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At least four new 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,” Washington State Health Officer Dr. Kathy Lofy told reporters at a press conference. “We now know that the virus is actively spreading in some communities.”

At the press conference, Lofy originally announced five total deaths in the area until Dr. Ettore Palazzo, the 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.