The pandemic has killed about 230,000 people in the country and destroyed millions of jobs, defining the last year of Donald Trump's presidency and becoming a rallying cry for his Democratic opponent, Joe Biden.
Here are stories from a cross-section of Americans - voters and officials - for whom COVID-19 is the driving force in Tuesday's election. Their stories underscore why the disease casts a long shadow over the 2020 U.S. presidential election.
SONIKA RANDEV, 36, NEW YORK, NEW YORK
Dr. Sonika Randev has had a dark year. In March, when she was a medical resident at New York's Metropolitan Hospital, Randev contracted COVID-19, spending three weeks battling fever, brain fog, body aches, a loss of taste and smell and what she termed a "bone-chilling cold."
Afterward, figuring she was immune to the coronavirus, Randev volunteered to care for the hospital's sickest COVID patients, watching many die.
"My unit became an end-of-life unit," she said. "We were basically waiting for patients to pass away or go to hospice."
Melancholy quickly set in.
New York's nightly ritual - in which people clapped and cheered for healthcare workers from their windows - stopped buoying Randev's spirits. She found herself shutting her windows to the sound, which only reminded her of "the sea of misery" the city had become. When friends and colleagues took to drowning their sorrows, Randev found drinking only made her feel worse, so she stopped.
She felt powerless.
Now, as she gets back on her feet, she said she is trying to take some of that power back - by voting for Democratic candidate Joe Biden.
"Being able to go to the polls and finally exert some control just by casting a vote, I think that's something powerful," Randev said.
Recalling how doctors were forced to reuse the same masks and gowns for days, Randev said Trump should have done more to boost supply of protective gear. She also feels Trump unfairly left state governments to fight the pandemic on their own, then "turned around and criticized" those who imposed strict lockdowns.
In a statement to Reuters in October, a Trump campaign spokeswoman said the president has faced the pandemic "head on," citing his restrictions on travel from China, adding that "he will not stop until we’ve beaten the coronavirus."
But Randev does not believe Trump would do any better in a second term. "He is who he is," she said. "He's never going to change."
CHRIS HOLLINS, 34, HOUSTON, TEXAS
It has been less than six months since Chris Hollins was thrust into the job of running elections in Harris County, Texas - the largest county in a historically conservative state that Biden has a chance of flipping https://www.reuters.com/article/idUSKBN27D1BR.
Already, the new county clerk has battled Texas' Republican governor and attorney general on voting rights access, underscoring the bitter battle for votes in the second-largest U.S. state.
Hollins launched drive-through voting and kept some early-voting locations open 24/7, largely for the convenience of the county's large numbers of medical and oil industry workers, who often work odd hours.
A Republican state representative sued Hollins for the county's use of drive-through voting in both the Texas Supreme Court, which rejected the suit on Sunday, and in federal court, where a judge on Monday ruled against it as well.
Hollins opposed the governor's order limiting counties to one drop-off location for absentee ballots.
As a public appointee, Hollins cannot publicly endorse a candidate, though he is a Democrat.
Prodded partly by the COVID-19 pandemic, county commissioners boosted the election budget seven fold from 2016 levels to $27.7 million. Hollins used that money to triple the county's early-voting locations to 120.
Plastic coverings that Hollins' office bought for voters' fingers - the county uses touchscreen voting terminals - have gone viral on social media, with some playfully describing them as "finger condoms."
Hollins said his job is "to make sure every voter in Harris County has an opportunity to cast their ballots and can do so safely."
He and the county have been largely been successful: By Oct. 29, more county voters had cast early ballots than in the entire 2016 election.
GLORIA "LEE" SNOVER, 52, BETHLEHEM TOWNSHIP, PENNSYLVANIA
Her father died of it. Her mother spent eight days in the ICU; her husband, 17 days. Five others in her family contracted it, including herself. For Lee Snover, COVID-19 was more than a news story. It was a family crisis.
Still, Snover goes to the polls more determined than ever to reelect Trump. The chair of the Republican Committee of Northampton County, Pennsylvania - a crucial swing district Trump won in 2016 - said that despite widespread criticism of the president's handling of the disease, it never occurred to her to blame him for the pandemic that ravaged her family's health and hamstrung its construction business.
Snover hit emotional rock-bottom the day of her father's funeral in April, when, battling her own mild COVID diagnosis, she was forced to stay home. The same day, her husband entered the hospital with worsening symptoms. Her mother would soon join. The virus would ensnare eight family members total.
COVID has infected 5,700 Northampton residents and killed 315, according to Pennsylvania Department of Health data. That is 103 deaths per 100,000 residents, well above the U.S. average.
Snover opposes economic shutdowns, equating them to letting the virus win, even though doctors have said social distancing is the best way to beat COVID. "We see life as you gotta survive, you gotta win. We're not victims. When something hits us, we beat it back and win," she said.
With Trump behind in opinion polls, Snover says her last vote as a party official carries special weight.
"All this about women's rights, and 'Women are so mighty,' but I look at them on Facebook and all they talk about is fear," she said. "Putting my finger on that machine button and casting that ballot -- that's a victory against COVID."
GARY SIMS, 52, RALEIGH, North Carolina
COVID-19 has caused Gary Sims to lose sleep, weight and time with his daughters - and he hasn't even had the disease.
As director of elections for Wake County, North Carolina, Sims must stage a vote in the most populous county of a crucial battleground state, in the midst of a public health nightmare. The stress is eating him alive, he said.
From online poll worker training to mailing out hundreds of thousands of absentee ballots, "everything has been unprecedented," Sims said.
He has had to reconfigure his agency's 76,000-square-foot headquarters so that it can process five times its usual haul of mail ballots while keeping workers much farther apart than normal.
He has seen his two grown daughters just once this year, even though they live close by - for their own protection, he said, since he can't work from home and is more exposed to the virus.
No stranger to pressure, the U.S. military veteran saw combat in two foreign conflicts. He worries political tensions could lead to confrontation, or that poll workers - many of whom are first-timers this year - could grow overwhelmed by the added burdens of enforcing social distancing and contending with a high turnout of partisan poll observers.
Sims' blood pressure has spiked. Struggling to stomach solid foods, he's subsisted mostly on protein shakes. He has lost 40 pounds (18 kg) in two months. "Did I need to lose the weight?" he said. "Yeah. Did I plan to lose it like that? No."
As an official in charge of fair elections, Sims cannot reveal his own voting plans, but said he is an independent who votes with his daughters in mind.
"They're getting their future started," he said. "So my vote is for what's best for them."
ISRAEL SUAREZ, 76, FORT MYERS, FLORIDA
Israel Suarez nearly died after he contracted COVID-19 in August, but he did not let that stop him from voting.
Suarez spent 10 days in a Florida hospital and said he was convinced he was going to die. After the ordeal, the lifelong Republican and native of Puerto Rico voted early in October, an act he called a civic duty.
"The coronavirus shouldn't stop anyone from exercising their moral and social responsibility to vote," said Suarez, who founded the Nations Association Charities in Fort Myers, Florida, a nonprofit that runs youth groups and other community outreach programs.
Until now, Suarez has affiliated with Republican causes and politics. But this year, he's supporting Biden.
"I'm so fed up with this man, Mr. Trump, because I almost died," Suarez said. "I almost lost my life because of him."
Suarez said Trump has divided and confused the country by failing to lead it successfully through the pandemic.Suarez added that he persuaded his wife and daughter to vote for Biden, too. Biden "is a moral man," Suarez said, "no matter what people think of him."