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December is now the deadliest month of the COVID-19 pandemic in the U.S.

Since the spring, month by month, the country had held the death toll below the terrible peak of the early pandemic, according to data from the COVID Tracking Project at The Atlantic. April began with 4,332 dead and ended with 59,599 dead—an increase of 55,267. In May, states reported 41,181 deaths—a significant decrease, but still what had been the second-highest monthly toll. Since then, each month brought more than 19,000 deaths, with a smaller peak in August, at 30,239 deaths. In November, deaths rose once again, to 37,058.  

Each month added to the country’s tragedy, and December began with 259,697 dead since the pandemic’s beginning. On December 23, the total was 317,513. That puts the total deaths reported so far this month at 57,683—over April’s record, with another week left in the year, during which the country is likely to record more than 10,000 additional deaths.

This milestone comes one day after the CDC declared that 2020 will be the deadliest year in U.S. history—3.2 million projected deaths, a 15 percent jump over last year, the largest percentage increase since the flu pandemic of 1918 and World War I caused a 46 percent increase.

And hospitalizations, the most stable indicator of the pandemic’s reach and severity, are still increasing, though not as drastically as at the beginning of the month. In the Midwest, after a massive increase in October and November, hospitalizations have actually been declining at an encouraging rate—after peaking at 28,899 on December 1, the figure is now down to 23,229. In the Northeast, the recent growth in hospitalizations is slow.. In the past week, hundreds of thousands of vaccine doses have been administered. It is possible, though not certain, that this month will also mark a turning point in the pandemic—a peak of cases and hospitalizations to which the country never returns.

Read: The end of the pandemic is now in sight

But while the Midwest may be reining in the virus, the current upward trend in hospitalizations is being driven by the South and West, and even within those regions, by certain states. California is now largely sustaining the nationwide rise, and has reported shocking increases in cases and hospitalizations in Southern and Central California, which have been approaching their limit on intensive-care-unit beds in recent days. (Conditions are considerably better in the Bay Area and Northern California, as defined by the state for its regional stay-at-home orders.) Nevada has the highest hospitalization rate of any state right now, a seven-day average of 650 per million, followed by Arizona at 572 per million.

In the South, Texas now nearly matches the worst period of its summer surge. In July, the state hit a seven-day-average high of 10,887 people hospitalized and 232 dead each day; those numbers are now at 9,982 and 215. Just behind California in the seven-day average of new cases per million is Tennessee, whose health commissioner warned that a post-Christmas surge would “break our hospitals.”

But the deadliest month of a dark year brings some hope, even beyond the vaccines. Case rates are declining in the Midwest and Northeast. Nationwide, hospitalizations and deaths are still increasing, but the rate of increase has slowed. The COVID Tracking Project categorizes more states as “falling” or “staying the same” for both new cases and hospitalizations. The worst month will hopefully remain the worst of the pandemic as the nation looks to March, a year from when the pandemic began in earnest, for possible relief.