ROME — A new government report indicates there were 46,909 excess deaths in Italy in March and April compared to what would have been expected. The report says it would be accurate to attribute most of the deaths to the coronavirus.

Italy’s social security and welfare agency (INPS) concluded the official COVID-19 death toll reported by the civil protection department “isn’t very reliable” since it includes only those who tested positive for the virus, omitting those who died at home or in nursing homes without ever being tested.

By the end of April, Italy’s official COVID-19 death toll stood at 27,938. INPS said excess deaths at that point had reached 46,909 and said most of the 18,971 deaths making up the difference could be attributed to the pandemic.

The agency reached that conclusion by noting that the five Lombardy provinces with the most excess deaths were the same five provinces hardest hit by the virus. In addition, most of the excess deaths were among the elderly men who account for most COVID victims.

Italy was the first country in the West to be slammed by the virus and its official toll lags only that of the U.S. and Britain.