The confirmed number of coronavirus cases in the U.S. has reached 5 million, by far the highest in the world. That’s according to the tally kept by Johns Hopkins University.

Health officials believe the actual number is perhaps 10 times higher, or closer to 50 million, given testing limitations and the fact that as many as 40% of all those who are infected have no symptoms.

The bleak milestone was reached as new cases in the U.S. run at about 54,000 a day.

While that’s down from a peak of well over 70,000 in the second half of July, cases are rising in nearly 20 states, and deaths are climbing in most. Many Americans have resisted wearing masks and social distancing.