Around the globe, the novel coronavirus pandemic has killed 23,000 people. Some of the hardest hit countries, like Italy and China, may be showing signs that the outbreak is slowing down, although resurgences are always possible. Unfortunately, the figures are only growing in the U.S., where there are at least 80,000 confirmed cases. On Thursday, the American death toll from COVID-19 hit 1,136, according to Johns Hopkins, and the World Health Organization is now warning that the U.S. is likely to become the new epicenter for the pandemic.

There's even more bad news: that official U.S. death toll is likely incomplete and undercounted. That's according to doctors and nurses who spoke to BuzzFeed News, many of whom say that the death tolls from counties they work in don't reflect the numbers coming out of individual hospitals. Some of that is the result of delays after filing or other flaws in the reporting process—in other cases though, many of the health care workers worry that people aren't being tested for coronavirus either before or after they die.

One ER doctor who works in multiple California hospital told BuzzFeed News that "those medical records aren't being audited by anyone at the state and local level currently and some people aren’t even testing those people who are dead." He added, "We just don't know. The numbers are grossly underreported. I know for a fact that we’ve had three deaths in one county where only one is listed on the website."

According to BuzzFeed News, there are likely three major reasons for the discrepancies: "a lack of tests and protective equipment means not everyone who contracted or dies of COVID-19 is diagnosed; overwhelmed hospitals may be running behind on reporting the numbers to state and county authorities; and some hospitals reporting their totals on a daily basis say they’re not being reflected promptly in county and state reports."

One of the reasons the outbreak is as bad as it is in the U.S. may be that the Trump administration bungled the early response and the president himself was more interested in setting up travel bans than in preventing the disease from spreading domestically. Some state officials are operating under a similar strategy, putting political posturing ahead of public health. This week, Mississippi governor Tate Reeve said he refused to implement a "shelter in place" order, which would require people to stay home unless absolutely necessary, because, "Mississippi's never going to be China."

The discrepancies with official death tolls may not be the result of such willful mismanagement, but the overall effect is similar—if officials don't know the full scope of the problem, then they can't effectively respond to it. And operating in the dark has not been a sound strategy so far. As of Thursday afternoon, the U.S. has the highest number of coronavirus cases in the world, 81,321 total and climbing, a significant achievement even with the nationwide shortage of testing.