As the coronavirus death toll climbs in Michigan — 540 as of Saturday — another grim number will never be known: The dead who go uncounted as casualties of the worst pandemic in a century.

“I don’t know if our fatalities would be twice as many or 10 times as high, and we won’t know until we have ready access to tests,” said Dr. Russell Faust, medical director of Oakland County’s health division.

Because of a nationwide shortage of tests, there are few efforts to test the dead for coronavirus, especially for those who are elderly or have underlying conditions.

Oakland County is an exception, though, and has tested several bodies to avoid having to quarantine emergency workers who are called to help as people are dying.

“The issue is there are a number of people who die ... outside of hospitals. EMS shows up and they do [cardiopulmonary resuscitation,] and the automatic assumption is that [the person’s] age or comorbidity — maybe emphysema — pushed them over the edge,” Faust said.

Without knowing if they’d been exposed to COVID-19, emergency crews would have to be quarantined for 14 days — something small towns can’t afford, Faust said.

Faust declined to say how many bodies had been tested, but he said a “handful” of those cases returned positive results.

“Had we not performed those tests, who would not have known they were COVID cases,” Faust said.

Tests remain at a premium in Michigan, whose hospitals and private labs have tested nearly 38,000 people for the virus as of Saturday. That’s roughly the same as Ohio and far fewer than Illinois, but Michigan has far more cases than its neighbors.

But nasal swab tests that detect the virus in mucus and saliva are increasing, and new tests have rolled out, including those that test the blood for antibodies produced by a COVID-19 infection.

In Detroit, infectious disease researcher Dr. Teena Chopra wants doctors at Detroit Medical Center to begin testing remains of patients whose deaths are suspected to be linked to COVID-19.

Doing so could bring the true impact of the virus into focus for the city, which officially had nearly 4,000 cases and 131 deaths as of Saturday.

Patients with coronavirus symptoms often die awaiting tests or results. Others died after tests indicate they were not infected with COVID-19, even though their symptoms matched the virus, said Chopra, an infectious disease researcher at Wayne State University who also leads infection control efforts at the DMC.

The reasons for the “false negatives” are unclear, she said.

“It may be that when we swab in [a certain stage of illness,] the virus is in a different place in its life cycle and is not detected. That’s a hypothesis only,” Chopra said.