As of this writing, according to Worldometers, the United States has recorded just over 10,400 deaths from COVID-19, the respiratory illness caused by the novel coronavirus, with over 356,000 confirmed cases.
But lurking behind those numbers may be an even-larger death toll, public-health experts warn, thanks to limited testing resources, lack of official protocols from one jurisdiction to the next, and in some cases, possible deliberate obfuscation by health authorities.
What's more, it can take months or even years after a pandemic for health authorities to get something approaching an accurate tally of the number of people killed by the disease. And the information they rely on can be incomplete, haphazard, or downright false.
"We definitely think there are deaths that we have not accounted for," said Jennifer Nuzzo, a senior scholar at the Johns Hopkins University Center for Health Security.
In some areas, coroners believe they may have had people in their jurisdictions die of COVID-19 as early as February, long before the extent and severity of the pandemic in the United States was beginning to be understood. Those deaths were chalked up to pneumonia or seasonal flu.
Geraldine Ménard, the chief of general internal medicine at Tulane Medical Center in New Orleans, said that earlier this year she had an exceptionally large number of patients with pneumonia.
"I remember thinking it was weird. I'm sure some of those patients did have [COVID-19]. But no one knew back then," she said.
Coroners, funeral directors, and other people tasked with handling the bodies of the deceased say they've been bedeviled by lack of testing.
In Virginia, for example, a funeral director says that three of the bodies that went through her facility likely died of COVID-19, even though only one such person had the disease listed as the official cause of death.
Similarly, in New York City, paramedics say that they've encountered the bodies of people who died at home, having shown "telltale" signs of COVID-19, but who were never tested.
In California, a woman says that her deceased husband began getting sick in March, with symptoms that would later come to be known as signs of COVID-19, but was sent home with cough syrup and told to rest. After he died, the woman paid for a private autopsy and later found out that her husband had indeed died of COVID-19.
Meanwhile, the official number of coronavirus deaths in the United States, once the pandemic is over, won't be known until 2021, when the federal government releases its annual list of the country's leading causes of death.