The Hawaii Department of Health announced Monday night that an Oahu adult is the first state resident to die from COVID-19, the novel coronavirus.

The person died Friday and suffered from multiple underlying health conditions, according to DOH. The available history for this person suggests they had a potential indirect travel-related exposure.

The department said “the person had been tested at a clinical commercial laboratory, and the results were indeterminate. Follow-up testing today, by the State Laboratories Division, confirmed COVID-19.”

Additionally, 21 more people were confirmed to have COVID-19 on Monday, taking Hawaii’s total case count to 77.

A dozen new cases were confirmed in Honolulu, along with two more cases in each of Hawaii and Maui counties. The state says five cases are pending, awaiting further investigation.

Four patients have been hospitalized.

Honolulu tops the case count with 53 cases, followed by Maui County with 11, Hawaii County with five cases, and Kauai county with three cases to date.

As more testing is conducted by private laboratories in conjunction with the state Department of Health’s case investigations and random surveillance, officials say to expect case numbers to continue to rise.

Hawaii Department of Health director Bruce Anderson said Monday that the department strongly supports the ‘stay-at-home’ and ‘work-at-home’ directives that have been implemented at the county level, and he expected to see a similar mandate state-wide soon.

“We ask everyone to abide by these orders to reduce the risk of spread,” Anderson said. “The stay-at-home orders, social distancing and everything being done are directly related to the ability of hospitals and healthcare providers to handle the increasing number of patients. We want to keep the incidence of disease down where the hospitals can handle it.”

More than 3,300 tests have been performed by private clinical labs to date, according to DOH. The agency’s own labs have tested 103 patients, most of whom are seriously ill, and done 263 surveillance tests, all of which have come back negative.

Dr. Sarah Park, state epidemiologist, said Monday it was encouraging that no positive results for COVID-19 have resulted from the state’s randomized sentinel surveillance testing. That signals there is no widespread community transmission, at least no documentation of it yet.

“There will likely be localized pockets of transmission and we hope it stays that way,” she said. “If we all do our part we have a fighting chance to prevent what is already happening in other states.”

Approximately 80% of COVID-19 patients are Hawaii residents who have returned to the islands after traveling on the mainland and abroad.

More than 42,200 cases have been documented in the U.S. to date, and about 470 people have died.