“What we are seeing today is different from March and April — it is extraordinarily widespread,” Birx said during an interview on CNN. “It’s into the rural as equal urban areas. And to everybody who lives in a rural area, you are not immune or protected from this virus.”

During the early weeks of the outbreak in the U.S., outbreaks were largely concentrated in several major cities including Seattle and New York City, the country’s virus epicenter for months. Since late June however, several southern and western states have seen their coronavirus case numbers spike, including California, Florida, Texas, Arizona and Georgia. Governors in several states have reimposed business closures and social distancing measures again after initially allowing sectors of their economies to reopen.

Birx said that residents in all areas of the country should wear a mask and practice social distancing, but especially if an outbreak is occurring close by or if they have recently visited a hot spot. Those who have at-risk individuals in their homes should take even more precautions, she said.

“If you have an outbreak in your rural area or in your city, you need to really consider wearing a mask at home, assuming that you’re positive if you have individuals in your households with comorbidities,” Birx said.

“If you’ve chosen to go on vacation into a hot spot, you really need to come back and assume you’re infected,” she added.

The U.S. has seen a total of 4.6 million cases of the coronavirus and more than 155,000 people have died after being infected.