A Richmond woman has died from COVID-19 — the third death confirmed in the city — as the coronavirus begins to spread outside of long-term care facilities that have suffered most.

The hardest hit is still Canterbury Rehabilitation & Healthcare Center, a skilled nursing center in western Henrico County that confirmed two additional deaths on Wednesday, bringing the total to 11. It has also reported 37 infected residents and 25 staff, a fourfold increase in confirmed cases among workers there.

The two latest fatalities at Canterbury were women, one in her 90s, who died at the center Tuesday, according to Dr. Danny Avula, director of the Richmond and Henrico health districts. The home accounts for almost half of the 103 positive cases of the disease in Henrico.

Avula said Wednesday that the Richmond woman died overnight after a short hospital stay. She was in her 90s, with underlying health conditions, he said.

All three Richmond deaths — including two men in their 70s who worked for Greyhound — involved people living outside of long-term care facilities where most of the first deaths from COVID-19 occurred in the region.

“These are individuals living in the community with their families as they contracted the virus and lost their lives,” Avula said in an interview.

“It’s not just frail people living in long-term care facilities,” he said. “It’s impacting our neighbors and friends.”

Richmond has confirmed 67 cases of COVID-19, including eight at a nursing home in the city’s Randolph neighborhood near Maymont Park.

Bob Crouse, president and CEO of The Virginia Home on Hampton Street, said Wednesday that two more residents had tested positive for the virus. The new cases bring the total to seven residents and one employee.

“All positive residents are on the same floor,” Crouse said in an email. “All but one on the same wing.”

Avula expects a sharp increase in the number of positive COVID-19 cases in nursing facilities as the health department receives results from expanded testing at nursing homes that have been at the center of the disease spread in the region.

“We will have an update [on Thursday] and they will be significantly higher,” he warned.

However, the expanded testing is aimed at identifying residents and workers who don’t show symptoms but could be spreading the disease. About half of the residents of a nursing home in the Seattle area who tested positive for the virus didn’t show the classic COVID-19 symptoms — fever, coughing and labored breathing — but he said the range of potential symptoms may be broadening.

“Every few days, it feels like another layer of the onion has to be pulled off,” Avula said.

In addition to The Virginia Home and Canterbury, the Masonic Home of Virginia in eastern Henrico now has five confirmed cases — four residents and one employee. One additional resident has tested positive in the past day.

Beth Sholom Senior Living has three cases, none in the past three days, the public health director said.

Avula cautioned that the spread of coronavirus is “starting to ramp up” in the Richmond region.

“I can’t imagine we’re going to see it slow down until the end of May or beginning of June,” he said.

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