California announced its first coronavirus-linked death Wednesday, bringing the death toll in the United States to 11.

The fatality is the first in the United States to occur outside Washington state, where the 10th coronavirus-related death was also announced Wednesday, according to The Seattle Times.

Placer County, California, public health officials described the deceased California patient as an “elderly adult with underlying health conditions.” The patient was the second confirmed case of covid-19 in the county, roughly 60 miles northeast of Sacramento. The patient was probably exposed to the virus during a mid-February trip on a Princess cruise ship that traveled from San Francisco to Mexico, officials said.

The patient had been in isolation after testing presumptively positive for the virus on Tuesday.

“We extend our deepest condolences to the loved ones of this patient,” Placer County Health Officer Dr. Aimee Sisson said in a statement. “While we have expected more cases, this death is an unfortunate milestone in our efforts to fight this disease, and one that we never wanted to see.”

Earlier Wednesday, Los Angeles County declared a local health emergency Wednesday, as officials confirmed six new cases of coronavirus.

“We’ve confirmed these cases as of last night with positive lab results,” said Barbara Ferrer, director of the Los Angeles County Department of Public Health.

The new cases were the result of close contact and did not amount to wide community spread, officials said.

Three of the patients in the newly confirmed cases had recently traveled to northern Italy, one of the places hardest hit by the outbreak. The remaining three new cases were either family members of the travelers or worked in close contact with them. The new cases raise the county total to seven.

“This is not a response rooted in panic,” Kathryn Barger, chair of the Los Angeles County Board of Supervisors, said in a news conference. “We’ve been preparing with our local, state and federal partners for the likelihood of this scenario.”

Four new cases were also confirmed in New York, Gov. Andrew Cuomo announced, as the virus continues to spread in the United States. American workers face increasing disruptions to their routines as companies, schools and local governments implement precautions to curb the outbreak, with many firms restricting travel or weighing work-from-home arrangements.

Officials in the United States have confirmed 11 deaths and more than 100 cases, while Iran and Italy have recorded 92 and 79 deaths, respectively. India reported a sharp rise in cases Wednesday after Italian tourists tested positive.

Meanwhile, the outbreak appeared to be relenting in China. Far more new cases were reported outside the country than within, suggesting Chinese authorities’ draconian efforts to curb transmission may be paying off at home even as the casualty count mounts elsewhere. The World Health Organization said Tuesday that covid-19, the disease caused by the virus, has killed about 3.4% of those diagnosed with the illness – a higher rate than experts previously estimated.

China announced 119 new cases Wednesday, along with 38 deaths, the lowest figures since at least Jan. 20. “We believe this decline is real,” WHO outbreak expert Maria Van Kerkhove told reporters the day before, adding that other hot spots may be able to reduce new cases, too.

Governments are struggling to contain anxiety among households, businesses and investors about a prolonged economic impact. South Korea proposed a $10 billion stimulus package Wednesday as its cases soared past 5,200, the highest national count outside China.

Authorities in Australia warned against the hoarding of toilet paper, while China tightened restrictions on arrivals amid concern about cases being imported. In Europe, organizers canceled the London Book Fair, which usually draws about 25,000 people. The French government said it would take steps to regulate the price of sanitizing hand gels.

Markets appeared to shrug off interventions from policymakers. Global stocks were muted Wednesday after the Federal Reserve’s rate cut.

In New York, the four new cases were closely linked to the Westchester County man diagnosed Tuesday, bringing the total number of cases in the state to six. Six new cases were also confirmed in Los Angeles County, but officials cautioned that they were the result of close contact and not community-wide spread.

The Trump administration vowed that any American can be tested for the virus if a doctor deems it necessary. On Wednesday, Vice President Mike Pence said the threat of contracting the virus “remains low” but that all passengers flying directly from Italy and South Korea will be screened multiple times.

Trump made a surprise appearance at the Pence briefing with airline and diagnostic lab chief executives on the coronavirus.

Pence opened the meeting by praising Trump’s handling of the crisis, describing the administration’s efforts as not just a whole-of-government approach but “really a whole-of-America approach.”

“The threat of contracting coronavirus remains low, according to all of our experts. … We’re going to continue to lean into this effort, and we will continue to do so until we find our way through the impacts of the coronavirus,” Pence said.

He said that at Trump’s direction, as of Tuesday morning, all passengers flying to the United States directly from Italy and South Korea are being screened multiple times. Trump argued that the Obama administration had “made a decision on testing that turned out to be detrimental,” although he did not go into detail. “It was a decision we disagreed with, but we have undone that decision,” Trump said.

Asked for his message to Americans about whether they should be afraid to travel, Trump gestured to the airline chief executives gathered around the table.

“I think where these people are flying, it’s safe to fly,” he said, adding that if certain areas begin to be more of a problem, “we may close them up.”

Outside China, the worst-hit nations remain South Korea, which has 5,238 cases; Iran, with 2,992 cases; and Italy, with 2,706.

In Russia, officials denied that there are more coronavirus cases in the country than they have revealed and condemned “fake news” from abroad.

“Unfortunately, it always accompanies us,” Russian President Vladimir Putin said at a meeting with government officials. “The purpose of such fakes is clear: to cause panic among people. That can be countered by only one thing — timely, comprehensive and accurate information for the country’s citizens.”

“Thank God, we don’t have anything critical happening yet,” Putin said.

Russia has had six confirmed cases — three of them on the Diamond Princess cruise ship — and Moscow diagnosed its first case Monday, a 29-year-old man who recently returned from Italy and is under quarantine. Russia’s preventive measures have included a temporary travel ban on nearly all Chinese citizens, closing the entire 2,600-mile border with China and random temperature checks at Moscow metro station entrances and local schools.

Meanwhile in Paris, One of the world’s most-visited museums, the Louvre, reopened after a temporary closure amid coronavirus concerns.

Staffers voted over the weekend to close the museum to visitors after the French government banned indoor gatherings of more than 5,000 people.

“The Louvre is a confined space which welcomes more than 5,000 people a day,” a union representative told Agence France-Presse after the vote. “There is real concern on the part of staff.”

In an emailed statement Wednesday, a top Louvre official, Maxence Langlois-Berthelot, acknowledged an “exceptional situation” and “legitimate concerns,” but added: “At present, the relevant authorities recommend the opening of museums and I am delighted that we can achieve this. Everyone is showing responsibility.”

The museum’s management said it has stepped up efforts to minimize the risk of infection for staffers.

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