Update: This story has been changed to reflect an update in positive cases.

Thirty-eight coronavirus cases and two deaths have been reported at a Johnston County rehabilitation and nursing center, according to a news release.

The county health department reported 11 new cases of COVID-19 at Springbrook Rehabilitation and Nursing Center in Clayton Wednesday night, bringing the total to 15.

By Thursday, the number rose to 26 cases there — 20 residents and six staff members. The two people who died are residents at the facility, the news release said.

By Saturday, that number became 40: 29 current and former residents and 11 staff members.

Principle Long Term Care Inc., the center’s parent company, had not responded to The News & Observer’s messages as of 3 p.m. Thursday.

The announcement comes as Gov. Roy Cooper announced an outbreak of 60 cases and two deaths connected with an Orange County skilled nursing facility. The governor said seven of those 60 people are hospitalized and more cases from that center are likely to come.

In Moore County, at least 50 people at a nursing facility in Pinehurst have tested positive for COVID-19, according to that county’s health department.

Johnston County has 91 confirmed cases with 18 people currently hospitalized and four deaths, according to a news release April 10.

The new cases at Springbrook came after the outbreak of four cases was first reported April 4: three residents and one staff member.

Eighteen of the 21 outbreaks throughout the state are in long-term care settings, Dr. Mandy Cohen, Secretary of the Department of Health and Human Services, said Wednesday afternoon.

Thirteen of those outbreaks are in nursing homes. Outbreaks refer to two or more laboratory-confirmed cases, according to DHHS.

DHHS officials previously suggested staff members wear protective gear but had not made it mandatory.

The state will now require all nursing home staff members to wear masks, close communal areas, screen staffers daily and report all new or suspected cases to the state health department, state officials said Wednesday.

When infections are diagnosed, those residents must be moved to another part of the facility to isolate them from residents who don’t have COVID-19.

This story was originally published April 8, 2020 at 9:58 PM.