Trump and his son-in-law didn't want to have federal responses to covid. At first it mostly hurt NYC and other places with international airports. NYC hates Trump and Trump hates NYC. Before covid, Trump also tried to defund a lot of public health efforts and Congress had to restore some of the funding. When covid spread to rural Republican regions the damage had already been done (even though Trump, the governors of Florida and Texas, Fox TV talking heads, etc. are all vaccinated).
Excess deaths. The true death toll is much greater than officially diagnosed deaths. In NYC, thousands died in their apartments without diagnoses. Florida and other states have renamed some covid deaths as "pneumonia" which conveniently happed to spike upward in March 2020. One study estimated a couple months ago the true toll in the USA was about a million, then. It's been acknowledged by mainstream media as credible but they rarely remind viewers / readers of that.
Deaths are relatively constant from year to year. The spike upward from covid suggests an anomaly and it can hint at the real figure. Especially at the start testing was not available (thanks to Trump administration interference).
I'm not a fan of The Economist magazine, definitely not my politics, but they are well informed if too establishment for our tastes. Several months ago they estimated 12 million was the global death toll. In India, there has been a lot of reporting that the official toll is woefully undercounted. Lots of rural places had minimal public health tracking and the toll is embarrassing for the Modi government. Three to four million might be the toll there, but precision is unlikely.
A couple weeks ago The Guardian estimated 16 million may now be correct. I'm not attached to that or any other figure, except to say the official numbers are clearly undercounts. Some places - like California - may be closer to reality, but others are ridiculously distant.
This reminds me of Chernobyl, where the Russian government says 4,000 died but the regional medical literature suggests a million may be a better figure (over the past three and a half decades). The late Dr. John Gofman, one of the world's leading experts on radiation and health, co-founder of the Livermore biomedical department, and kicked out of Livermore for warning of the danger of nuclear power reactors, estimated a million cancers would be caused by Chernobyl fallout, half of them fatal. I wish he had been wrong.