Three more people died of coronavirus in Washington state on Tuesday, taking the total number of deaths in the United States to nine as the rapidly-spreading disease reached beyond Seattle, Reuters reported. The total number of confirmed cases in the greater Seattle area rose from 18 to 27 on Tuesday, said the US Health Department.

Of the 27 cases reported as of Tuesday, nine were connected to a nursing care facility in Seattle’s Kirkland suburb, according to the Seattle & King County Public Health agency. Five of those who died had been residents of the nursing home.

“This is a very fluid, fast-moving situation as we aggressively respond to this outbreak,” Dr Jeff Duchin, a public health officer for Seattle and King County, said.

A person from North Carolina tested positive for coronavirus, apparently after a visit to the nursing home. His diagnosis is the first positive case announced in the state and is not part of the Seattle-area case cluster, which ranks as the largest concentration detected in the US. It is also likely to be the first known instance of coast-to-coast transmission of coronavirus in the country.

US President Donald Trump said his administration may stop travel to countries worst hit by the coronavirus outbreak but said officials were not considering any restrictions on domestic travel.

Online retailer Amazon on Tuesday said an employee at its Seattle office has tested positive. “We’re supporting the affected employee who is in quarantine,” a company official told Reuters over email. On Sunday, the company had said that two employees in Milan, Italy, had been infected with the virus. Both have been quarantined.

Data from the US Centers for Disease Control and Prevention showed 108 confirmed and suspected cases. The total consists of 60 cases reported by health officials in 12 states and 48 among people repatriated from abroad, most of them who were aboard the quarantined Diamond Princess cruise ship in Japan.

Coronavirus, also known as COVID-19, that originated in China’s Wuhan has become a global health emergency. It has spread to 75 nations, killed over 3,000 people across the world and infected more than 90,000 people. In China, 38 more deaths were reported on Wednesday morning and the total number of cases rose to 80,270, the South China Morning Post reported.

South Korea, the worst-affected country after China, reported 28 deaths on Tuesday and over 900 new cases. Italy has reported 79 deaths, the maximum outside China. In Iran, 77 people have died of the coronavirus outbreak.