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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, Ala.

And it is still climbing. Deaths are running at close to 770 per 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.

It wasn’t supposed to go this way. When the year began, the U.S. had recently garnered recognition for its readiness for a pandemic. Health officials seemed confident as they converged on Seattle in January to deal with the country’s first known case of the coronavirus, in a 35-year-old Washington state resident who had returned from visiting his family in Wuhan, China.

On Feb. 26, Trump held up pages from the Global Health Security Index, a measure of readiness for health crises, and declared: “The United States is rated No. 1 most prepared.”

It was true. The U.S. outranked the 194 other countries in the index. But monitoring at airports was loose. Travel bans came too late. Only later did health officials realize the virus could spread before symptoms show up, rendering screening imperfect. The virus also swept into nursing homes and exploited poor infection controls, claiming more than 78,000 lives.

“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.”

Dark said that before the crisis, “people used to look to the United States with a degree of reverence. For democracy. For our moral leadership in the world. Supporting science and using technology to travel to the moon. Instead, what’s really been exposed is how anti-science we’ve become.”

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