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The spread of the coronavirus in the U.S. may be worse than was previously known, Fox News reports.

There may have been as many as 53 million coronavirus cases in the U.S. by the end of September, according to a new Centers for Disease Control and Prevention estimate. That would be nearly eight times as many cases as had been reported by that time.

Even now, the CDC is reporting fewer than 12.5 million confirmed cases in the U.S. since January. And COVID-19 has killed more than 259,000 Americans, according to the federal health agency.

The CDC estimated that only about 45 million of the 53 million infected people may have been sick from the virus, and only 2.4 million were hospitalized.

Health officials have warned that people may carry and spread the coronavirus while showing only minor symptoms or even no symptoms at all.

The number of new coronavirus cases being diagnosed in the U.S. has been steadily rising since early October, CDC data show. The seven-day average number of new daily cases has hit a record high every day since Oct. 18 and has passed an average of 171,000 cases per day this week.

Many states have added new restrictions in response to rising cases.