West Virginia (0.213) with 607,366 cases, Guam (0.163) with 58,751 cases, Montana (0.096) with 314,564 cases, US Virgin Islands (0.092) with 23,311 cases, and New York (0.091) with 6,419,073 cases, West Virginia has been in the top 5 states for 328 of the last 419 days