Health officials on Monday confirmed four additional coronavirus deaths in Washington, bringing the state’s total death toll to six.
There are 18 confirmed cases in Washington, including the six deaths.
Most of those who have died were elderly or had underlying health conditions.
“Unfortunately, we are starting to find more COVID-19 cases here in Washington that appear to be acquired locally,” said Dr. Kathy Lofy, a health officer for the Washington State Department of Health.
All of the cases are in two adjacent counties: Snohomish and King, which is home to Seattle.
Lofy said the virus could be spreading in other areas of the state, which is ramping up testing to better understand how widespread the virus is in Washington.
Researchers say they think it has been spreading for weeks, potentially infecting hundreds of state residents.
Washington Gov. Jay Inslee (D) declared a state of emergency Saturday, directing state agencies to use all resources necessary to prepare for and respond to an outbreak.
Of the six deaths, four had been residents of a nursing home, illustrating the danger the disease poses to the elderly and those who have underlying health conditions.
Officials noted that the vast majority of people who get infected will fully recover.
Nationwide, 96 cases have been confirmed, including in individuals who have been repatriated from the Diamond Princess cruise ship.
Some patients haven’t had any known contact with the virus and haven’t been traveling to countries where there are outbreaks, leading officials to believe it is spreading within communities.
There have been nearly 89,000 cases of the coronavirus globally, including more than 8,700 outside of China, where it was first detected.
The virus has hit 64 countries and the World Health Organization said the global risk of the virus is “very high.”