Thousands of people may have died of Covid-19 without ever being diagnosed with the virus, according to new data for England and Wales.
The Office for National Statistics (ONS) says that between March 7 and May 1 this year there were 46,380 more deaths than in an average year - but almost 13,000 of these deaths were not attributed to coronavirus.
The ONS concludes that many cases may have been missed - the vast majority were in care homes.
ITV News has spoken to several families who say their relatives passed away with symptoms of Covid-19, without the virus ever being recorded as a cause of death.
In April, 89 year-old Isobel Hick died at her care home in Scarborough, after several other residents had been diagnosed with Covid-19.
But because she hadn’t been tested for the virus, her death certificate simply records “dementia” as the cause of death.
Her great niece Kathryn Smith says she believes her aunt was displaying symptoms of coronavirus before she died.
Before Isobel became ill, two residents at her home had tested positive for coronavirus at hospital ahead of being returned to the facility.
"The likelihood of her having contracted Covid was very high, and I believe that the likelihood is that she did die with Covid," she said.
"Of course they were never able to access a test, so we don't know that for sure."
Kathryn says a lack of testing and personal protective equipment (PPE) at care homes means when residents arrive with coronavirus, the facilities quickly become an "incubator" for the illness, putting those inside at "much greater risk".
As chief executive of the Social Care Institute of Excellence, Kathryn said her concern is that other deaths with Covid-19 may have gone unrecorded.
"The fact that [coronavirus] wasn't recorded on the death certificate in itself doesn't change anything, but it doesn't recognise that that was probably the issue.
"If we don't recognise that that's an issue, then we're not going to resolve the issue and we're not going to prevent that from being for other people and for more people."
Had testing and PPE been more readily available, she says, "perhaps my aunt might not have died".
Among the excess deaths not attributed to Covid-19, dementia and Alzheimer’s feature most frequently, recorded as the main causes of death in more than 5,000 cases.
However, the ONS says it’s likely that many of these people did in fact die with Covid-19, partly due to the fact it is often difficult to diagnose older people with complicated health issues, but also because care home residents have not been tested.
At Springfields care home in Ilford, 24 people have died since the beginning of the pandemic - a quarter of all their residents. But just six of them had been tested and confirmed as having Covid-19.
The manager only received testing kits for the residents yesterday, after requesting them for six weeks.
Jennifer Johnson said for that time no tests have been carried out at the home, leaving residents and families in the dark about whether coronavirus exists on the premises.
"Obviously the residents are asking questions every day, the families want to know, and I haven't got the answers."
Another complicating factor is that GPs are less able to visit homes during the pandemic, liaising with carers via phone and video conference instead.
This makes diagnosing the cause of death more difficult.
One GP, Professor Martin Marshall, told ITV News: "It is more difficult to make a diagnosis when someone has dementia, particularly severe dementia, just because of the challenges with communication.
"Some of the more subtle signs of Covid are more difficult to pick up when somebody has dementia, so it can be more of a challenge."
As testing has been expanded, the proportion of excess deaths attributed to Covid-19 has risen. But thousands will forever remain unrecorded, with the true death toll from this virus likely to only ever remain an estimate.
Reporting on the crisis in care homes from Paul Brand: