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Tokyo saw more deaths than usual in April, the month when coronavirus cases in the city peaked.

The hardest-hit city in the country, Tokyo saw 10,107 deaths from all causes in the month, according to data released Thursday by the Metropolitan Government. That’s almost 12 percent higher than the average of the previous four years for which data are available, and 7 percent higher than the same month in 2019.

The city officially reported just over 100 deaths from the coronavirus in April. The mortality data suggests there were around 1,000 more deaths in the month than average, though Tokyo has a growing population that increased by 0.6 percent, or 80,000 people, from last year to surpass 14 million for the first time. Deaths also increased in 2019 from the previous year by 6 percent.

Coronavirus cases in Tokyo rose significantly in April, when the capital began to see around 200 infections a day, leading the government to declare a national state of emergency. That succeeded in flattening the curve, leading to the emergency being lifted in the capital on May 25. An uptick in cases in Tokyo following that has led the city to issue its own Tokyo Alert warning to residents, which is now set to be lifted as early as Thursday.

A total of 311 have died from the disease to date. Another 256 are hospitalized as of Thursday, 22 of them in serious condition.

Japan has weathered the pandemic with far fewer deaths and confirmed infections that most other leading economies. President Donald Trump has questioned whether the U.S death count from the virus, which stands at about 113,000, had been overstated but health experts say the tally may actually be higher than that, using data such as overall morality figures.

Although Japan has had the fewest number of confirmed COVID-19 infections and related deaths of any Group of Seven leading nation, it has also taken a deliberate approach to limit testing for the virus. That’s raised questions about whether the outbreak may have been worse than reported. Unfounded claims that the nation suppressed the true number of cases in the early days of the outbreak have dogged authorities throughout the pandemic.

An antibody test by SoftBank Group on 40,000 employees and families and medical workers found 191 cases, for a positive test rate of 0.43 percent, with only eight of more than 19,000 workers at its stores having been in contact with the virus. It’s the largest test of its kind undertaken so far in Japan.

Excess mortality has been used as a method to grasp the true scale of the fatalities from the outbreak. The figure includes those who died without being tested for the virus as well as those who may have died of other causes but couldn’t seek treatment due to an overloaded medical system.

It also reflects the impact the pandemic has had on reducing deaths from other causes, such as traffic accidents and suicides, which have both dropped. Mortality data tracker Euromomo found “substantial” excess mortality in many countries in Europe during the pandemic.

The Tokyo data does not give details on the causes of death. The capital saw 33,106 deaths in the three months through March, 0.4 percent fewer than the average of the previous four years for the same period, while no excess mortality was seen in the first three months of the year outside of Tokyo. Nationwide data will be released later in June.

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