Health officials in Placer County, Calif., have confirmed the state’s first coronavirus-related death in an elderly adult with underlying health issues. The news comes on the same day that Washington state reported an additional COVID-19 fatality, bringing the national death toll to 11.

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"We extend our deepest condolences to the loved ones of this patient,” Placer County Health Officer Dr. Aimee Sisson, said in a statement. “While we have expected more cases, this death is an unfortunate milestone in our efforts to fight this disease, and one that we never wanted to see."

Sisson said the patient tested "presumptively positive on Tuesday," and was "likely exposed during international travel from Feb. 11-21 on a Princess cruise ship that departed from San Francisco to Mexico." The health department said others on the cruise may have been exposed to the coronavirus.

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"Placer County Public Health is working closely with Sacramento County Public Health and the Centers for Disease Control and Prevention (CDC) to identify and contact other cruise passengers," the department said.

Princess Cruises issued a health advisory Wednesday for passengers currently aboard Grand Princess, and for guests who were on a previous voyage after the CDC began investigating "a small cluster of COVID-19 cases in North California connected to our previous Grand Princess voyage that sailed roundtrip San Francisco from Feb. 11 to Feb. 21."

The liner said that it is working closely with the CDC to follow its recommendations.

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The patient had been in isolation at Kaiser Permanente Roseville before death, and had "minimal community exposure between returning from the cruise and arriving at the hospital by ambulance on Feb. 27."

The health department said that 10 health care workers and five emergency responders who had contact with the patient before being moved to isolation are now being quarantined. None of the 15 individuals are showing symptoms.