As President Donald Trump entered the final year of his term last January, the U.S. recorded its first confirmed case of COVID-19. Not to worry, Trump insisted, his administration had the virus “totally under control.”

Now, in his final hours in office, after a year of presidential denials of reality and responsibility, the pandemic’s U.S. death toll has eclipsed 400,000. And the loss of lives is accelerating.

“This is just one step on an ominous path of fatalities,” said Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University and one of many public health experts who contend the Trump administration’s handling of the crisis led to thousands of avoidable deaths.

“Everything about how it’s been managed has been infused with incompetence and dishonesty, and we’re paying a heavy price,” he said.

The 400,000-death toll, reported Tuesday by Johns Hopkins University, is greater than the population of New Orleans, Cleveland or Tampa, Florida. It’s nearly equal to the number of American lives lost annually to strokes, Alzheimer’s disease, diabetes, flu and pneumonia combined.

With more than 4,000 deaths recorded on some recent days — the most since the pandemic began — the toll by week’s end will probably surpass the number of Americans killed in World War II.

“We need to follow the science and the 400,000th death is shameful,” said Cliff Daniels, chief strategy officer for Methodist Hospital of Southern California, near Los Angeles. With its morgue full, the hospital has parked a refrigerated truck outside to hold the bodies of COVID-19 victims until funeral homes can retrieve them.

“It’s so incredibly, unimaginably sad that so many people have died that could have been avoided,” he said.

President-elect Joe Biden, who will be sworn in Wednesday, took part in an evening remembrance ceremony Tuesday near the Lincoln Memorial in Washington. The 400,000 dead were represented by 400 lights placed around the reflecting pool. The bell at the Washington National Cathedral tolled 400 times.

Other cities around the U.S. planned tributes as well. The Empire State Building was lit in “heartbeat” red — the same lighting used last year as a show of support for emergency workers at the height of the virus surge in New York City. The red lights pulsed as a visual heartbeat. In Salt Lake City, the bells at the Utah Capitol were to ring 15 times in honor of the more than 1,500 lives lost to COVID-19 in the state.

The U.S. accounts for nearly 1 of every 5 virus deaths reported worldwide, far more than any other country despite its great wealth and medical resources.

The coronavirus would almost certainly have posed a grave crisis for any president given its rapid spread and power to kill, experts on public health and government said.

But Trump seemed to invest as much in battling public perceptions as he did in fighting the virus itself, repeatedly downplaying the threat and rejecting scientific expertise while fanning conflicts ignited by the outbreak.

As president he was singularly positioned to counsel Americans. Instead, he used his pulpit to spout theories — refuted by doctors — that taking unproven medicines or even injecting household disinfectant might save people from the virus.