As thousands remained on a cruise ship held off the coast of San Francisco amid a coronavirus outbreak, a cruise line medical officer said Saturday that the California passenger who died of the virus this week brought it on board the Grand Princess.

Dr. Grant Tarling, the cruise’s medical officer, said the man _ who died in Placer County after leaving the cruise _ sought medical care on the ship Feb. 20 and had been sick for several days. Tarling said two waiters who served the man multiple times were subsequently infected.

If true, it could mean there was so-called community spread of the virus in California earlier than authorities have previously disclosed. California public health officials could not immediately comment.

“In order to protect patient confidentiality, we cannot provide information about specific cases such as this,” the California Department of Public Health said in a statement. Placer County officials could not be reached for comment.

Although Princess Cruises officials indicated the short period between the Placer County man boarding the ship and the onset of symptoms suggested he brought the virus on board, the incubation period for COVID-19 is still under debate. The World Health Organization puts it between one and 14 days, most commonly around five days.

There were cases of coronavirus in California as early as January, tied to travel from China.

The Placer County man self-reported the onset of symptoms to have started two to three days after boarding, according to Tarling.

Previously, President Donald Trump expressed concern that allowing passengers to leave the ship would put the U.S. at risk of a faster spread of the coronavirus. Federal and state officials have grappled with how to deal with the cruise ship, where 19 crew members and two passengers have tested positive for the virus.

Vice President Mike Pence said Saturday in a meeting with cruise line executives and port directors in Fort Lauderdale, Fla., that officials have developed a plan for passengers that will be implemented this weekend.

“All passengers and crew will be tested for coronavirus and quarantined as appropriate,” he said. “Those that require additional medical attention will also receive it.”

But few other details have been released about the plan.

Meanwhile, at the Long Beach harbor Saturday, passengers aboard the Carnival Panorama cruise ship were not allowed off the vessel while officials dealt with a “medical matter,” according to a Facebook post by the cruise director.

Long Beach city officials said on Twitter that a passenger aboard the cruise was taken to a hospital and is being tested for the coronavirus. According to the cruise director, the passenger did not meet the Centers for Disease Control and Prevention’s criteria for coronavirus risk.

The ship is docked at a Long Beach terminal, but “in an abundance of caution, (the CDC) has decided to hold passengers on board until the patient can be evaluated,” the city of Long Beach account tweeted.

Siehara Kennedy, who is aboard the cruise ship, said passengers have been waiting more than three hours to get off. Passengers are not being isolated in their rooms and have been allowed to gather in the ship’s bars and casino, she said.

Across the state, more than 80 people have been infected with the virus. In the U.S., there have been at least 439 confirmed cases, with most in Washington state, where 108 people have tested positive and 16 have died. More than 100,000 people have become infected worldwide, according to the World Health Organization.

But in California, it is the Grand Princess cruise ship that has been causing worry of a more widespread outbreak. A state source described conversations about moving passengers and crew members on the Grand Princess as fluid and said discussions on how to proceed by state and federal officials would resume Saturday.

By Saturday, the state said approximately a dozen passengers of the Grand Princess cruise that returned to San Francisco on Feb. 21 had tested positive for the virus. Local officials reported four cases in Placer County, two in Contra Costa County, two in Sonoma County and one each in Santa Cruz, Ventura, Madera and Alameda counties tied to the cruise.

On Saturday morning, Santa Cruz County public health officials also confirmed a coronavirus case. The county’s public health division said in a news release that the person had been on a cruise from San Francisco to Mexico between Feb. 11 and Feb. 21. They are working to determine whether the person came in contact with anyone else.

The Placer County man who died after returning Feb. 21 from the voyage to Mexico is the state’s only confirmed COVID-19 fatality.

The Grand Princess was then returning from a subsequent cruise to Hawaii when it was held off the California coast. With testing still underway, officials don’t know how many of the more than 3,000 people on board have the virus.

According to a source on the ship who asked not to be identified, the boat had moved just south of San Francisco and closer to shore to allow easier U.S. Coast Guard access. But on Saturday morning, the ship moved farther offshore, about 50 miles from the coast.

Friday evening, gloves and masks were delivered to the cruise ship by helicopter, according to Negin Kamali, a spokeswoman for the Princess Cruises company. On Saturday morning, a critically ill passenger and their companion were evacuated from the ship by a Coast Guard cutter.

“They are being transported to a shoreside medical facility for treatment unrelated to COVID-19,” Kamali said. “The captain of Grand Princess and the Princess Cruises port operations team continue to await specific directives from state and local response operations about where the ship will proceed.”

Media outlets reported that one person aboard the cruise has cancer and needed to be removed to receive chemotherapy treatment.

Pence said the federal government is working with the state of California to bring the cruise ship into a noncommercial port over the weekend and quarantine those aboard as necessary.

Trump said he would ultimately let Pence, who leads the task force in charge of the response, decide whether to allow passengers to leave the ship. But he said several times that he would be inclined to leave them on board because bringing them ashore would increase the number of official cases on American soil.

“I like the numbers being where they are. I don’t need to have the numbers being doubled because of one ship,” Trump said.

“A lot of people think we should do it the other way,” he said. “We have to take care of Americans.”

Karen, a Canadian passenger on the Grand Princess who asked to be identified by only her first name, said she fears what could come next.

“I’m not afraid of this virus,” she said. “I’m terrified of a quarantine on board.”

“That changes things,” said another person on the ship. “I’m not going home anytime soon.”

Passengers on the vessel _ current and those who may have been exposed earlier _ told the Los Angeles Times that the response to the outbreak by the company and health officials had been filled with missteps.

In particular, passengers said that Princess Cruises was lax on health screening protocols before boarding and withheld information about the risks they faced, even as the ship’s situation became international news.

At a White House briefing, federal public health officials could not say precisely how many people have been tested for the virus.

They said 5,861 specimens have been taken by federal, state and local public health labs. But most patients give at least two samples, one from the nose and a second from the throat.

But Dr. Stephen Hahn, commissioner of the Food and Drug Administration, promised a massive expansion of testing availability in the coming days. The CDC has shipped out 75,000 tests to public labs in 48 states and 1.1 million tests to commercial labs, with another 1 million tests going out Monday.

That’s enough for roughly 850,000 patients under the current protocols.

Elsewhere in the state, panic over the coronavirus has led to canceled classes and events. The Elk Grove Unified School District, the largest in Northern California, announced Saturday it would close schools and cancel all student activities _ including a prom _ for a week to buy time and decide next steps.

Superintendent Chris Hoffman said no students have tested positive for the virus, but some parents and family members have.

“I don’t know where this is going,” he said in a news conference. “I don’t know that anybody knows where it’s going.”

Stanford University said that it would shift classes online for the final two weeks of the winter quarter after a faculty member in the School of Medicine tested positive for the coronavirus. School officials said the clinic where the faculty member worked was closed over the weekend for cleaning.

USC said it would conduct lectures and seminars online rather than in classrooms for three days next week as a test should the campus be forced to suspend in-person contact.

In Silicon Valley, the film festival Cinequest postponed its second week of events because of coronavirus concerns.

“In keeping with the health safety directive from the Santa Clara County Public Health Department, and the concerned request from San Jose Mayor Sam Liccardo, we are rescheduling the second week of this, our 30th anniversary festival, to occur August 16-30,” Cinequest co-founders said in a statement.

Washington state, where 108 people have been infected, appears to be bearing the brunt of the U.S. outbreak. Fourteen of the state’s 16 deaths are connected to the Life Care Center of Kirkland, a long-term care facility, according to Seattle & King County Public Health. Officials said 15 people in the nursing facility have been hospitalized in the last 24 hours.

In New York, Gov. Andrew M. Cuomo declared a state of emergency Saturday after the number of confirmed coronavirus cases in the state rose to 76.

By Alejandra Reyes-Velarde, Anita Chabria, Melody Gutierrez and Noah Bierman, Los Angeles Times

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