Patients in 18 states have tested positive or are presumptively positive for the spreading coronavirus as public health officials race to get ahead of the growing worldwide epidemic.

Officials in Nevada, New Jersey, Tennessee and Texas said they had identified new cases in the last 24 hours, adding to an outbreak that has infected at least 162 people nationwide.

There are worrying signs that the number of cases is poised to grow.

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California Gov. Gavin Newsom Gavin NewsomBen Shapiro's Daily Wire leaving California: 'Terrible governance has consequences' Who's right on climate change: Trump or Newsom? The Hill's Morning Report - Sponsored by The Air Line Pilots Association - Trump, Biden couldn't be more different on climate change MORE (D) declared a state of emergency Wednesday after a patient near Sacramento became the 11th American to die. A cruise ship returning from Hawaii, linked to the death in Sacramento, is being held off the coast of California after nearly two dozen passengers and crew members showed symptoms.

Two new cases were reported in New York City, Mayor Bill de Blasio Bill de BlasioDe Blasio to furlough himself, 494 other staff members amid financial crunch: report The Hill's 12:30 Report - Presented by Facebook - Trump's West Coast campaign swing NY cancels traditional Macy's Thanksgiving parade, will hold virtual event MORE’s (D) office said Thursday. Los Angeles County reported six new cases, and Santa Clara County reported three of its own.

In Seattle, the region hardest hit by the virus so far, officials closed a public school district that serves 20,000 children. The Northshore School District will be closed for up to two weeks, local officials said.

While the Trump administration has focused on containing the virus, local health departments are shifting their focus to mitigation, an acknowledgement that the virus is beyond containment and is already spreading through communities.

“The goal is to slow down the spread and have it happen over a larger period of time so that hospitals aren’t overwhelmed and supply chains can keep up,” John Wiesman, Washington state’s secretary of Health, told The Hill in an interview last week. “It’s important for the public to understand what that goal is so that they’re not confused and say, 'Hey this isn’t working.'”

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The new cases come as the Trump administration struggles to deliver a coherent response to the viral outbreak. Vice President Pence is headed to Seattle to meet Gov. Jay Inslee Jay Robert InsleeBarr asked prosecutors to explore charging Seattle mayor over protest zone: report Bottom line Oregon senator says Trump's blame on 'forest management' for wildfires is 'just a big and devastating lie' MORE (D). Earlier this week, the administration pledged to make a million coronavirus tests available by the end of the week. Speaking to reporters on Capitol Hill, Health and Human Services Secretary Alex Azar said the federal government would be able to test as many as 75,000 people.

Public heath experts said they were growing concerned that the administration’s messaging does not meet the reality, that the virus is likely to spread widely in the United States.

“I hear a lot of wishful thinking and a little bit of a scattershot approach,” said Prabhjot Singh, health systems expert at the Mount Sinai Health System. “What we’re not hearing, which we probably need to hear more clearly, is that most people are going to be exposed to the coronavirus, and we need to be ready to comfort and care for people who are.”

The Centers for Disease Control and Prevention said Wednesday that it would loosen testing criteria, making tests available to anyone who wanted to be tested. But even if a million tests were available, public health experts say the United States lacks the capacity to process those tests in laboratories.

“We acknowledge this is a time of angst and concern and uncertainty for many people,” Azar told reporters.

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Speaking on Sean Hannity Sean Patrick HannityDershowitz suing CNN for 0 million in defamation suit If Trump doesn't know why he should be president again, how can voters? Trump says he read 'boring' Woodward book 'very quickly' MORE’s show on Fox News on Wednesday, President Trump Donald John TrumpBarr criticizes DOJ in speech declaring all agency power 'is invested in the attorney general' Military leaders asked about using heat ray on protesters outside White House: report Powell warns failure to reach COVID-19 deal could 'scar and damage' economy MORE questioned the World Health Organization’s (WHO) official projection that the virus kills 3.4 percent of those who contract it.

“I think the 3.4 percent is really a false number, and this is just my hunch, but based on a lot of conversations with a lot of people that do this because a lot of people will have this and it’s very mild. They’ll get better very rapidly, they don’t even see a doctor, they don’t even call a doctor. You never hear about these people,” Trump said.

Speaking on Capitol Hill on Thursday, Assistant Secretary of Health Brett Giroir said data suggests the actual mortality rate is in fact lower than the WHO’s estimates.

“The best estimates now of the overall mortality rate for COVID-19 is somewhere between 0.1 percent and 1 percent. That’s lower than you’ve heard probably in many reports,” Giroir said. “This is likely more severe in its mortality rate than a typical flu season, but it’s certainly within the range. So we don’t want people to go crazy.”

Later in the interview with Hannity, Trump seemed to suggest those who have the virus could even continue going to work, something health officials strongly advise against.

“If we have thousands or hundreds of thousands of people that get better just by sitting around and even going to work — some of them go to work, but they get better,” Trump said.

The likelihood of a broader spread was evident Thursday as four new states reported initial cases. Texas health officials said a man in his 70s is in quarantine in Fort Bend County, outside of Houston. In Nevada, a patient identified through a Las Vegas-area Veterans Administration hospital became that state’s first preemptive positive case. Tennessee Gov. Bill Lee (R) said a 44-year old man who had recently traveled out of state was being quarantined at home. And in New Jersey, a 32-year old man in Bergen County was diagnosed.

Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, said during an appearance on Capitol Hill that the risk to the general public remains low, though it is higher in some areas.

“The risk in the United States as a whole is still low,” Fauci said. “The risk of getting infected when you have community spread in a certain area is a bit higher.”