Health officials in Washington state reported three grim new features of the coronavirus situation in the US Saturday. They reported the country’s first death, the first case in a healthcare worker, and the first possible outbreak.

In a press briefing held by the Centers for Disease Control and Prevention, Dr. Jeffrey Duchin, health officer at Public Health of Seattle and King County, announced that there are three new presumptive cases of COVID-19 in the county, including the person who died. All of the cases appear to be from undetected spread of the new coronavirus in the community. The cases were identified because the state just recently gained the ability to do its own testing.

Two of the cases are linked to a long-term care facility called Life Care in Kirkland, Washington, east of Seattle. One of the cases is in a healthcare worker at the facility, a woman in her 40s who is said to be in “satisfactory” condition. She has no known travel outside of the US. The other is a resident of the facility, a woman in her 70s. She is in serious condition.

The cases likely represent the start of an outbreak at the facility, which has approximately 108 residents and 180 staff. So far, 27 residents and 25 staff have reported some COVID-19 symptoms, Dr. Duchin said.

An outbreak of COVID-19 at a nursing home is particularly alarming since the data on the disease so far has clearly shown that the people most at risk of getting infected and having life-threatening disease are the elderly and people with underlying health conditions—such as cardiovascular disease, lung conditions, and diabetes.

“We are very concerned about an outbreak in a setting where there are many older people,” Dr. Duchin said.

A team from the CDC is on its way to the facility to help manage the situation. This team is expected to arrive in Kirkland Saturday night.

The country’s first reported COVID-19 death was also in King County. The person who died was a man in his 50s with underlying health conditions. He died in a local hospital in Kirkland, but he was not a resident at Life Care and has no immediately known links to the facility. Health investigators are trying to track down how he was infected. (In an earlier press conference, President Trump had identified the person who died as a woman. That is incorrect. It was a man.)

The new information—a rapid escalation of the situation in the US—follows news of potential community spread in four separate areas of the US: two areas in California, and one in Oregon in addition to the Seattle and King County area.

This escalation “raises our level of concern about the immediate threat of COVID-19 for certain communities,” Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, said in the briefing. Still, the risk to the general public not in these areas is considered to be low, she said.

The new information brings the country’s tally to 69 cases and one death. That includes 47 cases in repatriated citizens (44 from the Diamond Princess and three from Wuhan, China, where the outbreak began).