Adjusted for population, the rate of new cases across 56 counties in greater Minnesota tripled between early September and early October, compared with a doubling of the rate across the seven-county Twin Cities area, the Star Tribune reported.

Kris Ehresmann, director of the infectious disease division at the Minnesota Department of Health, suggested it could stem from fewer people in more sparsely populated areas wearing masks, maintaining enough physical distance and following other public health guidelines to slow the spread of the COVID-19 virus.

Other health experts suggest rural Minnesota residents are influenced by the example of neighboring states where public health responses such as mask mandates haven’t been as aggressive. There’s also the possibility that people in border communities could become infected when traveling to Wisconsin and the Dakotas.

Houston County, Minnesota, sits across the Mississippi River from La Crosse, Wisconsin, one of the nation’s COVID-19 hot spots. The Minnesota county has had more new cases in the past six weeks of the pandemic than it reported in the first six months. It has led to the temporary closing of school in La Crescent, across the river from La Crosse.

“A good number of our population commutes to La Crosse on a daily basis for work, for shopping, for other things,” said John Pugleasa, Houston County’s director of public health and human services. “That’s a population that’s had a significant increase, and our folks are in and out of there a lot. That’s the definition of community transmission.”

The situation in La Crescent forced Amy Jore to juggle waitressing and motherhood while working one morning last week at Kaddy’s Kafe. Jore was serving her customers while supervising her 10-year-old son, Henry, as he tackled his homework in the restaurant’s storeroom.

“My main concern is the lack of control we have as people of the community, and the lack of protection I can provide for my family,” Jore said. “This has had an impact on my family — financially, mentally, emotionally.”

Minnesota health officials on Sunday reported 1,682 new confirmed cases and 21 deaths in the last day related to COVID-19. A total of 133,431 positive tests and 2,335 deaths have been confirmed since the start of the pandemic.