Pointing to upper New York staters being "rural upstate types" doesn't explain what's happening in other states such as California (which has had a stay at home order since December 1), Rhode Island (which has been bad for months), New Jersey (which had a recent spike), or Connecticut (which has had several spikes despite having really good numbers in the fall).
California has its share of "rural upstate types" in the central valley. We have friends there and their level of denial or "it's just us, we can do what we want" is stunning. Five or six cases from extended family gatherings so far. And that's just among our friends. And these are educated, smart, kind, generous, successful people.
That's not the only answer, of course. It's surely more complex than that.
I watch NJ like a hawk because my congregation is open for worship, and we have a food bank, feeding program, thrift shop, and homeless program, all open. So far, with our guidelines, we have not had a single case of spread on property since opening last July. Same is true of the Episcopal diocese as a whole (individuals have tested positive, but no spread to other people in the same place at the same time), so we have a very high confidence in our protocols (masking, distancing, capacity limitations).
From what I see, people are very good about distancing and masking. However, we aren't under "draconian measures." Many things are open (albeit under limitations), people are out and about, etc. I think there may be a hidden story in the schools that may not be getting out. The number of private schools that have had to go virtual because of spread among students is pretty high.
We are also a densely populated state, though my county, number 2 in worst cases right now, is not that dense.
Overall, the government has basically decided that if the hospitals can handle it, they're going to do their best to keep things open and running. They've been clear that without economic help, shutting down broad swaths is basically economic suicide.
So far, knock wood, the hospitals have been doing OK. Not great, but OK. I'm deeply concerned about one hospital in the area where two parishioners became COVID positive after long-term stays for other reasons. Nothing at all like last Spring, overall, even though our numbers are way higher than last Spring.
If I had to guess, I would say younger people (middle age and less) not following rules, and unwise private large gatherings.