The United States has surpassed 1 million confirmed Covid-19 cases, just a few months after the novel coronavirus first arrived in America.

The confirmed number of cases, based on the Johns Hopkins Coronavirus Resource Center’s tally, is almost surely an undercount. The US’s initial response to the outbreak was stifled by undertesting and, while America’s testing capacity has increased in the last month, experts say there are still likely many more cases than are actually included in the official counts. Various attempts to roughly capture the share of the population that has been exposed to the coronavirus through serological testing seem to confirm that the US has not fully measured the extent of the outbreak within its own borders.

And within a matter of days, the US is also likely to pass another ominous milestone: more than 60,000 confirmed deaths from Covid-19. The current total sits north of 55,000 and more than 1,000 Americans are dying every day from the virus.

President Donald Trump once claimed that such a toll would count as a victory, given the projections of millions of deaths if there were no social distancing measure put into place. The ultimate cost in lives of the coronavirus remains to be seen, and, again, experts believe the actual number of people to die from the disease or because the health system has been overstretched is likely much higher than the official count.

The US has by far the most confirmed Covid-19 cases (Spain is second with about 230,000) and deaths (Italy is next, with about 27,000), though many countries have the same issues with undertesting and asymptomatic cases make it difficult to track the virus. China has also acknowledged initially undercounting its cases and outside reporting suggests the pandemic has been deadlier there than the official numbers suggest, though it is difficult to assess whether it has been worse than in America.

Regardless, at this point, the United States has been and will continue to be the clear epicenter of this global pandemic.

The US health system was less prepared for a pandemic than those of other wealthy nations. A high uninsured rate, high out-of-pocket health care costs, and low medical system capacity combined to make the country more vulnerable to a pathogen before the coronavirus ever came to our shores. America’s lax response in the early days of the outbreak only compounded those structural problems.

“Everyone working in this space would agree that no matter how you measure it, the US is far behind on this,” Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, told Vox in mid-March of the initial coronavirus response.

As the US implements dramatic measures to control the spread of Covid-19, with schools and businesses closing and general social distancing underway, the country is still struggling to understand the full scope of the outbreak because of the slow start of testing. It has undeniably hindered the US response.

“The testing failure is putting additional strain on our already challenged health system,” Cynthia Cox, director of the Peterson-Kaiser Health System Tracker, said in March. “The combination of all of these factors will make the US worse off than similar countries.”

Testing is not only important because it gets people diagnosed and appropriate treatment if they have an infection, it also establishes how widespread a virus actually is. Experts know the size of the problem, they know the rate at which people are being hospitalized or dying, and they can follow its movements.

But the United States faltered in rolling out coronavirus tests, initially putting America behind its economic peers in tracing the outbreak. A manufacturing problem with the test kits that were initially sent out in the field, and a delay in approving commercial tests, set the nation back in stopping or slowing down Covid-19.

Even as testing capacity has ramped up in the US, as of April 27, America is still lagging behind other places in the world hit hardest by the virus in the share of its population being tested. The US has tested about far fewer people per million residents as Italy, a focal point of Europe’s outbreak, and Germany, considered a model of rapid and widespread testing.

There have been nearly 5.4 million tests conducted in the US for its population of 329 million, but the number of tests per capita conducted varies greatly by state.

The US has finally started to catch up to the rest of the developed world in responding to Covid-19. But as case numbers and deaths continue to increase, we’re still learning the full scope of the crisis.

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