Three commuters, center, wear masks as they walk through the World Trade Center transportation hub, Wednesday, March 4, 2020, in New York. (AP Photo/Mark Lennihan)

Three commuters, center, wear masks as they walk through the World Trade Center transportation hub, Wednesday, March 4, 2020, in New York. (AP Photo/Mark Lennihan)

SEATTLE (AP) — The U.S. death toll from the coronavirus climbed to 11 on Wednesday with a patient succumbing in California — the first reported fatality outside Washington state — as federal authorities announced an investigation of the Seattle-area nursing home where most of the victims were stricken.

Officials in California’s Placer County, near Sacramento, said an elderly person who tested positive after returning from a San Francisco-to-Mexico cruise had died . The victim had underlying health problems, authorities said.

California Gov. Gavin Newsom declared a statewide emergency. Washington and Florida had already declared emergencies.

Washington also announced another death, bringing its total to 10. Most of those who died were residents of Life Care Center, a nursing home in Kirkland, a suburb east of Seattle. At least 39 cases have been reported in the Seattle area, where researchers say the virus may have been circulating undetected for weeks.

ADVERTISEMENT

Seema Verma, head of the federal Centers for Medicare and Medicaid Services, said the agency is sending inspectors to Life Care along with experts from the Centers for Disease Control and Prevention to figure out what happened and determine whether the nursing home followed guidelines for preventing infections.

Last April, the state fined Life Care $67,000 over infection-control deficiencies following two flu outbreaks that affected 17 patients and staff. An unannounced follow-up inspection in June determined that Life Care had corrected the problems, Verma said.

Meanwhile, public officials in Washington came under pressure to take more aggressive steps against the outbreak, including closing schools and canceling large events. While the state and Seattle have declared emergencies, giving leaders broad powers to suspend activities, they have not issued any orders to do so.

“We have encouraged people who are responsible for large gatherings to give consideration whether it really makes sense to carry those on right now,” Gov. Jay Inslee said. “Right now, we are deferring to the judgment ... of these organizations.”

While some individual schools and businesses have shut down, the governor said large-scale school closings have not been ordered because “there are so many ramifications for families and businesses,” especially for health care workers who might not be able to go to work because of child care responsibilities.

Local and state health officials have not recommended school closings unless the schools have had a confirmed case of the disease.

Jennifer Hayles, 41, of Kirkland said she was appalled that Inslee and health officials haven’t canceled next week’s Emerald City Comic Con. The four-day cosplay and pop-culture event draws close to 100,000 people each year, and some participants, including D.C. Comics and Penguin Random House, have pulled out over the virus.

ADVERTISEMENT

Hayles said she spent hundreds of dollars on tickets and other items related to the event but will have to skip it because she has a compromised immune system.

“There’s a lot of people who are talking about the economic cost of people forced to pull out of Comic Con, but if we have an explosion of cases of coronavirus, the economic cost is going to be much higher,” Hayles said.

Comic Con’s organizer, Reedpop, announced Wednesday that it would make an exception to its no-refunds policy for those who want their money back, but said it remained committed to holding the event unless local, state or federal officials change their guidance.

Lakshmi Unni said that she was keeping her son, an eighth-grader at Redmond Middle School in Seattle’s eastern suburbs, home on Wednesday and that she had urged the school board and principal to close.

“Yesterday at least three kids were coughing,” Unni said. “We don’t know if they were sick with the virus, but if they do become sick, the chances of spreading are very, very high.”

Some schools, businesses and other employers aren’t waiting.

Seattle and King County public health officials urged businesses to allow employees to work remotely if possible, and the county said it will allow telecommuting for some of its workers for the next three weeks.

Microsoft said it has asked its Seattle-area workers who can do their jobs at home to work from home until March 25. The directive also affects Microsoft employees in the San Francisco Bay Area. The Redmond, Washington-based company said employees should still come in if they work at a data center, retail store or other location where their presence is needed, unless they have an underlying health condition, are over 60 or fall into other categories that health authorities say pose higher risks.

Microsoft is also asking people to cancel travel to its Puget Sound and Bay Area campuses unless it is “essential for the continuity of Microsoft.” The company is also canceling non-essential business travel to other regions where the virus is active.

The Fred Hutchinson Cancer Research Center in Seattle announced it is canceling events at the complex and requiring nonessential staff to work remotely at least through the end of the month to lessen the chance of infection among patients with weakened immune systems.

School officials in Renton, south of Seattle, announced that Hazen High School will close for the rest of the week after a student tested positive for the coronavirus. Online petitions urged officials to close other schools on Seattle’s east side.

The F5 technology company closed its 44-story tower in downtown Seattle after learning an employee had been in contact with someone who tested positive for the virus. Outdoor recreation giant REI shut down its Seattle-area operations for two days as a precaution.

Full Coverage: Virus Outbreak

A federal immigration field office near Tukwila also closed after an employee visited the Kirkland nursing home. Acting Homeland Security Secretary Chad Wolf said the move was a precaution and the place will remain shut for 14 days.

Health officials in North Carolina reported that a person from Wake County tested positive for the illness after visiting the nursing home. The patient’s flight from the Seattle area to the Raleigh-Durham airport raised fears other passengers were exposed to the virus.

“My understanding is we have the manifest. Now the trick is to go find them,” said Robert Redfield of the CDC.

Life Care Center said on its website that it is screening employees for symptoms before they start work and as they leave. The nursing home is prohibiting visits from residents’ family members.

Shortly before the California death was announced, Princess Cruise Lines notified passengers of its Grand Princess that federal health officials are investigating a “small cluster” of coronavirus cases connected to the ship’s mid-February voyage. It asked current passengers to stay in their cabins until cleared by medical staff and said those who had been on the previous voyage should contact their doctor if they develop fever or other symptoms.

The Grand Princess is at sea off Mexico and will return early to San Francisco, where CDC and company officials will meet to determine the course of action, the cruise line said.

In Los Angeles, a contract medical worker who was conducting screenings at the city’s main airport has tested positive for the virus. The person wore protective equipment while on the job so it was unclear how the worker contracted the virus, Homeland Security officials said.

In New York, health officials put hundreds of residents in self-quarantine after members of two families in the New York City suburb of New Rochelle were diagnosed with the virus. Gov. Andrew Cuomo said the disease appeared to have spread from a lawyer to his wife, two children, a neighbor and two others.

The new results brought the number of confirmed cases in the state to 11.

___

Associated Press Writer Carla K. Johnson in Seattle contributed to this report.