At least four more patients have died from COVID-19 in Washington state, bringing the total number of deaths in the U.S. to at least six as the coronavirus spreads throughout local communities around Seattle, local health officials said Monday.

Public health officials near Seattle reported the nation’s first two deaths in a nearby suburb and several new cases over the weekend. On Saturday, local health officials said about 50 residents and employees of a nursing care facility outside of Seattle were ill with “respiratory symptoms or hospitalized with pneumonia or other respiratory conditions of unknown cause” and were being tested for the coronavirus that’s infected more than 89,000 and killed at least 3,040 across the globe since Dec. 31.

The outbreak there worsened on Monday after local health officials reported that at least three residents of Life Care Center, a skilled nursing facility in Kirkland, Washington, were among the deceased. The virus has also spread to a woman in her 40s who works at the facility and is currently in the hospital, officials said.

“Unfortunately, we are starting to find more COVID-19 cases here in Washington that appear to be acquired locally here in Washington,” Dr. Kathy Lofy, Washington’s state health officer, told reporters at a news conference. “We now know that the virus is actively spreading in some communities.”

At the news conference, Lofy originally announced five total deaths in the area until Dr. Ettore Palazzo, chief medical and quality officer at EvergreenHealth where several patients are being treated, announced a sixth death that state health officials didn’t know about.

“So six should be the correct number,” Lofy told a confused room of reporters. “We were, at the department, aware of the five deaths from King County. We had not received the report about the Snohomish County patient just yet. ... Apologize for that.”

Washington state currently has at least 18 cases, 14 of which are in King County where the nursing facility is located and four in Snohomish County, she said. There are 29 other cases pending test results, officials said.

“At this time we have not detected COVID-19 cases outside of King and Snohomish counties, but given the movement of people around our state, it is possible the virus is spreading in other counties, too,” Lofy said. The state’s public health laboratory has the capacity to test about 200 specimens a day and the University of Washington will start testing for COVID-19 on Monday or Tuesday, she added.

King County Public Health Officer Dr. Jeff Duchin said local physicians are just starting to identify patients they previously weren’t able to test due to stringent federal testing guidelines. However, the cases they are identifying now are seriously ill patients. They aren’t testing anyone with mild symptoms yet, he said, adding that a majority of the active cases are probably going undetected.

“At some point, we’re going to be shifting our approach from counting every case to focusing on outbreaks, perhaps cases that occur at hospitals,” Duchin said, “and we won’t be able to do the kind of individual case follow up and case management that we’re doing early on during this so called containment phase of the epidemic.”

Seattle-area officials are setting up a coronavirus hotline and looking to buy a motel to convert into a quarantine facility. They are also placing modular housing previously used for oil workers in Texas at several locations around the area that can accommodate at least 100 people, they said.

—CNBC—