The Philippines is known for training nurses and exporting them to all corners of the world, but now the nation finds itself shorthanded just as its number of coronavirus infections and deaths skyrocket.

The islands’ death toll from COVID-19 has surged nearly fivefold since April 1 to 462, and the confirmed cases have tripled to 6,981. That’s despite President Rodrigo Duterte imposing a lockdown on the main island of Luzon until at least April 30.

With more Filipinos becoming sick, the consequences of a medical brain drain are weighing on the health care industry. There is an estimated shortage of 23,000 nurses nationwide, according to the Private Hospitals Association of the Philippines Inc. The situation is so severe that most Filipinos die without even seeing a medical professional, a lawmaker said. Meanwhile, about 150,000 Filipino nurses currently work in the U.S. alone.