On Tuesday, a Louisiana honeymooner became the tenth American to die in the last year after visiting the Dominican Republic.

Susan Simoneaux and Keith Williams had been together for a decade by the time they tied the knot. To celebrate, they planned a dream honeymoon in Punta Cana. Days after returning home, Simoneaux was rushed to the hospital with fluid in her lungs. She died soon after.

Williams said he was unaware about the recent string of American deaths connected to the Dominican Republic. “I would have never went if I would have known,” he told local CBS affiliate WWLTV. “I did not know to be honest with you.”

The deaths have not been officially connected by either Dominican or U.S. authorities, but there are some frightening threads running through the reports. Of the nine other casualties, at least half — Nathaniel Holmes, 63, and Cynthia Day, 49, Miranda Schaup-Werner, 41, and David Harrison, 45, had fluid in their lungs.

Other causes of death are still waiting on autopsy or toxicology reports. But three travelers died at the Bahia Principe resort in La Romana within days of one another, while two others died at the Hard Rock Hotel & Casino in Punta Cana. More than one was reported drinking at a hotel minibar.

This lengthening string of fatal trips could become a serious problem for the Dominican Republic, which owes an estimated 17 percent of its economic function to tourism. More than a third of their annual tourist activity comes from the United States. Worried local officials have begun hashtagging social media posts with #BeFairWithDR, something they have done in the past when facing controversy.

“Cheerful, welcoming and hospitable, our Dominican Republic, the economy that grows the most in America, with its beautiful beaches and mountains, its tasty gastronomy and hardworking people invites you to know and love it,” Dominican government spokesman Roberto Rodriguez Marchena tweeted.