"It didn't have to be like this, and it shouldn't still be like this," said Kristin Urquiza, whose father, Mark, died of covid in June, as the virus was sweeping through Phoenix.
Urquiza described it as "watching a slow-moving hurricane" tear apart her childhood neighborhood, where many people have no choice but to keep going to work and risking their health.
"I talk to dozens of strangers a day who are going through what I did in June, but the magnitude and the haunting similarities between our stories six months later is really hard," said Urquiza, who addressed the Democratic National Convention in August. She co-founded Marked By COVID, to organize grieving families and supporters. The group calls for a faster government response and a national memorial for pandemic victims.
Given its large population, the U.S. death rate from covid remains lower than the rate in many other countries. But the death toll of 400,000 now exceeds any other country's count — close to double what Brazil has recorded, and four times the toll in the United Kingdom.
"It's very hard to wrap your mind around a number that is so large, particularly when we've had 10 months of large numbers assaulting our senses and really, really horrific images coming out of our hospitals and our morgues," said Dr. Kirsten Bibbins-Domingo, chair of epidemiology at the University of California-San Francisco.
Scientists had long expected that wintertime could plunge the country into the deadliest months yet, but even Bibbins-Domingo wasn't ready for the sheer pace of deaths, or the scale of the accumulated losses. The mortality burden has fallen heavily on her own state of California, which was averaging fewer than 100 deaths a day for long stretches of the pandemic, but has ranged up to more than 500 in recent days.
She said California followed the science with its handling of the pandemic, yet the devastation unfolding in places like Los Angeles reveals just how fragile any community can be.
"It's important to understand virology. It's important to understand epidemiology. But ultimately, what we've learned is that human behavior and psychology is a major force in this pandemic," she said.
The U.S. in mid-January has averaged more than 3,300 deaths a day — well above the most devastating days of the early spring surge, when daily average deaths hovered around 2,000.
"At this point, looking at the numbers, for me the question is: Is there any way we can avoid half a million deaths before the end of February?" said Dr. Ashish Jha, dean of the Brown University School of Public Health.
"I think of how much suffering as a nation we seem to be willing to accept that we have this number of people getting infected and dying every day."
How Did U.S. Go From 300,000 Deaths to 400,000?
The path to 400,000 deaths was painfully familiar, with patterns of sickness and death repeating themselves from earlier in the pandemic.
A shocking number of people in nursing homes and assisted living facilities continue to die each week — more than 6,000 in the first week of January.
Deaths linked to long-term care account for more than a third of all covid deaths in the U.S. since the beginning of the pandemic. In a handful of states, long-term care contributed to half the total deaths.
Certain parts of the country have a disproportionately high death rate. Alabama and Arizona, in particular, have experienced high rates, given their populations. The virus continues to kill Black and Indigenous Americans at much higher rates than whites.
The chance of dying of covid remains much higher in rural America than in the urban centers.
People over 65 make up the overwhelming majority of deaths, but Jha said more young people are dying than earlier in the pandemic, simply because the virus is so widespread.
In this newest and grimmest chapter of the pandemic, the virus has preyed upon a public weary of restrictions and rules, and eager to mix with family and friends over the holiday season.
Like many other health workers, Dr. Panagis Galiatsatos at Johns Hopkins Hospital is now witnessing the tragic consequences in his daily rounds.
"My heart breaks, because we could have prevented this," said Galiatsatos, an assistant professor of medicine who cares for covid patients in the intensive care unit.
"A lot of what we saw during the holiday travel was the inability to reach our loved ones or family members — not like a public service announcement, but one on one, talking to them [about the exposure risks]. … I really felt like we failed."
Galiatsatos still recalls a grandmother who was transported six hours from her home to his hospital — because there were no beds anywhere closer. On the phone, he heard her family's shock at her sudden passing.
"They said, 'But she was so healthy. She cooked us all Thanksgiving dinner and we had all the family over,'" he said. "They were saying it with sincerity, but that's probably where she got it."
Light at the End of a Very Long Tunnel
The enormous loss of life this winter has happened, paradoxically, at a time that many hope marks the start of the final chapter of the pandemic.
A quarter of all covid deaths have happened during the five weeks since the Food and Drug Administration authorized the first vaccine.
"The trickle of vaccine is so tragically scant. What we need is more of a river of it," said Dr. Howard Markel, who directs the University of Michigan's Center for the History of Medicine.
Markel, who has written about the 1918-19 flu pandemic, said it's estimated it killed upward of 700,000 Americans.
Of the covid pandemic, he said, "I hope we're not talking … 600,000 or more."
At this point, about 3 in 100 people have been vaccinated, placing America ahead of many other countries but behind the optimistic promises made in the early days of the rollout. Given the current pace of vaccination, experts warn, Americans cannot depend solely on the vaccine to prevent a crushing number of additional deaths in the coming months.
UCSF's Bibbins-Domingo worries that the relief of knowing a vaccine will eventually be widely available — the light at the end of the tunnel — may actually lull millions more Americans into a false sense of safety.
"This tunnel is actually a very long tunnel, and the next few months, as the last few months have been, are going to be very dark times," she said.
The emergence of more contagious variants of SARS-CoV-2, the covid virus, complicates the picture and makes it all the more imperative that Americans spend the coming months doubling down on the very same tactics — masks and physical distancing — that have kept many people safe so far.
But Jha, of Brown University, says the country now faces a different task from that of the fall, when "big behavioral changes and large economic costs" were required to prevent deaths.
"Right now what is required is getting people vaccinated with vaccines we already have," he said. "The fact that's going super slow still is incredibly frustrating."
It is this dichotomy — the advent of lifesaving vaccines as hospitals are filled with more dying patients than ever before — that makes this moment in the pandemic so confounding.
"I can't help but feel this immense somberness," said Kristin Urquiza. "I know that a vaccine isn't going to make a difference for the people that are in the hospital right now or who will be in the hospital next week or even next month."
This story is from a reporting partnership with NPR.
