On April 15, the United States reached a grim nadir in the pandemic: 2,752 people across the country were reported to have died from Covid-19 that Wednesday, more than on any day before or since.
For months, the record stood as a reminder of the pain the coronavirus was inflicting on the nation, and a warning of its deadly potential. But now, after seven desperate months trying to contain the virus, daily deaths are rising sharply and fast approaching that dreadful count again.
How the virus kills in America, though, has changed in profound ways.
Months of suffering have provided a horrific but valuable education: Doctors and nurses know better how to treat patients who contract the virus and how to prevent severe cases from ending in fatality, and a far smaller proportion of people who catch the virus are dying from it than were in the spring, experts say.
Yet the sheer breadth of the current outbreak means that the cost in lives lost every day is still climbing. More than 170,000 Americans are now testing positive for the virus on an average day, straining hospitals across much of the country, including in many states that had seemed to avoid the worst of the pandemic. More than 1.1 million people tested positive in the past week alone.
At the peak of the spring wave in April, about 31,000 new cases were announced each day, though that was a vast undercount because testing capacity was extremely limited. Still, the toll of the virus was an abstraction for many Americans because deaths were concentrated in a handful of states like New York, New Jersey and Louisiana.
Now the deaths are scattered widely across the entire nation, and there is hardly a community that has not been affected. On Wednesday, when 2,300 deaths were reported nationwide — the highest toll since May — only three counties reported a toll of more than 20.
Forty-four states have set weekly case records and 25 states have set weekly death records in November, as the nation’s death toll has surpassed 264,000 and officials worry that Thanksgiving gatherings may cause infections to spread still more widely in the coming days.
On April 15, more than half of the people who died were in just three states: New York, New Jersey and Connecticut. Michigan, Massachusetts, Maryland and California also each reported more than 100 deaths that day.
But in much of the country, the spring looked far different.
In Oklahoma City, Lizanne Jennings, an I.C.U. nurse, was part of a team in her hospital that was planning for the onslaught of sickness they were hearing about in places like Italy and New York City. The staff was counting beds and calculating how many people they might be able to fit in the units.
“It was just always a sense of ‘it’s coming, it’s coming,’” Ms. Jennings said, describing it as “pre-traumatic shock syndrome.”
In March, Ms. Jennings remembered sitting after work one day with her husband, Dennis Davis, a machinist and former bodybuilder.
“I need you to pay attention,” Ms. Jennings, 53, recalled telling him. “Look at me: People we know, people we love — our family, our friends — people are going to get this virus. And people we know are going to die.”
New York City alone recorded hundreds of deaths on April 15, underscoring its unique role in that spring surge.
“The city was silent except for the ambulances,” said Dr. Steven A. McDonald, an emergency room doctor at NewYork-Presbyterian Hospital.
In a city locked down, emergency rooms were relentlessly frenzied, filled with patients gasping for breath.
Dr. McDonald would head into work every day with the same thought on his mind. “You know someone is going to die in your care that day,” he said. “The question is, How many people?”
The emergency began to subside in the city as summer began, but not before the virus had killed more than 20,000 people and infected, by one estimate, more than a fifth of New York City’s population.
Now daily case counts around New York City have begun ticking up again, with an average of 6,600 each day in the metro area, a fivefold increase from the start of October. Still, the surge has so far been nothing like the one in the spring.
Patrick J. Kearns, a funeral director in Queens, who in the spring regularly had to transport bodies to a crematory in Schenectady, N.Y., nearly three hours away, has noticed a two- or three-day backlog forming again at the city’s crematories. He has called the crematory in Schenectady, he said, to let them know he may be returning in the weeks ahead.
“We are at risk of repeating what happened in April,” Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota and a member of President-elect Joseph R. Biden Jr.’s coronavirus task force, said of the death toll.
“Once you go over the case cliff, where you have so many cases that you overwhelm the system, basically at that point when you fall off that case cliff, you’re going to see mortality rates go up substantially,” he said. “I shudder to imagine what things might be like in two weeks.”
With an inconsistent and shifting response from government officials, the virus surged in the Sun Belt in the summer, and then began rising steadily through the Midwest and the Great Plains — and then all over in recent weeks. The country reached a peak seven-day average of 176,000 reported cases on Wednesday, and there is reason to fear the worst is still coming. Outbreaks continue to grow in Southern California, West Texas and South Florida.
After rising cases has come the new surge of deaths.
Texas and Illinois have reported more than 800 deaths over the past week, while Pennsylvania, Michigan, California and Florida added more than 400 each. In the Upper Midwest, where reports of new cases have started to level off, deaths are still mounting. Nearly 40 percent of all coronavirus deaths in Wisconsin have been reported since the start of November. In North Dakota, where military nurses have been deployed in hospitals, more than 1 of every 1,000 residents has now died.
The dispersed nature of the catastrophe means it seems invisible in many places. The emergency is too widespread to draw teams of health care workers from other places to help. The sounds of ambulances are heard across many states. Families say their losses have sometimes been overshadowed in communities amid fatigue and impatience after more than eight months of social distancing and economic turmoil.
Around the country, medical examiners and funeral home directors are grappling with a steady rise in the toll. “Our volume is exploding,” said Dale Clock, who along with his wife owns and operates two funeral homes in western Michigan. On a recent night, they handled four Covid-19 deaths in just 12 hours, he said. In the past two weeks, nearly half of the families they served had lost relatives to the virus. All of that comes as one worker has had to quarantine because of the virus, and the staff is working overtime.
In the spring, Mr. Clock said, the homes had seen only a few Covid-19 deaths every few weeks.
For Ms. Jennings, the Oklahoma nurse, it has been a long eight months.
The surge her hospital had braced for in the spring never materialized, at least not in big numbers. In July, she traveled to Texas to work with Covid-19 patients at a hospital in the Rio Grande Valley, arriving to find a community that was taking the virus seriously. But “the damage was done,” she said. Many patients, she said, did not survive.
Back in Oklahoma, she said that many people seemed not to believe the virus was real or to take it seriously. It frustrated her, she said.
Last Friday, her mother, Linda Jennings, who had been infected with the coronavirus, died.
“I’m weary and I’m miserable,” she recalled her mother, who was 78, saying as she lay in a hospital bed. “I can’t do this anymore.”
Then on Monday, Ms. Jennings sat beside her husband, eight and a half months after warning him of the dangers of this frightening new virus. He was lying on his stomach in a hospital bed, hooked up to a machine that helps with breathing. He had been admitted 11 days earlier, she said, with a Covid-19 diagnosis.
“I love you so much,” Ms. Jennings remembered saying as she held his hand in the last hours before he died. “I said, ‘You’re going to go, OK? I’m letting you go. You’re going to be at peace.’”
Rick Rojas contributed reporting.