The United States has surpassed yet another devastating milestone in the ongoing COVID-19 pandemic: 250,000 Americans have now died from the disease. That’s more than twice the number of U.S. service members killed in World War I.

Coronavirus case numbers are exploding across the country at the beginning of what is shaping up to be a difficult winter of illness in America.

In the past week, 36 states and one territory set records for daily new confirmed cases, and 12 states saw a day with the highest number of new deaths.

The virus is currently hitting the middle of the country especially hard, with the highest number of new cases per capita in North and South Dakota, Minnesota, Wyoming, Wisconsin, Iowa, Nebraska, and Montana. More than 76,000 people are currently hospitalized with the virus, according to the COVID Tracking Project.

With cases spiking, more deaths will follow — but advances in medicine in recent months have improved the odds of surviving COVID-19.