West Virginia was the last state in the U.S. to have a patient. From CNN:

How one woman fought to get her husband tested while her state was applauded for having no coronavirus
By Mallory Simon, CNN

Updated 5:17 PM ET, Sat March 21, 2020

(CNN)Carolyn Vigil was lying in bed next to her husband when she first saw the meme. It noted West Virginia had no reported cases of coronavirus, and jokingly pleaded for its people to hang on.

She remembers it so well because it’s the day her husband James began to feel sick in their Shepherdstown home in the West Virginia panhandle.

Her husband was sick from Covid-19. But her “coronavirus-free” state wasn’t set up to test him.

He would become the state’s Patient #1. They didn’t know it then, of course, nor did anyone else. But in the following days they felt like that they were the only people in the state who wanted to find out. From medical professionals who simply had no information to health administrators in the same boat, all the way up to the President saying the state was doing a good job for having no cases.
And all the while, Patient #1 — James Vigil — was there for the testing.