The virus that some once thought might vanish when the weather warmed up has instead proliferated despite the rising temperatures across the U.S., with the COVID-19 case-count rolling past the 4 million mark, according to Johns Hopkins University, with more than 143,000 deaths.
That number is likely an undercount—a Centers for Disease Control and Prevention study published Tuesday found that the actual U.S. infection rate could be anywhere from six to 24 times higher than the official total. Even still, the 4 million mark is chilling enough.
The U.S., unlike the European Union, China and other previous hotspots, has utterly failed to flatten the infection curve, and instead becomes more of an outlier every day as cases mount.
The pain is not spread evenly across the country. States like California, Georgia, Texas, Oklahoma and Arizona, many of which reopened relatively early, are experiencing exploding caseloads. Meanwhile, the Northeast, once the nation’s hotspot, has cooled considerably. Just this week, California, with more than 409,000 cases, surpassed New York—which has reopened only cautiously, with movie theaters, museums and health clubs still shuttered in parts of the states and indoor dining still forbidden in New York City—for highest case count, though New York’s death total, which exceeds 32,000, remains the nation’s highest so far.
Hospitals are reaching capacity in the hardest hit parts of the country, as a data tracker from the U.S. Department of Health and Human Services reveals. In California, for example, hospitals have reached more than 97% capacity, while over a quarter of those hospitalizations are related to COVID-19. Arizona hospitals are at 94% full and 41% COVID-19-related, respectively, while Georgia is at 77% and 33%. Meanwhile, New York—which during the spring had resorted to setting up emergency makeshift hospitals in Manhattan’s Jacob Javits Convention Center and Central Park—is at just under 77% hospital capacity, but only 5.67% of inpatients are there for COVID-19.
Death rates, for now, are not climbing as fast as case counts. Currently, the U.S. represents 26% of cases worldwide, but a slightly less severe 22% of all deaths. That can give rise to all manner of misinformation—not least being that the virus is somehow growing less lethal. But deaths and hospitalizations have been lagging indicators throughout the pandemic. Fatalities may trail infection rates by as much as a month, which means that a dip in cases in one state in, say, June, may lead to a dip in deaths in July—even as cases in July spike.
It is a certainty that 4 million cases will not be the last dark milestone the U.S. crosses. The death toll is projected to approach a quarter of a million as early as November 1. If case counts climb commensurately, that will put us at nearly 7 million known cases a few weeks before Thanksgiving. COVID-19, which first clobbered the country in early 2020, will remain very much our national plague into 2021.
Correction, July 23: The original version of this story misstated the number of COVID-19 deaths in New York so far. That number is more than 32,000, not more than 72,000.
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Write to Jeffrey Kluger at jeffrey.kluger@time.com