Federal officials announced Friday that their tally of 2019 novel coronavirus cases in the United States had increased to 34, with more infections expected sooner than later, even as questions lingered about how efforts at containing the deadly illness had fallen short so far.

The jump came after the State Department repatriated 18 infected U.S. citizens from aboard a cruise ship docked in Yokohama, Japan. Three other people confirmed to have the disease have been repatriated, in addition to 13 other American travelers who fell ill upon returning from abroad, as The New York Times reported.

“This new virus represents a tremendous public health threat,” Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, said on a call with reporters.

The virus has infected over 75,000 people in more than two dozen countries and killed at least 2,240, mostly in mainland China, where the disease originated. The virus has affected every aspect of life in that country, from travel to business to government to family relations, and spread outward from there. Roughly 760 million people are subject to some type of quarantine measure, more than double the population of the entire United States.

But the release of the new numbers also amounted to the first significant CDC update since the feds’ response to the outbreak came under harsher scrutiny this week. According to The Washington Post, federal officials learned 14 passengers on flights out of Japan were infected while the evacuation was under way earlier this week, and decided to fly them home with hundreds of uninfected people despite a CDC recommendation they not do so.

“It was like the worst nightmare,” one U.S. official told the paper. “Quite frankly, the alternative could have been pulling grandma out in the pouring rain, and that would have been bad, too.”

Meanwhile, Reuters on Friday reported that only three states were able to effectively test for the illness, a logistical problem poised to fan the flames of anxiety about a possible pandemic. It’s a looming crisis for which some U.S. hospitals have begun to prepare.