Alabama's top health official says the state has "literally shrunk." According to preliminary data, it saw 64,714 total deaths and 57,641 births in 2020.

The U.S. hit more than 4,000 deaths on Jan. 7, which also saw 274,703 new infections, according to Johns Hopkins University. The U.S. continues to lead the world in both cases and deaths.

Per capita deaths in the U.S. from COVID-19 and other causes are 85% higher than in countries like Germany and Israel. "The United States really has done remarkably badly," a study author says.

Early in the pandemic, most deaths occurred in large cities. But now, as COVID-19 spreads across the U.S., smaller communities are suffering many losses as well.