Updated at 10:15 p.m. ET
Four more people in the Seattle area have died after contracting COVID-19, health officials say, bringing the total in both Washington state and the U.S. to six. The state now has a total of 18 cases.
Three of the people who died were residents of King County, Wash., which now has 14 confirmed cases of the coronavirus that causes COVID-19. The fourth person had been living in Snohomish County, north of Seattle. That county has a total of four cases.
All six of the deaths occurred at the EvergreenHealth hospital in Kirkland. The deaths that were announced Monday include three women — two in their 80s and one in her 70s. The fourth patient was a man in his 40s, according to the Snohomish County Health District.
King County's health department had reported Washington state's first two deaths from the respiratory illness over the weekend. At least three of the people who died had been living at a nursing facility that is now suspected of being the site of America's first outbreak of the new coronavirus.
Dozens of other people have shown symptoms of COVID-19 at that facility, the Life Care Center of Kirkland. The nursing center northeast of Seattle says anyone with symptoms is being isolated under infection control protocols, but it notes that at this time of year, colds and flu-like symptoms are common.
Dr. Kathy Lofy, state health officer at the Washington State Department of Health, warns that it's possible new cases will appear in more counties.
"Unfortunately, we are now starting to find more COVID-19 cases in Washington that appear to be acquired locally," Lofy said. "We now know that the virus is actively spreading in some communities here in Washington."
Washington's public health lab now has the capacity to test about 200 potential cases a day, Lofy said, adding that the state agency is working to help more labs get ready to test for COVID-19. A lab at the University of Washington will begin testing for the virus on Tuesday, a move that Lofy said would "add tremendous capacity" for testing.
"A team of CDC officials is on the ground" in King County to help the local effort, according to the county's health department, Public Health — Seattle & King County.
"At this time, we are not recommending widespread school closures or cancellation of activities at schools," the agency said. "If there is a positive case at a school, we will be working [to] provide guidance."
There are currently at least 93 cases of the coronavirus illness in the U.S. — including 48 cases among people repatriated from China and from the Diamond Princess cruise ship — according to the Centers for Disease Control and Prevention.
Late Monday, Georgia reported two cases in the same household. One of the patients had traveled to Italy. Officials in the state said both patients from the Atlanta area had experienced only mild symptoms and were being isolated in their home.
Over the weekend, health officials reported the first confirmed COVID-19 cases in Florida, New York and Rhode Island.
"Florida has 2 presumptive positive #COVID19 cases," the Florida Department of Health said via Twitter. "One adult resident of Hillsborough County and one adult resident of Manatee County. Both individuals are isolated and being appropriately cared for."
The New York case involves a woman in her 30s who had recently traveled to Iran and is now isolated in her home. While she has symptoms of COVID-19, she is not in serious condition and "has been in a controlled situation since arriving to New York," Gov. Andrew Cuomo said in a statement.
In the Rhode Island case, the patient "is in their 40s and had traveled to Italy in mid-February," the Rhode Island Department of Health said. It added that the CDC is working to trace people who were on the patient's return flight to the United States.
The coronavirus illness is likely to continue to spread in the U.S., health officials say. In a sign of that, cases of "community spread" — among people with no history of travel to affected areas and no contact with people known to be infected — have now been reported in California, Washington state and Oregon.
Health officials expect more coronavirus cases to be reported in the U.S. as more labs across the country add the ability to test for the coronavirus that causes COVID-19.
The health departments in New York and Rhode Island had only recently gained the ability to test for the virus; for weeks, the CDC was the only U.S. agency capable of carrying out such tests. As more labs test for the virus, their results are being reported as presumptive, with the federal agency still relied on for a final confirmation.
To prevent the virus from spreading, experts recommend the same measures that limit any virus, from washing hands with soap and water for at least 20 seconds to coughing in elbows and avoiding handshakes. The CDC says it "does not recommend that people who are well wear a facemask to protect themselves from respiratory diseases, including COVID-19."
COVID-19's most common symptoms include fever, shortness of breath and a dry cough, the World Health Organization says. And in most cases, people don't develop a serious illness.
"Most patients (80%) experienced mild illness," the World Health Organization said in a recent update on the coronavirus. "Approximately 14% experienced severe disease and 5% were critically ill."
There are currently about 90,000 confirmed cases of the novel coronavirus in the world. Of that number, slightly more than half — nearly 45,400 people — have recovered from the virus. But more than 3,000 people have died.