By CARLA K. JOHNSON

AP – The U.S. death toll from the coronavirus topped 200,000 Tuesday, a figure unimaginable eight months ago when the scourge first reached the world’s richest nation with its state-of-the-art laboratories, top-flight scientists and stockpiles of medicines and emergency supplies.

“It is completely unfathomable that we’ve reached this point,” said Jennifer Nuzzo, a Johns Hopkins University public health researcher.

The bleak milestone, by far the highest confirmed death toll from the virus in the world, 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.

The number of dead in the U.S. 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, Alabama.

And it is still climbing. Deaths are running at close to 770 a 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 U.S. hit the threshold six weeks before a presidential election that is certain to be in part a referendum on President Donald Trump’s handling of the crisis.

In an interview Tuesday with a Detroit TV station, Trump boasted of doing an “amazing” and “incredible” job against the scourge, adding: “The only thing we’ve done a bad job in is public relations because we haven’t been able to convince people — which is basically the fake news — what a great job we’ve done.”

And in a pre-recorded speech at a virtual meeting of the U.N. General Assembly, Trump lashed out at Beijing over what he called “the China virus” and demanded that it be held accountable for having “unleashed this plague onto the world.” China’s ambassador rejected the accusations as baseless.

For five months, America has led the world by far in sheer numbers of confirmed infections and deaths. The U.S. has less than 5% of the globe’s population but more than 20% of the reported deaths.

Brazil is No. 2 with about 137,000 deaths, followed by India with approximately 89,000 and Mexico with around 74,000. Only five countries — Peru, Bolivia, Chile, Spain and Brazil — rank higher in COVID-19 deaths per capita.

“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 Houston who has seen death firsthand. “In the case of our country, we failed miserably.”

Blacks, Hispanics and American Indians have accounted for a disproportionate share of the deaths, underscoring the economic and health care disparities in the U.S.

Worldwide, the virus has infected more than 31 million people and is closing in fast on 1 million deaths, with over 965,000 lives lost, by Johns Hopkins’ count, though the real numbers are believed to be higher because of gaps in testing and reporting.

For the U.S., 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. Besides its labs, experts and strategic stockpiles, the U.S. could boast of its disease trackers and plans for rapidly communicating lifesaving information during a crisis. The U.S. Centers for Disease Control and Prevention was respected around the world for sending help to fight infectious diseases.

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, where infection controls were already poor, claiming more than 78,000 lives.

At the same time, gaps in leadership led to shortages of testing supplies. Internal warnings to ramp up production of masks were ignored, leaving states to compete for protective gear.

Trump downplayed the threat early on, advanced unfounded notions about the behavior of the virus, promoted unproven or dangerous treatments, complained that too much testing was making the U.S. look bad, and disdained masks, turning face coverings into a political issue.

On April 10, the president predicted the U.S. wouldn’t see 100,000 deaths. That milestone was reached May 27.

Nowhere was the lack of leadership seen as more crucial than in testing, a key to breaking the chain of contagion.

“We have from the very beginning lacked a national testing strategy,” Nuzzo said. “For reasons I can’t truly fathom we’ve refused to develop one.” Such coordination should be led by the White House, not by each state independently, she said.

Roberto Tobias Jr., a 17-year-old from Queens in New York City, lost his mother and father to COVID-19 a month apart in the spring. He and his sister also contracted the virus but recovered. Tobias is now applying to college, hoping to get into Columbia University and become a neurosurgeon.

“Because it’s just me and my sister, we sort of have to rely on each other,” he said. “We were the only blood left.”

The real number of dead from the crisis could be significantly higher: As many as 215,000 more people than usual died in the U.S. from all causes during the first seven months of 2020, according to CDC figures. The death toll from COVID-19 during the same period was put at about 150,000 by Johns Hopkins.

Researchers suspect some coronavirus deaths were overlooked, while other deaths may have been caused indirectly by the crisis, by creating such turmoil that people with chronic conditions such as diabetes or heart disease were unable or unwilling to get treatment.

Dark, the emergency physician at Baylor, 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,” he said, “what’s really been exposed is how anti-science we’ve become.”

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Associated Press writer Kelli Kennedy in Miami contributed to this story.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

By STEVE PEOPLES

NEW YORK (AP) — Presidential politics move fast. What we’re watching heading into a new week on the 2020 campaign:

Days to general election: 43

Days to first debate: 8

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THE NARRATIVE

The October surprise of 2020 came early.

The death of Ruth Bader Ginsburg injects another generational fight to an election year that already featured the deadliest public health threat in a century, the worst economic collapse since the Great Depression and the most significant civil unrest since the civil rights era. Six weeks before Election Day, the fight to replace Ginsburg is set to dominate headlines, with the prospect of reshuffling voters’ priorities and campaign strategies, especially for President Donald Trump.

Still, the pandemic rages on. Millions of school children are stuck at home. The economic recovery is dragging. And more than 200,000 Americans have died.

Coming soon: one of the most highly anticipated presidential debates in the modern era is just eight days away.

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THE BIG QUESTIONS

Is this suddenly a new election?

A presidential election that was shaping up to be a referendum on Trump’s divisive leadership through dueling crises may suddenly be transformed into one about Trump’s next lifetime appointment to the nation’s highest court.

Or not.

It’s clear that the most passionate partisans in Washington and elsewhere will be obsessed with the election-eve nomination fight. The stakes are huge for the future of the U.S. judiciary and several major issues, abortion rights among them. But it’s less clear that the persuadable voters of Florida, Pennsylvania and Arizona are equally interested in the Supreme Court battle.

Americans For Prosperity President Tim Phillips, a conservative leader whose organization has spent months knocking on swing-state voters’ doors and has a keen sense of the electorate, is skeptical that the court battle will change the direction of the election. He was out canvassing over the weekend and tells us that the Supreme Court didn’t even come up. He notes that most Americans are dealing with much more imminent crises: millions of children can’t go to school, grandparents remain in isolation, and Main Street in towns across the nation is struggling to stay open.

If anybody says they know how this nomination fight will or won’t reshape the 2020 landscape, they’re only guessing.

And the nominee is?

Those close to the president are encouraging him to announce his Supreme Court nominee on or before the day of the first presidential debate, which is Sept. 29.

He has promised to pick a woman, and Republicans are hopeful that a female pick could help Trump’s GOP with its problem with suburban women and serve as a counterweight to Biden’s historic selection of Sen. Kamala Harris as his running mate. Any nominee will have a record and a background that will undergo intense scrutiny.

Democrats will be praying for unearthed baggage that might delay the process or reflect poorly on Trump, as was the case with the president’s last nominee. Trump’s team will do everything in its power to make sure that doesn’t happen.

Under normal conditions, Supreme Court nominations are immensely important. In this case, the pick could directly or indirectly reshape all three branches of the U.S. government.

What will Trump say about 200,000 dead Americans?

The pandemic’s death toll, which exceeded 200,000 on Sunday, is staggering, by far the highest in the world. For context, more Americans have now been killed by COVID-19 than were killed in all the military conflicts after World War II and the 9/11 attacks combined.

The scary part is that there are still several hundred Americans dying each day heading into flu season. Before this is over, COVID could overtake cancer and heart disease as the leading cause of death in the United States this year.

Trump, who largely left states to deal with the pandemic on their own, has been escalating his promises of a vaccine in the near future to stop the death. But the president’s well-documented history of spreading false information about the pandemic and other issues has badly damaged his credibility, and as a result, roughly half of Americans report that they may not take the vaccine when it’s available.

Can Trump reset expectations for the first debate?

Trump and his allies have spent much of the summer degrading Biden’s mental acuity, portraying the 77-year-old Democrat as a senile old man who has lost the capacity to speak or think. Polling suggests that this line of attack has not been effective, and worse for Trump, it’s dramatically lowered expectations for Biden in the first debate.

It may be too late already, but Trump’s team has to shift those expectations — at least a little — before their first debate.

Biden is a far more experienced debater and has a much better command of global affairs and domestic policy than Trump. At the same time, Trump will enter the debate vulnerable on multiple fronts, having been caught on tape encouraging foreign governments to meddle in the election before presiding over the worst economic collapse and public health crises in a century.

Biden has the experience and the ammunition to do real damage. But a week before the debate, thanks to Trump’s messaging, the Democrat is the perceived underdog.

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THE FINAL THOUGHT

Biden’s home state of Pennsylvania is increasingly looking like 2020′s premier battleground state.

While it’s true that both candidates have multiple paths to 270 electoral votes, their chances of winning would decrease dramatically if they fail to capture the state’s 20 electoral votes. There has been little public polling in recent weeks, but each side privately tells us the race there is tightening.

Trump is scheduled to campaign in Pennsylvania twice this week. And after Florida, no state will see more spending on presidential advertising over the coming six weeks than Pennsylvania, according to the ad tracking firm Kantar/CMAG. Also, just days ago, Biden unveiled a frame for the election that’s decidedly Pennsylvania-focused: This is a campaign between “Scranton and Park Avenue,” Biden declared, drawing a contrast between his working-class Pennsylvania roots and Trump’s privileged upbringing in New York.

Trump became the first Republican since 1988 to win Pennsylvania four years ago. But he did it by just 44,000 votes out of more than 6 million cast.

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2020 Watch runs every Monday and provides a look at the week ahead in the 2020 election.

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AP’s Advance Voting guide brings you the facts about voting early, by mail or absentee from each state: https://interactives.ap.org/advance-voting-2020/