New York City may still be massively undercounting deaths associated with the novel coronavirus, according to new data from the Centers for Disease Control and Prevention. The federal data out Monday states that while the New York City Department of Health and Mental Hygiene has reported 13,831 deaths and 5,048 probable COVID-19-associated deaths as of May 2, it does not include deaths among residents who did not have access to testing, those who tested falsely negative, those who got infected after testing negative, or a health-care provider who did not see the virus as the cause of death. Between March 11 and May 2, the CDC reported that 5,293—or 22 percent of the total number of all deaths in the city—of the city’s 24,172 COVID-19 death toll were “excess deaths” that were not identified outright.

“The 5,293 excess deaths not identified as confirmed or probable COVID-19-associated deaths might have been directly or indirectly attributable to the pandemic,” the CDC said in its Morbidity and Mortality Weekly Report on Monday. “The percentages of these excess deaths that occurred in persons infected with SARS-CoV-2 or resulted from indirect impacts of the pandemic are unknown and require further investigation.”