PITTSBORO, N.C. (AP) — Testing confirmed just over 50 additional cases of COVID-19 at a North Carolina nursing home with a coronavirus outbreak, health officials said Sunday, as the number of cases around the state continued to rise.

All residents and staff of The Laurels of Chatham were tested for COVID-19 after six people associated with the facility had previously tested positive, Chatham County said in a news release Sunday. The results showed an additional 51 individuals had the virus, bringing the total to 57.

“We anticipated that universal testing at the facility would reveal more positive cases, and we remain concerned for the staff, residents and their families affected by this outbreak,” Chatham County Public Health Director Layton Long said in a statement. “While COVID-19 is highly infectious, especially in congregate living facilities, we remain focused on limiting the spread of the virus.”

Data released Sunday by the N.C. Department of Health and Human Services showed an increase in confirmed cases to just over 4,500, up by about 200 from the day before. The death toll increased by one to 81.

Both figures are almost certainly an undercount due to a lack of widespread testing and the likelihood that many people without symptoms could be spreading the highly contagious virus.

State data show there are 28 ongoing outbreaks in nursing homes across the state. An outbreak is defined as two or more laboratory confirmed cases.

Among those outbreaks is one at PruittHealth-Carolina Point in Durham, where a fourth person died over the weekend, The News & Observer reported.

In Concord, at least 14 people in a skilled nursing and rehabilitation center have tested positive, with around 200 tests still pending, health officials told local media.

Nationwide, the U.S. has over a half million confirmed cases, with deaths surpassing 21,000 on Sunday, according to a tally by Johns Hopkins University.