It didn’t have to be this way.

The United States has had nearly twice as many COVID-19 deaths as the next closest country after five months of failed national leadership, haphazard local policies on testing, tracing and reopening, and widespread public resistance to basic, simple precautions that could have saved lives.

The anticipated summer lull has instead become a summer surge, with record-setting numbers of new cases in California and elsewhere. (Remember when President Trump predicted confidently that warm weather would kill the virus?) And yet we still see mind-boggling resistance to change. Just a few days ago, in a astonishingly reckless move and with utter disregard for science or the health of our children, the Orange County Board of Education recommended that schools reopen without masks or distancing.

Would we act differently if more of us had lost someone, or if we cared about the risk we’re exposing healthcare workers to? Most who test positive end up recovering, which might be one reason for blase attitudes. But would we take the pandemic more seriously if we knew what it’s like to die a COVID-19 death?

We asked healthcare providers to describe what they see each day in emergency rooms and intensive care units, and the picture they paint is horrifyingly sad.

“We have people that are sitting in bed and they’re breathing like they’re running a marathon at full speed,” said Dr. Adupa Rao, a pulmonologist and critical care specialist at Keck Hospital of USC.

“They’re breathing so fast and so deep, they’re trying to catch their breath,” Rao said. “It’s almost like you’re watching a goldfish out of water, gasping to get air, and it can never get enough.”

And one of the most unfortunate things healthcare providers are seeing is that people are not getting better. That’s despite treatments that include high-dose oxygen, ventilators, lung-bypass machines, blood thinners to prevent clots that attack organs and cause great pain, and steroids to reduce inflammation in the lungs. In advanced stages, the sickest patients at least have the mercy of being sedated.

“I think the unspoken tragedy of this whole COVID experience has been the loss of humanity toward the end of someone’s life,” Rao said. “We used to have the ability to be with our loved ones when they were passing away. Now people are passing away in isolation.”

“We have to understand that we are at war here. We are dealing with an enemy that is microscopic, something we can’t see,” said Manny Khodadadi, an emergency room nurse at USC Verdugo Hills Hospital. “If we were in World War II we could see the airplanes coming, see the tanks, see the people running through the fields shooting at us. In this war we can’t see the enemy. It’s a surprise attack and the tools we have to fight this are our masks, properly worn masks, and keeping our hands clean.”

Death can come quickly, leaving loved ones in shock.

“Sadly, it’s the same face every time. It’s the face of denial,” Rao said. “The face of utter this-can’t-be-happening, The blank look of, ‘I know you’re telling me something, but it’s not registering.’”

It didn’t have to be this way.

Over a critical period beginning in mid-April, President Trump and his team convinced themselves that the outbreak was fading, that they had given state governments all the resources they needed to contain its remaining “embers” and that it was time to ease up on the lockdown.

In doing so, he was ignoring warnings that the numbers would continue to drop only if social distancing was kept in place, rushing instead to restart the economy and tend to his battered re-election hopes.

Even as a chorus of state officials and health experts warned that the pandemic was far from under control, Mr. Trump went, in a matter of days, from proclaiming that he alone had the authority to decide when the economy would reopen to pushing that responsibility onto the states. The government issued detailed reopening guidelines, but almost immediately, Mr. Trump began criticizing Democratic governors who did not “liberate” their states.

Mr. Trump’s bet that the crisis would fade away proved wrong. But an examination of the shift in April and its aftermath shows that the approach he embraced was not just a misjudgment. Instead, it was a deliberate strategy that he would stick doggedly to as evidence mounted that, in the absence of strong leadership from the White House, the virus would continue to infect and kill large numbers of Americans.

Trump and his top aides would openly disdain the scientific research into the disease and the advice of experts on how to contain it, seek to muzzle more authoritative voices like Dr. Anthony S. Fauci and continue to distort reality even as it became clear that his hopes for a rapid rebound in the economy was not materializing.

Mr. Trump’s bizarre public statements, his refusal to wear a mask and his pressure on states to get their economies going again left governors and other state officials scrambling to deal with a leadership vacuum.

Trump has tried to build a public case that the federal government had completed its job and unshackle the president from ownership of the pandemic and the lack of a cohesive response.

Soon, the president was regularly making nonsensical statements like, “If we stop testing right now, we’d have very few cases, if any.”

The real-world consequences of Mr. Trump’s abdication of responsibility rippled across the country.

Other nations had moved aggressively to employ an array of techniques that Mr. Trump never mobilized on a federal level, including national testing strategies and contact tracing to track down and isolate people who had interacted with newly diagnosed patients.

“These things were done in Germany, in Italy, in Greece, Vietnam, in Singapore, in New Zealand and in China,” said Andy Slavitt, a former federal health care official who had been advising the White House.

“They were not secret,” he said. “Not mysterious. And these were not all wealthy countries. They just took accountability for getting it done. But we did not do that here.”

Mr. Trump’s disdain for testing continues to affect the country. By the middle of June, lines stretched for blocks in Phoenix and in Austin, Texas. And getting results could take a week to 10 days, officials in Texas said — effectively inviting the virus to spread uncontrollably.

Add to that Trump’s disdain for wearing masks, and the virus has run rampant.

Now, Trump is trying to conceal the actual number of cases being reported, by having the reports go to the White House instead of the Centers for Disease Control. Trump also has prevented the head of the CDC from speaking to congress.

Trump owns this crisis. This is his legacy. This is what failed leadership looks like.