A middle-aged patient in Washington state became the first person to die from the 2019 novel coronavirus inside the United States, officials said on Saturday as they announced additional cases, including a nursing home that could become the next hot zone.

At least 69 people on American soil have had confirmed cases of the novel 2019 coronavirus, which is believed to have originated in a large seafood and live animal market in Wuhan, China—where it killed thousands before spreading to dozens of other countries. One American also died in China earlier this month.

The U.S. outbreak seemed to reach a new stage over the weekend, with the number of confirmed patients who contracted it locally—not from traveling abroad—creeping up. California announced Saturday that it had recorded a third such “community spread” case, a patient who was apparently infected by a Santa Clara County woman diagnosed a day earlier.

The person who died in Washington state overnight was a man in his 50s considered at high risk, said Dr. Jeff Duchin, health officer for Seattle and King County.

Dr. Robert Redfield, director of Centers for Disease Control and Prevention (CDC), said there was currently “no evidence” that the person who died had traveled recently to China or had any contact with someone who had—making it another case of “community spread” or unknown origin.

“It’s a tough one, but a lot of progress has been made,” President Trump said at a press conference Saturday, stressing that the risk to the general population remained low. “We’re doing really well,” he added, “under incredibly adverse circumstances... We’re prepared.”

“I want to assure this family that they are in the hearts of every American,” said Vice President Mike Pence, who was named this week as czar of the president’s coronavirus task force despite a public-health track record that has come under harsh scrutiny. Pence called Trump’s actions in response to the outbreak “unprecedented.”

Pence announced additional travel restrictions on Iran and specific regions in Italy and South Korea. Trump also said he was “very strongly” considering imposing restrictions on the U.S. border with Mexico.

Pence added that the government had contracted the company 3M to make an extra 30 million face masks, on top of 40 million already available. “Let me be very clear: The average American does not need to go out and buy a mask,” he said.

The death came amid a surge in cases in Washington overnight. Officials announced three new cases—on top of one announced late Friday—including the first healthcare worker to test positive in the U.S., and also discussed the first possible outbreak in a longterm care nursing facility.

Duchin said the facility in question was Life Care in Kirkland, Washington. One patient was a woman in her 70s, a resident in serious condition; another patient in the state was said to be a healthcare worker in her 40s who had no known travel outside the U.S. Duchin said the facility had 108 residents and 180 staff, and there were dozens of people in both groups who had experienced symptoms and would be tested.

“I would like to say that while there is some spread in some communities, there is not national spread of COVID-19,” Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the CDC, said.

Shortly after Duchin announced the outbreak at Life Care, Washington Gov. Jay Inslee announced he had declared a state of emergency, directing agencies to use all resources necessary to prepare for and respond to the outbreak. “This will allow us to get the resources we need,” Inslee said. “This is a time to take common sense, proactive measures to ensure the health and safety of those who live in Washington state.”

Those updates on Saturday bring the total number of cases detected in the American public health system to 22 and the total in the U.S.—including repatriated people from Wuhan and the Diamond Princess cruise—to 69.

U.S. Health and Human Services Secretary Alex Azar said more cases were to be expected on American soil but that “any single death for us is a real tragedy.”

The reported illnesses have ranged from mild symptoms to severe respiratory illness and death and can include symptoms like fever, coughing, and shortness of breath. Symptoms are believed to typically appear between two and 14 days after exposure. Authorities have worked to reassure Americans that the U.S. health system has the capacity to handle a surge of the deadly illness, which has previously had about a two percent fatality rate globally among confirmed cases.

Over the course of several hours on Friday afternoon, officials in California, Washington state and Oregon all announced that residents with no known risk factors had tested positive. In Washington, officials said a high-school student who had been on campus just that morning had the virus. They did not say anything then about the now-deceased patient. In Oregon, a school employee had tested positive and may have exposed an untold number of elementary school staff and students.

A Washington state student fell sick Monday with fever, body aches, and a headache, and was seen at two clinics in Snohomish County. The teen felt better by Friday morning and returned to Jackson High School—only to be notified soon after that they tested positive, authorities said.

“The few students they were in contact with have been notified and will remain home for 14 days with symptom monitoring by the Snohomish Health District,” the school district said in a letter to parents.

The Food and Drug Administration on Saturday took new steps to expand testing of novel 2019 coronavirus in hospitals following complaints from labs that the previous requirements for in-house testing development were too onerous.

Under the policy announced Saturday by the FDA’s commissioner, Stephen Hahn, due to “critical public health needs” during this “dynamic and evolving situation,” labs can begin using their own tests after validating them—but before the FDA has finished reviewing their request for emergency use authorization.

In January, the World Health Organization declared the outbreak a “public health emergency of international concern” and the HHS Secretary Azar declared a public health emergency for the United States to aid the nation’s health system in responding to the outbreak. Cases have been confirmed in Oregon, Wisconsin, Illinois, Massachusetts, Texas, California, Arizona, and Washington state.

Several major companies have begun to cancel conferences and travel plans within the U.S. over fears of an outbreak, which some have warned could have cascading effects on the travel industry and larger economy. Already, the U.S. stock market had its worst week since the 2008 financial crisis.

The CDC has, in various statements, described its response to the virus so far as both “aggressive” and “unprecedented,” even as experts have criticized the agency’s ability to quickly provide working diagnostic tests to identify the illness. Both a potential vaccine and drug treatment option are expected to enter clinical trials in April and—if successful—translate to the public market within 12 to 18 months.

Meanwhile, around the globe, the viral outbreak that began in Wuhan, China has now infected more than 85,000 people in 40 countries.

Italy’s Civil Protection Agency announced that it had a total of 1,128 cases on Saturday. South Korea—which has the largest outbreak outside of mainland China—confirmed more than 800 new cases overnight, as Iran saw a 205-case jump and France banned public gatherings of more than 5,000 people in an effort to slow the spread of its 73 cases on Saturday. Also on Saturday, Ecuador and Qatar confirmed their first cases of the virus.

In North Korea, Kim Jong Un held a high-level meeting in which he ordered all-out efforts to fight the virus and threatened “serious consequences” if it “finds its way into our country.”