The US edged close to registering 200,000 Covid-19 deaths on Monday, the latest grim milestone for the country only weeks before voters decide whether President Donald Trump will stay in office.
According to a rolling tally by Johns Hopkins University, more than 199,800 Americans have died and more than 6.8 million have been infected.
The US has had the world's highest official death toll for months. Brazil and India have the next highest tallies, recording 136,895 and 87,882 fatalities, respectively.
Overall, the US accounts for 4 per cent of the world's population and 20 per cent of its coronavirus deaths, while its daily fatality rate relative to the overall population is four times greater than that of the EU.
Critics say the statistics expose the Trump administration's failure to meet its sternest test before the November 3 election.
"Due to Donald Trump's lies and incompetence in the past six months, we have seen one of the gravest losses of American life in history," Democratic presidential nominee Joe Biden said on Monday.
"With this crisis, a real crisis, a crisis that required serious presidential leadership, he just wasn't up to it. He froze. He failed to act. He panicked. And America has paid the worst price of any nation in the world."
On Monday, Mr Trump said on Fox and Friends that the US was "rounding the corner with or without a vaccine".
But he has high hopes that the swift approval of a vaccine will boost his re-election chances.
"I would say that you'll have [a vaccine] long before the end of the year, maybe by the end of October," he told Fox.
He said his priority was "total safety – it's No 1".
Mr Trump set even more ambitious goals, saying that by April next year, most Americans who want to be immunised will have a vaccine.
Most experts say that waiting on a vaccine is not a viable strategy.
Without enforcing rules on face masks, physical distancing and carrying out contact tracing, and without ramping up testing, tens of thousands more could die before life returns to normal in the US, experts say.
"What we need to do is shift towards a more screening approach that's proactive to test asymptomatic individuals," Harvard University surgeon and health policy researcher Thomas Tsai told AFP.
He said the government should approve rapid, at-home antigen tests, which it has been reluctant to do so far, and which would require the government to pay for it instead of insurance companies.
"Covid will be the third leading cause of death this year in the US," Tom Frieden, head of the Centres for Disease Control and Prevention under former US president Barack Obama, tweeted.
"The staggering death toll from the virus is a reflection of a failed national response, but it's not too late to turn it around."
Only the number of people who die from heart disease and cancer will be higher.
The US probably reached 200,000 coronavirus deaths in July, said Eric Topol, director of the Scripps Research Institute, citing the excess mortality rate.
The initial lack of tests led to the toll of the virus being undercounted.
"We are the outlier to have been caught totally flat-footed with no testing and just not learning from mistakes," Mr Topol said.
Belgium, Spain and Britain still have higher total death rates per capita than the US, but were able to partly control the first wave of outbreaks through near-total lockdowns.
"We never got adequate suppression and yet we're opening everything and trying to make believe that everything is just great," Mr Topol said.
Adoption of public health measures remains mixed across the US.
In many cities, students have gone back to university online, the indoor areas of bars and restaurants remain closed, and mask use is up.
But hot spots are still flaring up, currently in the Midwest and at universities that returned to in-person learning.
Critics say Mr Trump abdicated responsibility and left it to state governors to deal with the crisis and decide on lockdowns.