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Italy’s death toll jumped Saturday by the highest number since April 21, after previously uncounted deaths outside hospitals were added in.

The 474 fatalities reported by the civil protection service took the Mediterranean country’s total since February to 28,710, second only to the United States.

But the toll included 282 uncounted deaths in April that Milan’s Lombardy region said it had reported to the civil protection service on Saturday.

The northern region recorded most of Italy’s initial deaths, and its toll now accounts for just under half of the country’s total.

Italy’s real number of