Updated at 8:45 p.m. ET

The U.S. death toll from COVID-19 has risen to 11 people, after officials reported fatalities in California and Washington state on Wednesday. The most recent death is connected to a cruise ship that traveled from the U.S. to Mexico.

Officials in Placer County, Calif., announced that an elderly resident has become the first person to die from the illness in California. The patient, who was not identified, had underlying health conditions, according to the county.

The patient tested positive for the coronavirus illness on Tuesday and "was likely exposed during international travel from Feb. 11-21 on a Princess cruise ship that departed from San Francisco to Mexico," according to a statement published on Placer County's website.

Roughly a week passed from the end of the cruise to when the patient was hospitalized, officials say. An ambulance took the patient to a hospital on Feb. 27; in the interval, the person had "minimal community exposure," the county says. The patient had been in isolation at Kaiser Permanente Roseville.

Gov. Gavin Newsom extended his condolences to the patient's loved ones and said the state is working with federal agencies to trace people who might have had contact with the patient. Later Wednesday, Newsom declared a state of emergency over coronavirus in California, which has more than 50 confirmed cases, according to health officials.

Placer County spans a wide area, from the outskirts of Sacramento to Lake Tahoe.

Among California's cases are 24 people who arrived in the U.S. on repatriation flights from outbreak locations in Asia.

The other cases include seven people who were infected via person-to-person exposure and 12 travel-related cases.

"Approximately 515 persons have been tested to date," the California Department of Public Health says.

To prevent the virus from spreading, health experts recommend washing hands for at least 20 seconds or using a hand sanitizer. Face masks should be worn only by people who are either sick or are caring for someone who is, according to the World Health Organization.

Washington state

Washington state raised its own death toll from COVID-19 to 10 people earlier Wednesday. The state now has 39 confirmed cases of the coronavirus disease, with 31 of them in Seattle and King County. The other eight cases are in neighboring Snohomish County.

Many of the cases are linked to Life Care Center of Kirkland, Wash., the long-term care facility northeast of Seattle that is at the center of the outbreak in King County.

On Wednesday afternoon, officials in Seattle and King County issued recommendations for vulnerable residents to try to contain the spread of coronavirus in the area.

"People at higher risk of severe illness should stay home and away from large groups of people as much as possible, including public places with lots of people and large gatherings where there will be close contact with others," they said in a statement.

That group includes people 60 and older; people with underlying health conditions such as heart disease, lung disease or diabetes; those with weakened immune systems; and people who are pregnant.

In addition, officials said companies should take steps to allow employees to work from home and recommended that people avoid visiting hospitals, long-term care facilities and nursing homes.

More than 230 people in Washington state are under supervision out of concern that they may have been exposed to the pathogen, the Washington Department of Health says.

Los Angeles declares emergency

Hours before Gov. Newsom declared an emergency for the entire state, the city of Los Angeles declared a health emergency over the coronavirus, citing the need to address the possibility of community transmission of the disease that has caused more than 3,200 deaths globally.

The move comes after Los Angeles County confirmed six new cases of the coronavirus and seven overall, according to Dr. Barbara Ferrer, director of the Los Angeles County Department of Public Health.

"I have signed a declaration of local emergency for the City of Los Angeles," Mayor Eric Garcetti announced via Facebook. "While there are only a few known active COVID-19 cases in the region, the declaration helps us access state and federal funding to strengthen and support our efforts to prepare our region and keep our communities safe."

Los Angeles County mirrored the city's move, in a step that the chair of the county's board of supervisors, Kathryn Barger, said was a planned reaction to the virus.

"This is not a response rooted in panic," Barger said, adding that the emergency declaration would help agencies coordinate their response and contain the virus in a county where more than 10 million people live.

One person has been hospitalized while five others are being monitored at home, Ferrer said. The county's first patient, a Chinese national who was diagnosed in January, has recovered from the virus, she said.

"Three of the new cases were travelers who were traveling together in northern Italy," Ferrer said at a news conference. Two others are relatives of a person who was infected with the coronavirus outside of the county, she said. The sixth case is a person who works in a field that exposes them to international travelers, Ferrer added.

Later Wednesday, the Los Angeles Times reported that a worker at the city's international airport who screened incoming flights from China and nearby countries had tested positive for the virus.

Cases rise in U.S.

There are at least 80 confirmed cases of COVID-19 that originated in the U.S., the Centers for Disease Control and Prevention said earlier Wednesday. That number doesn't include the 49 Americans diagnosed with COVID-19 who have been repatriated from outbreaks in Wuhan, China, and aboard the Diamond Princess cruise ship.

At least 13 states have reported coronavirus cases since late January.

While international travel has been linked to 24 of the U.S. cases, the cause of transmission is still under investigation in 40 cases. Person-to-person spread in the U.S. has caused infection in 16 cases, according to the CDC .

The CDC data reflects numbers that were reported by 4 p.m. ET the previous day — meaning the actual number of cases in the U.S. might be higher than the most recent posting by the agency.

"States are now testing and publicly reporting their cases," the CDC says. "In the event of a discrepancy, state case counts are the most up to date."

In addition to California and Washington, other states reporting coronavirus cases include Arizona, Florida, Georgia, Illinois, Massachusetts, New Hampshire, New York, North Carolina, Oregon, Rhode Island, Texas and Wisconsin.

Although Texas previously had cases from people returning from China or who had been aboard the Diamond Princess, officials on Wednesday reported a newly detected infection in a person who had recently traveled aboard.

"Having a COVID-19 case in Texas is a significant development in this outbreak, but it doesn't change the fact that the immediate risk to most Texans is low," said Dr. John Hellerstedt, DSHS commissioner. "This travel-related case reinforces the fact that we should all be taking basic hygiene steps that are extremely effective in limiting limit the spread of COVID-19 and all respiratory illnesses."

Copyright 2020 NPR. To see more, visit https://www.npr.org.

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