VIRUS UNPREDICTABLE AS DEATH TOLL IN U.S. HEADS TO 200,000

It is a staggering toll, almost 200,000 people dead from the coronavirus in the United States, and nearly five times that many — close to 1 million people — around the world.

As of Sunday, California recorded 15,014 deaths, adding 27 Sunday and 77 on Saturday. The state has more than 785,000 confirmed cases, the most of any state in the nation.

And the pandemic, which sent cases spiking skyward in many countries and then trending downward after lockdowns, has reached a precarious point. Will countries like the United States see the virus continue to slow in the months ahead? Or is a new surge on the way?

“What will happen, nobody knows,” said Catherine Troisi, an infectious disease epidemiologist at The University of Texas Health Science Center at Houston. “This virus has surprised us on many fronts, and we may be surprised again.”

In the U.S., fewer new coronavirus cases have been

detected week by week since late July, following harrowing outbreaks first in the Northeast and then in the South and the West.

But in recent days, the nation’s daily count of new cases is climbing again, fueling worries of a resurgence of the virus as universities and schools reopen and as colder weather pushes people indoors ahead of what some epidemiologists fear could be a devastating winter.

The coronavirus death toll in the U.S. is now roughly equal to the population of Akron, Ohio, or nearly 21⁄2 times the number of U.S. service members who died in battle in the Vietnam and Korean wars combined, and about 800 people are still dying daily.

Around the world, at least 73 countries are seeing surges in newly detected cases, and worries are fast mounting.

In India, more than 90,000 new cases are now being detected daily, adding 1 million cases since the start of this month and sending the country’s total cases soaring past 5 million.

In Europe, after lockdowns helped smother the crisis in the spring, the virus once again is burning its way across the continent as people proceed with their lives.

Israel, with nearly 1,200 deaths attributed to the virus, imposed a second lockdown last week, one of the few nations that has done so.

When the first wave of infections spread around the world, governments imposed sweeping restrictions on movement: More than 4 billion people were under some sort of stay-at-home order at one point. But most nations now are desperately trying to avoid resorting again to such intense measures.

“We have a very serious situation unfolding before us,” Hans Kluge, the World Health Organization’s regional director for Europe, said last week. “Weekly cases have now exceeded those reported when the pandemic first peaked in Europe in March.”

Across Latin America, the death toll stands at more than 310,000. Two-thirds of the total come from just two nations: Brazil with more than 132,000 reported deaths and Mexico with 72,000. Dr. Carissa Etienne, the director of the Pan American Health Organization, warned that the threat remained.

“Latin America has begun to resume almost normal social and public life at a time when COVID-19 still requires major control interventions,” she said last week. “We must be clear that opening up too early gives this virus more room to spread and puts our populations at greater risk. Look no further than Europe.”

Deaths in the U.S. from the coronavirus rose above 199,300 as of Sunday afternoon, leaving families across the country grieving. It was only four months ago, in late May, that the nation’s death roll reached 100,000. Even the current tally may be a significant undercount of the toll in the U.S., analyses suggest, failing to include some people who die from COVID-19 as well as those who die from secondary causes that are also linked to the pandemic.

As the virus overtook the U.S. this spring, deaths surged. In mid-april, more than 2,000 people were dying each day, on average. Deaths rose again this summer as cases spiked in the South and West. The pace has slowed considerably since.

Although the capabilities of health care systems vary widely across the globe, earlier detection of infections, efforts to keep the virus out of nursing homes and away from the most vulnerable groups, and better treatments have meant fewer people needing to be placed on ventilators and improved outcomes for those who fall seriously ill.

Still, as the race for a vaccine continues, there is no cure for COVID-19.

Each day, about 800 people with the virus are dying in the U.S. on average. That’s down from more than 1,200 deaths every day in early August. Yet even as some of the country’s most populous states report vast improvements, and as Northeastern states have kept new infections low, deaths continue to trend upward in nine states and two territories.

Dr. Tom Inglesby, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, said it was conceivable that the death toll in the U.S. could reach 300,000 if the public lets down its guard.

“There are many countries we might consider our economic peers, or that are far less developed in terms of economy or health care systems, that are having far less mortality,” he said.

The contrast with other rich industrialized countries is stark, reflecting how the virus is still tearing through parts of the U.S. On one day last week, the U.S. reported 849 new deaths. The same day, Italy, once the epicenter of the pandemic, had 13 deaths. Both Canada and Germany reported seven deaths that day.

The virus took off later in the U.S. than in some other places, but cases were never fully reined in. Since the beginning of April, the country’s average daily case total has not dropped below 20,000, and an essential question loomed at summer’s end: Would a general trend downward in the nation’s daily reports of new cases and deaths since August continue — or was a recent uptick in cases a sign of a new, concerning pattern?

Yvonne Maldonado, a pediatric infectious disease specialist at Stanford University, compared the country’s current juncture with where California was weeks ago when a new surge of cases emerged.

“For those of us in California, we went through that period where we were really proud of the lockdown and our ability to really flatten the curve,” Maldonado said. “We wound up becoming overconfident.”

The pandemic could be protracted, she warned, like the influenza pandemic of a century ago. Then, the deadly flu churned through the U.S. in three waves: one in the spring of 1918, another that fall, and yet another in the winter and spring of 1919. In that flu pandemic, about 675,000 Americans died.