The coronavirus death count in New York City, already unfathomable, is expected to surge in the coming days as officials begin including people who have been dropping dead at home without an official diagnosis.

Emergency Medical Service data first reported by Gothamist suggests the undercount of individuals who have likely died from the virus is massive. On Tuesday alone, 256 people were pronounced dead at home across the five boroughs. Until this month, about 25 people in New York City were found dead in their homes on a typical day, suggesting that most of Tuesday’s calls were related to the outbreak that has already killed over 5,400 people across the state and infected 140,386 more.

According to New York City Fire Department data obtained by The Daily Beast, first responders have reported 2,192 “dead-on-arrival” calls over the last two weeks. On average, the department handled about 453 of those calls over the same period last year.

That data also showed that the number of cardiac or respiratory arrest calls has exploded, from 20 to 30 a day at the end of March and the beginning of April in 2019, to 322 on one day in April in 2020—with more than 100 calls every day since March 28. While 30 to 50 percent of those calls ended in a death in 2019, more than 50 percent of those calls have ended in a death every day since March 22 this year, with the percentage steadily rising to 75 percent as of April 5.

“Every person with a lab-confirmed COVID-19 diagnosis is counted in the number of fatalities, whether they passed away at home or in a hospital,” a spokesperson for the NYC Department of Health and Mental Hygiene said in a statement to The Daily Beast. “The Office of the Chief Medical Examiner (OCME) and the NYC Health Department are working together to include into their reports deaths that may be linked to COVID but not lab-confirmed that occur at home.”

They did not specify when the city will begin reporting that data, but the decision to include the possible virus-related fatalities comes after Gothamist’s report about at-home deaths that were likely related to the disease and not included in the city’s reports.

While New York City reported over 400 coronavirus deaths in less than 24 hours on Wednesday, that number did not include those who died in non-hospital settings without a formal lab diagnosis.

While initially refusing to discuss his administration’s reporting system, Mayor Bill de Blasio on Wednesday agreed the city should include home deaths to give an accurate account of the tragedy ravaging the city. He acknowledged that a “vast majority” of deaths at home are “coronavirus related.”

“The blunt truth is coronavirus is driving these very tragic deaths,” de Blasio said on CNN. “We’re talking about something like 100, 200 people per day. Don’t take this disease ever lightly because the real death toll is even higher.”

The mayor added that New York—currently the epicenter of the pandemic in the United States—has seen more deaths in the “last couple of days” than “the number of people who died in the World Trade Center.”

State and city officials are still struggling to track the number of coronavirus cases, as officials believe there are a number of individuals infected with the virus who have not, or cannot, be tested.

One emergency room doctor told The Daily Beast that his hospital is “aggressively sending people home.”

“Being in the hospital is not going to change their course of illness,” the physician said, indicating the hard choices medical professionals face during this pandemic.

De Blasio said that he was hopeful the virus was starting to slow after seeing indications that the city’s overwhelmed hospital system was seeing fewer admissions—until he learned that hundreds of people are dying in their homes without seeking medical care.

“We never saw anything like this in normal times,” he added. “We have to acknowledge that, and say this is further evidence of just how destructive this disease is.”

On Wednesday, New York Gov. Andrew Cuomo said that 779 more people had died across the state, marking the second day in a row that the Empire State saw an increase in deaths related to the pandemic.

“If the hospitalization rate keeps decreasing the way it is now, then the system should stabilize these next couple of weeks, which will minimize the need for an overflow that we have built into the system,” Cuomo said, adding that “the number of deaths, as a matter of fact, will continue to rise as those hospitalized for a longer period of time pass away.”

The death toll has already overwhelmed city hospitals and morgues. To deal with the flood of bodies, 45 refrigerated trucks have been set up across the five boroughs, some of which are already full, and a temporary morgue has been erected outside Bellevue Hospital in Midtown Manhattan. The Federal Emergency Management Agency said last week that New York will also receive 250 ambulances, about 500 EMTs and paramedics, and 85 more refrigerated trucks to help with the overload.

On Monday, de Blasio, who’d previously refused to detail any plans for mass burials, said that the city has contingency plans in place if needed to bury COVID-19 victims in temporary plots on Hart Island, which has been used as New York’s potter’s field for 150 years, until morgues and cemeteries can handle the influx.

“We’re going to try and treat every family with dignity, respect, religious needs of those who are devout, and the focus right now is to try to get through this crisis and obviously also put all of our energy and resources into saving those we can save,” de Blasio said. “That’s how we’re going to go about it. We’ll have the capacity for temporary burials. That’s all I’m going to say.”