As the coronavirus continues to spread deeper into California communities — with multiple cases reported from Sacramento to San Diego and a third confirmed death — officials say they are expecting the state’s total cases to rise well beyond the current 157 as more testing is done in the coming days.

The state’s latest count does not include passengers from the Grand Princess cruise ship currently docked in Oakland.

On Tuesday, Sacramento County health officials announced that a patient in her 90s at an Elk Grove nursing home had died from COVID-19. The woman is the third confirmed death from COVID-19 in California, and she is the state’s first known case of infection with the coronavirus in a nursing home. Health officials said all patients in the nursing home would be tested for the virus, but that effort was delayed by a lack of test kits.

Other residents of the facility are receiving special protective measures, including having meals delivered to rooms and being barred from gatherings.


Elsewhere, the number of cases continues to rise.

On Tuesday evening, the Transportation Security Administration confirmed that three of its officers who work at Mineta San Jose International Airport tested positive for COVID-19.

“The officers are receiving medical care and all TSA employees they have come in contact with over the past 14 days are quarantined at home,” the agency said in a statement. “Screening checkpoints remain open, and the agency is working with the CDC, as well as the California Department of Public Health and the Santa Clara County Public Health Department to monitor the situation as well as the health and safety of our employees and the traveling public. We will update as more information becomes available.”

Los Angeles County reported the first instance of the virus spreading in the community on Monday. A new case was reported Tuesday — the county’s 20th — by health officials who said a traveler returning from Iran tested positive after flying into Los Angeles International Airport. The individual is currently isolated at home.


The San Francisco Department of Emergency Management also reported one new case Tuesday, bringing the county’s total to 14. The patient, who had known contact with another person who tested positive, is hospitalized, officials said.

Orange County also reported two new cases of the virus, pending confirmation from the Centers for Disease Control and Prevention, bringing that county’s total to five.

Officials confirmed a new coronavirus case in Alameda County – an older individual who left the Grand Princess cruise ship in February. There are now at least four cases of coronavirus in Alameda County, including one individual in Berkeley, which has a separate health officer. The new case is under isolation at home.


San Joaquin County Public Health Services confirmed its first case of the coronavirus. The individual was a passenger on the Grand Princess cruise ship, but was not on the cruise that most recently disembarked in Oakland. The individual has been symptomatic and was hospitalized several days ago.

And Tuesday evening, Calaveras County confirmed an adult and child in a family in Copperopolis tested positive for coronavirus. Their exposure occurred outside the county. The family has remained isolated at home since public health workers launched their investigation of the cases. Close personal contacts of the family identified in the investigation will be quarantined.

Meanwhile, in Washington state, Seattle and King County health officials reported two more deaths, bringing the total deaths linked to the virus in the state to 22. The individuals were not residents of the Life Care Center of Kirkland, a nursing home where 19 patients have died. Both people had previously tested positive.

Beyond health concerns, the effects of the virus have stirred ongoing financial fears that have affected U.S. and global markets. On Tuesday, a day after a global meltdown, stocks and oil markets appeared to stabilize after U.S. and international governments vowed to push more aid into a coronavirus-weakened global economy.


In keeping with new guidance from California health officials, Los Angeles County health officials and local organizers are trying to curtail massive public events. Dr. Barbara Ferrer, L.A. County public health director, advised the public to take extra precautions as the number of cases continued to rise.

“It’s time to start thinking about limiting activities anywhere you have a lot of exposure to the general public,” she said Tuesday, stressing the fact that pregnant women, elderly individuals and those with underlying health conditions are most at risk for developing serious effects from the virus.

Ferrer said starting Wednesday, teams will visit all nursing homes and long-term-care facilities in Los Angeles County — roughly 300 — to ensure they are adequately prepared to enforce infectious disease protocols and help with preventive measures against coronavirus. Teams include health inspectors with the Department of Public Health.

Teams also will assess 330 homeless shelters throughout L.A. County, she said. In dealing with the unsheltered population, the department has a three-pronged strategy: Ensure that shelters take precautions to separate the sick from the healthy; ensure that people on the street have the proper information they need to stay healthy; and identify places where sick individuals may be quarantined.


Officials are looking at sites that would allow them to isolate homeless people who might have COVID-19 from healthy people inside shelters. San Francisco also is developing quarantine locations for people who have tested positive for the virus, have been in contact with an individual with known exposure, and are either homeless or living in shared quarters.

Contra Costa County joined other Bay Area counties Tuesday in urging residents to avoid crowds. As of Tuesday evening, the county had 10 confirmed cases of coronavirus — four people with known contact with people who previously tested positive, and six people who had no recent history of travel outside the U.S. or known contact with a confirmed case.

Dr. Rohan Radhakrishna, deputy health officer, said he recommended all large community events be postponed or canceled. In particular, he said, people at higher risk — those 50 or older and people with underlying medical problems like heart and lung disease, diabetes, cancer or weak immune systems — should not go to mass gatherings such as religious services, celebrations, concerts, sporting events or parades.

Radhakrishna also said employers should suspend nonessential travel, including canceling conferences; allowing employees to telecommute; staggering schedules to reduce the number of workers in the office at the same time; and not requiring doctor’s notes for employees who are feeling ill.


“Given that we now know the novel coronavirus is spreading in our county, this is critical time, perhaps the best and only time for each of us to do our part to protect the community and decrease the spread of this virus,” Radhakrishna said.

In Santa Clara County — where public health officials face the largest number of confirmed cases in California — local leaders issued a rare legal order banning mass gatherings of 1,000 or more people, effective Wednesday through the rest of March.

The order includes sporting events. The San Jose Sharks said the hockey team would abide by the county’s new order, which is enforceable by the county sheriff and police, after declining an earlier recommendation to halt mass gatherings late last week. The San Jose Earthquakes are scheduled to play Sporting Kansas City on March 21, but it remains unclear whether the game will be postponed.

Santa Clara County reported two new coronavirus cases Tuesday, bringing the county’s total to 45 confirmed cases and one death.


“We are clearly facing a historic public health challenge,” Santa Clara County’s health officer Dr. Sara Cody said at a news conference Monday night. “The number and type of cases to date indicate that the risk of exposure to this virus in our community is increasing.”

Across the state, public schools and universities have closed or moved classes online, large gatherings have been canceled, and health officials are urging “social distancing” — reducing chances of contact with an infected person — to mitigate the growing outbreak.

UCLA, USC, UC Santa Cruz, UC Berkeley, UC San Diego, San Jose State, San Francisco State, Santa Clara, Princeton, Ohio State and Vanderbilt universities became the latest institutions to announce they would suspend all or most in-person classes. More than 25 universities in the U.S., the Mideast, Asia and Italy have announced moves to online learning.

Rancho Mirage announced it was shuttering its library and observatory until March 23, and the Los Angeles Times postponed its annual Festival of Books and Food Bowl. Times staffers also have been given the option to work from home and have been instructed to avoid the workplace for 14 days following any air travel. And Tuesday afternoon, after much speculation, concert promoter Goldenvoice announced the Coachella Valley Music and Arts Festival would be postponed until October.


But not all gathering places are shutting down. Universal Studios and Disneyland Resort are not closing and are instead monitoring the growing outbreak and regularly communicating with health officials, park officials said. Hand-sanitizing stations have been placed throughout Disneyland, and employees have been instructed to stay home when sick.

A satellite image shows the Grand Princess arriving at the Port of Oakland on Monday with support services nearby. (Satellite image 2020 Maxar Technologies/ Lorena Elebee)

For passengers aboard the Grand Princess, Monday brought relief as the cruise ship reached the Port of Oakland, providing the comfort of land, but no clear answers about their individual futures. After days of being forced to idle off the coast of Northern California, the ship docked with about 3,500 passengers and crew, including at least 21 who had tested positive for the new coronavirus.

“We’re trying to stay calm, and we’re trying to stay positive, but it’s getting harder and harder. They can’t make up their minds how to keep us safe,” said passenger Beryl Ward, 77, of Santa Fe, N.M.


Late in the afternoon, after hours of waiting, a handful of passengers wearing masks headed toward tan medical tents that had been erected earlier. State officials said Sunday the 3,000 travelers stuck in limbo since Wednesday would be screened for symptoms before being sent by ambulance for medical treatment, if necessary, or would board waiting tour buses headed for military bases for a 14-day quarantine.

The operation represented a controversial and high-risk move for federal, state and local officials. They had spent days debating the trade-offs of keeping passengers on board or allowing them to disembark — though more than 1,000 crew members, mostly foreign nationals, will remain quarantined on board.

Passengers wearing masks trickled out of the Grand Princess and walked to the bottom of a ramp, where masked officials in yellow protective gear and blue plastic gloves took their temperature and led them to a tent for more screening before they lined up to board a bus.

By Tuesday afternoon, more than 540 people had been offloaded from the ship. Roughly 228 Canadians were sent back to Canada, and 171 Californians were taken to Travis Air Force Base. At least 26 individuals were sick and being treated for the coronavirus or some other illness, officials said.


Thousands more were still waiting Tuesday to be released. Authorities said foreigners from more than 50 countries would be flown home, while U.S. passengers would be flown or bused to military bases in California, Texas and Georgia.

Elsewhere, cruise ship agencies have canceled upcoming stops in Monterey Bay after the city asked companies to alter their impending trips, city officials said. The Royal Princess has canceled its March 31, April 14 and April 28 visits to Monterey, and the Maasdam–Holland America cruise ship has canceled its April 29 visit.

“The city of Monterey has an obligation to ensure the public health of our residents, employees and visitors, and we appreciate the cruise ship companies taking action on behalf of our request,” City Manager Hans Uslar said in a statement.

The city of Santa Barbara also announced the cancellation of a Grand Princess cruise scheduled to visit the area March 24. City officials plan to contact other cruise lines to cancel upcoming visits to Santa Barbara until the CDC removes its travel advisory for cruise ships. There are 10 cruise stops planned for Santa Barbara through June.


“I appreciate Princess Cruises taking action and protecting the safety of the community and passengers. We are asking other cruise lines to follow their lead and take a cautious approach,” Santa Barbara Mayor Cathy Murillo said.

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As of Tuesday afternoon, there were more than 118,000 total virus cases worldwide, and more than 4,200 total deaths. Nationwide, more than 800 people were confirmed to be infected with the virus.

In California, the second person to die from the virus was a woman in Santa Clara County Officials said she was in her 60s and had been hospitalized for several weeks. Last week, Placer County public health officials announced that a 71-year-old Rocklin resident who had tested positive for COVID-19 after returning from a cruise to Mexico last month died.


In Long Beach, three people are believed to have contracted the coronavirus after preliminary testing, officials announced Monday afternoon.

Riverside University Health System-Public Health also announced three new cases in Coachella Valley. The individuals are believed to have traveled to an area with a known outbreak, or had contact with a known case, Riverside County public health officer Dr. Cameron Kaiser said. Two of the individuals have been isolated at home. The third is at a Coachella Valley hospital.

The county also confirmed its second case from the Diamond Princess cruise ship, bringing the number of COVID-19 cases in the county to at least six.

The nation’s capital also took a hit as six lawmakers, in rapid succession, announced their self-quarantine following exposure to someone with the virus.


Several lawmakers were exposed to a single person with coronavirus at a conservative political conference late last month. U.S. Rep. Julia Brownley (D-Westlake Village) met in Washington last week with someone later diagnosed with the virus.

All of them said they would self-quarantine even though they felt fine. Brownley shuttered her Washington office for the week. She and her staff would work from home, she said.

Medical personnel in tents, left, tend to passengers as they disembark from the Grand Princess cruise ship at the Port of Oakland. (Josh Edelson / AFP / Getty Images)

Times staff writers Richard Read, Jaclyn Cosgrove, Sarah Parvini , Thomas Curwen and Anita Chabria contributed to this report.