NEW YORK >> A president who downplayed the coronavirus threat, scorned masks and undercut scientists at every turn. Governors who resisted or rolled back containment measures amid public backlash. State lawmakers who used federal COVID-19 aid to plug budget holes instead of beefing up testing and contact tracing.

As a powerful new wave of infections sweeps the U.S. just ahead of Election Day, the nation’s handling of the nearly 8-month-old crisis has been marked by what health experts see as grave missteps, wasted time and squandered opportunities by leaders at all levels of government.

The result: The country could be looking at a terrible winter.

“The inconsistency of the response is what’s been so frustrating,” said Dr. Irwin Redlener of the National Center for Disaster Preparedness at Columbia University. “If we had just been disciplined about employing all these public health methods early and aggressively, we would not be in the situation we are in now.”

Though Redlener sees some of the new wave as inevitable, he estimates at least 130,000 of the nation’s more than 227,000 deaths could have been avoided had the country more widely embraced masks and social distancing.

Even if a Chinese-style lockdown wasn’t possible, Redlener said, a more modest approach like Canada’s, with a strong central message of caution in reopening and widespread mask-wearing and distancing, would have saved lives over the state-by-state and widely partisan approach.

Now the U.S. is seeing cases spike, especially in the Midwest and the Plains, with the country posting a record-high number of new infections last week of nearly a half-million.

Dr. Anthony Fauci, the nation’s top infectious-disease expert, likewise pointed to states’ varied responses to reopening for the rocketing case numbers.

“It was like a free-for-all,” Fauci said in an online forum Wednesday.

The handling of the crisis has emerged as a central issue in the race between President Donald Trump and Democrat Joe Biden. Trump has mocked Biden’s mask-wearing and repeatedly assured the country that it is “rounding the corner” on the outbreak. Biden has hammered the president for downplaying the virus and undermining scientists.

Governors in many of the hard-hit states have been under fierce political pressure that has made it difficult to enact the kind of measures public health officials say are necessary to stop the spread of the virus and keep hospitals from being overwhelmed.

In the early days of the outbreak, governors were nearly universal in enacting aggressive restrictions to try to flatten the curve. But they quickly faced backlash from residents who were irate over the economic devastation and what they saw as an infringement on their constitutional freedoms.

At the same time, many states were snapping up millions of doses of hydroxychloroquine, the anti-malaria drug that Trump touted as a remedy but was later dropped by the Food and Drug Administration as a COVID-19 treatment. Utah alone spent $800,000 to build up its stockpile of the drug.

States also started receiving a flood of federal dollars from the CARES Act, in part to help local governments deal with COVID-19. But many states have been criticized for spending the money on efforts completely unrelated to public health, like the $16 million North Dakota is doling out to support fracking at a time the state has become one of the worst hot spots for the virus. Iowa has spent millions on information technology projects in state agencies.

In Utah, state epidemiologist Angela Dunn called for restrictions to be reinstated in June to avoid overwhelming hospitals, warning: “This might be our last chance for course correction.” Republican Gov. Gary Herbert did not heed the advice and refused to impose a statewide mask requirement.

Utah’s hospitals are now treating more COVID-19 patients than ever before even as the state remains open for business, most high school students are attending class in person, and football and other sports have gone on.

“This response to this third wave has been very half-hearted,” said Dr. Andrew Pavia, chief of pediatric infectious disease at University of Utah Health in Salt Lake City. “Everyone in health care from the ED tech to the ICU doc is just really going: ‘C’mon, people, help us out here.’ The frustration, the fatigue, the disappointment is really palpable.”

In neighboring Idaho, Republican Gov. Brad Little has also resisted a mask mandate even as hospitals are in a crisis and having to airlift patients to Seattle and other locations.

As Little added small restrictions this week such as limits on crowd sizes, his lieutenant governor and a few GOP lawmakers released a video denouncing such measures as unconstitutional.

“This pandemic has been more politicized than any pandemic I’ve ever experienced or worked on or studied, and that’s a lot of pandemics,” said Dr. Howard Markel, a public health historian at the University of Michigan.

While some of the blame goes to local leaders and their supporters, Markel said a large share belongs to Trump and other administration officials who have not supported governors taking tougher steps, have undercut and insulted infectious-disease experts, and have themselves refused to wear masks.

“That sets an example, whether you recognize it or not,” he said.

Redlener, too, questioned how it was that Trump “didn’t understand how many people followed his advice” and said the president has “blood on his hands.”

Cooler weather driving more people indoors where the virus is more easily spread are now combining with fatigue and anger over virus restrictions for a dangerous new stage.

“When you put those three together, we shouldn’t be surprised what we’re seeing,” said Michael Osterholm, a University of Minnesota expert on infectious diseases and pandemic preparations.

Some of the same factors are playing out in Europe, which is also seeing a surge.

“We lost control of the epidemic,” Dr. Eric Caumes, head of infectious and tropical diseases at Paris’ Pitie-Salpetriere Hospital, told broadcaster Franceinfo. Though infections rose in France over the summer, the government didn’t impose additional restrictions, encouraging people to return to work and school.

Italy, the one-time European epicenter of the pandemic, has seen days of protests over new restrictions that have forced bars and restaurants to close at 6 p.m., shuttered theaters, gyms and pools, and required high school students to transition to 75% distance learning.

Italy is averaging over 20,000 cases a day, and hospital COVID-19 wards are filling up.

At Rome’s Gemelli hospital, few beds remain in the intensive care unit, while one of the country’s leading virologists, Andrea Crisanti, has blistered the government’s response to the surge. He said he submitted a proposal Aug. 20 calling for ramped-up testing and never got a response.

“Three months later they’re passing new decrees,” he wrote in an essay published by the Lettera 150 online think tank. “They continue in the error of not asking themselves how, once the contagion levels are reduced via progressively more restrictive measures, they’re going to keep them low.”

In Britain, the government has tried to strike a balance between saving lives and protecting the economy ̶ and has been widely accused of getting it wrong on both fronts. Britain has Europe’s highest coronavirus death toll, at more than 45,000, and one of its deepest economic slumps.

After locking down the country in March, Prime Minister Boris Johnson eased restrictions in June. By August, the government encouraged people back into restaurants with an “Eat Out to Help Out” discount scheme.

When a new surge came, the government clamped down again.