The U.S. death toll from the coronavirus topped 200,000 Tuesday, by far the highest in the world, hitting the once-unimaginable threshold six weeks before an election that is certain to be a referendum in part on President Donald Trump’s handling of the crisis.

“It is completely unfathomable that we’ve reached this point,” said Jennifer Nuzzo, a Johns Hopkins University public health researcher, eight months after the scourge first reached the world’s richest nation, with its state-of-the-art laboratories, top-flight scientists and stockpiles of medical supplies.

The number of dead is equivalent to a 9/11 attack every day for 67 days. It is roughly equal to the population of Salt Lake City or Huntsville, Alabama.

And it is still climbing. Deaths are running at close to 770 a day on average, and a widely cited model from the University of Washington predicts the U.S. toll will double to 400,000 by the end of the year as schools and colleges reopen and cold weather sets in. A vaccine is unlikely to become widely available until 2021.

“The idea of 200,000 deaths is really very sobering, in some respects stunning,” Dr. Anthony Fauci, the government’s top infectious-disease expert, said on CNN.

The bleak milestone was reported by Johns Hopkins, based on figures supplied by state health authorities. But the real toll is thought to be much higher, in part because many COVID-19 deaths were probably ascribed to other causes, especially early on, before widespread testing.

Trump said it was “a shame” the U.S. reached that number but argued the toll could have been much worse.

“I think if we didn’t do it properly and do it right, you’d have 2.5 million deaths,” Trump told reporters at the White House before leaving for a campaign rally in Pittsburgh. He added that the United States is now “doing well” and “the stock market is up.”

He also gave his often-repeated broadside that China was at fault for the pandemic. In a prerecorded speech to the U.N. General Assembly, he demanded that Beijing be held accountable for having “unleashed this plague onto the world.” China’s ambassador rejected the accusations as baseless.

On Twitter, Democratic presidential candidate Joe Biden said, “It didn’t have to be this bad.”

“It’s a staggering number that’s hard to wrap your head around,” he said. “There’s a devastating human toll to this pandemic — and we can’t forget that.”

For five months, America has led the world by far in sheer numbers of confirmed infections — nearly 6.9 million as of Tuesday — and deaths. The U.S. has less than 5% of the globe’s population but more than 20% of the reported deaths.

Brazil is No. 2 with about 137,000 deaths, followed by India with approximately 89,000 and Mexico with around 74,000. Only five countries — Peru, Bolivia, Chile, Spain and Brazil — rank higher in COVID-19 deaths per capita.

“All the world’s leaders took the same test, and some have succeeded and some have failed,” said Dr. Cedric Dark, an emergency physician at Baylor College of Medicine in hard-hit Houston. “In the case of our country, we failed miserably.”

Black and Hispanic people and American Indians have accounted for a disproportionate share of the deaths, underscoring the economic and health care disparities in the U.S.

Worldwide, the virus has infected more than 31 million people and is closing in fast on 1 million deaths, by Johns Hopkins’ count, though the real numbers are believed to be higher because of gaps in testing and reporting.

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