Spain's Covid-19 death toll could be nearly 60% higher than the official figure of 28,432, according to an investigation by El Pais newspaper.
The country's official death toll only includes people who were formally diagnosed with coronavirus, not those who were suspected of having the virus but never tested.
A lack of widespread testing, particularly in the early stages of the outbreak, means the official count could underestimate the death toll in Spain as in many other countries.
By counting Regional Statistics of all suspected and confirmed fatalities from the virus, El Pais estimates a total of 44,868 deaths. If accurate, Spain would have the second highest number of fatalities in Europe after Britain.
The Health Ministry said it followed all International protocols in accounting for Covid-19 deaths and stressed that the higher number of deaths was reflected in other official indicators.
“There is evidence that in all pandemics there is an increase in indirect deaths and this has also happened with the coronavirus pandemic,” said a Health Ministry Spokesperson.
The El Pais figure is roughly in line with figures from the National Epidemiology Centre and National Statistics Centre or INE, which register excess mortality by comparing deaths across the country with historical averages.
In June, the INE reported 43,945 more deaths in the first 21 weeks of 2020 than in the same period of 2019, but was unable to confirm how many could be attributed to the pandemic.