higher risk. They tend to be older and have morbidities that can serve as risk factors for severe cases of COVID-19. Rural hospitals are not equipped to handle the rising number of cases and many are overwhelmed by the number of patients hospitalized with severe cases of COVID-19.

Traditional Halloween activities could strain health systems further. Health officials have warned trick-or-treating, indoor parties, haunted houses and communal candy bowls have all been deemed high-risk activities for COVID-19 transmission. But the CDC has offered a list of safe alternatives for kids to celebrate the holiday, including pumpkin carving with family, putting up Halloween decorations at home and having a virtual Halloween costume contest.