Benson County, North Dakota has a dubious honor: it ranks among the highest number of COVID-19 cases per-capita in the state.

Shelley Aabrekke, the county's public health nurse, knows it too well. She works closely with the Lake Region District Health Unit — which works in Benson and three surrounding counties — and said the coronavirus pandemic is becoming a round-the-clock job.

"We can't do it all ourselves. the state is getting contact tracers from other areas to help. We do a few here, but I've told them I can't do this all. ... We are working weekends and everything to do contact tracing," she said. "We are working weekends to help other communities do COVID testing events. It's not a Monday-to-Friday job anymore, and it's not an 8-to-5 job.”

As of Thursday, a New York Times database counted 157 coronavirus cases detected in Benson County, located just west and south of Devils Lake. That makes it the eighth-highest number of cases in a North Dakota county, and well behind the hundreds, if not thousands, of cases in other places.

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But Benson's population is small enough that its case load — across the course of the pandemic — calculates out to 2,298 detected cases per 100,000 people. That statistic is higher than almost every other North Dakota county, and often by quite a bit. Cass County only has 1,697 cases per 100,000 people; Grand Forks, only 1,048.

In fact, Benson is the very highest per-capita with just a few exceptions for counties with notably small populations. Billings and Slope, for example, have a mere handful of detected cases, but their populations are so low that a per-capita statistic is rendered far less meaningful.

The local cases in Benson County underscore a change this summer in the virus: it's no longer constrained to outbreaks in larger urban centers, but is now spreading in rural counties throughout the Red River Valley at a rate not seen during the early months of the pandemic.

In a 17-county area in the upper Red River Valley, the data still bears out that shape. As of Thursday morning, in Polk and Grand Forks counties, just 44% of all cases had been diagnosed after July 4. That same statistic for 15 surrounding rural counties was 62% of all cases — indicating that a surge is still on its way.

Aabrekke said on Thursday morning there were just 33 active cases in Benson County, and that she'd like to keep it that way. But she needs the public's help doing all the things it can to keep the virus contained: wearing masks, staying socially distanced and washing their hands often.

"I don't think we're totally different than anybody else. We like to go out and visit people, and some views are, it's not a big deal. And others, it is," she said. "And in public health, this is a big deal. We want to contain it and not have it spread to everyone."