Washington state reported on Saturday the first death in the U.S. from the new coronavirus, the first health care worker to be infected with the disease, and most worrying, the first known outbreak in a long-term care facility.

At a nursing facility in Kirkland, Wash, approximately 27 of the 108 residents and 25 of the 180 staff have some symptoms, health officials said during a teleconference with the Centers for Disease Control and Prevention. Authorities report that some among them have pneumonia.

“We are very concerned about an outbreak in a setting where there are many older people, as we would be wherever people who are susceptible might be gathering,” said Jeff Duchin, health officer for public health for Seattle and King County. He added that older adults and people with underlying health conditions like diabetes, heart or lung disease should be especially careful to protect themselves by washing their hands, not touching their faces, and avoiding contact with people who are sick.

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The deceased, a man in his 50s with underlying health conditions, was not a resident of the facility, and officials have not yet found a link between his case and the outbreak in the nursing facility. “At the present time, we do not see a connection between the two. But there are some evolving threads that are being investigated,” said Frank Riedo, the medical director of infection control at EvergreenHealth Hospital, where the death occurred. “I think … what we’re seeing is the tip of the iceberg,” he added. “We’re seeing the most critically ill individuals. Usually that means there’s a significant percentage of individuals with less severe illness floating around out there. So in all likelihood there is ongoing low level transmission.”

As of Saturday, the World Health Organization reported that there were more than 85,403 cases worldwide, from 46 countries. While most of the cases are still from China, cases elsewhere are on the rise.

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The United States has reported more than 60 cases at this point. The bulk of the cases, 47, are people who were evacuated from China or from the Diamond Princess Cruise ship. There have been 15 previous cases in people who contracted the virus overseas.

So far, two people from the nursing facility outbreak have tested positive for Covid-19. One is a health worker in her 40s, who is currently in “satisfactory condition,” Duchin said, while the other is a resident in her 70s with significant underlying chronic health issues and is in “serious condition.”

“We haven’t been onsite yet,” he said, adding that a team from the CDC will be arriving Saturday evening to help investigate and control the situation.

Kathy Lofy, state health officer for the Washington State Department of Health, said that if Washington starts to see more spread, the state might consider social distancing measures, such as canceling large events.

“While there is some spread in some communities, there is not national spread of Covid-19,” said Nancy Messonier, director of the National Center for Immunization and Respiratory Diseases. “CDC and the federal government are working to keep it that way.” She emphasized that most people in the United States are at low immediate risk, but added that this was “an historic public health challenge.”