The US death toll from the coronavirus has topped 200,000, 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.
The number of dead is equivalent to a 9/11 attack every day for 67 days.
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 US 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.
In an interview on Tuesday with a Detroit TV station, Trump boasted of doing an "amazing" and "incredible" job against the virus.
And in a prerecorded speech to the UN 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 US has less than five per cent of the globe's population but more than 20 per cent 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.
Worldwide, the virus has infected more than 31 million people and is closing in fast on one million deaths, with nearly 967,000 lives lost, by Johns Hopkins' count, though the real numbers are believed to be higher because of gaps in testing and reporting.
Trump downplayed the threat early on, advanced unfounded notions about the behaviour of the virus, promoted unproven or dangerous treatments, complained that too much testing was making the US look bad, and disdained masks, turning face coverings into a political issue.
On April 10, the president predicted the US wouldn't see 100,000 deaths. That milestone was reached May 27.
The real number of dead from the crisis could be significantly higher: As many as 215,000 more people than usual died in the US from all causes during the first seven months of 2020, according to CDC figures. The death toll from COVID-19 during the same period was put at about 150,000 by Johns Hopkins.
Researchers suspect some deaths were overlooked, while others may have been caused indirectly by the crisis, by creating such turmoil that people with chronic conditions such as diabetes or heart disease were unable or unwilling to get treatment.
Australian Associated Press