The deaths of at least nine American tourists in the Dominican Republic during the past year has sparked many questions but few answers about the safety of a stay on the Caribbean Island.

On Tuesday, the U.S. State Department confirmed the death of another American tourist in the Dominican Republic. Joseph Allen, 55, of New Jersey died at his hotel last week. Allen is the eighth American to die at Dominican Republic hotels in the past year. One man is said to have died at a private home.

Here is what we know about the deaths that have taken place so far.

Who has died at DR resorts since January 2019:

January 2019

  1. Jerry Curran, 78, died at the Dreams Resort in Punta Cana.

April 2019: 

  1. John Corcoran, brother of Barbara Corcoran of "Shark Tank" fame, died at a private home from what his family said was a heart attack.
  2. Robert Bell Wallace, 67, of California, fell ill while staying at the Hard Rock Hotel and Casino in Punta Cana. He died after being admitted to the hospital.

May 2019

  1. According to her family, Miranda Schaup-Werner, 41, of Pennsylvania, consumed a drink from a resort minibar at the Bahia Principe Hotel in La Romana on May 25 and died within hours.
  2. On May 30, Maryland residents Nathaniel Holmes, 63, and Cynthia Day, 49, were found dead at the Bahai Principe Hotel by the staff members.

June 2019

  1. On June 10, Leyla Cox, 53, of Staten Island, New York, was discovered dead in her hotel room at the Excellence resort in Punta Cana.
  2. Three days later, Joseph Allen, 55, of New Jersey, died in his room at the Terra Linda hotel in Sosua.

Two deaths were reported at resorts in the Dominican Republic last year.

June 2018

  1. Yvette Monique Sport, 51, of Glenside, Pennsylvania, had a drink from her room's minibar at the Bahai Principe in Punta Cana and died.

July 2018

  1. David Harrison died at the Hard Rock Hotel and Casino in Punta Cana while on vacation.

What has been the cause of death for the nine people?

In some cases, the cause of death has not been released. In some cases, toxicology tests have not been completed.

Pulmonary edema (fluid in the lungs) has been listed as contributing to the deaths of Schaup-Werner, Day and Holmes. All three also had enlarged hearts and internal bleeding.

Sport’s cause of death was listed as a heart attack.

Harrison, according to his widow, had a heart attack. An autopsy also showed he had fluid in his lungs.

Tom Inglesby, director of the Johns Hopkins Center for Health Security, told the Washington Post that pulmonary edema, bleeding and vomiting blood, are “consistent with poisoning,” perhaps accidental.

“It’s rare for travelers to die of unknown causes like this, and to have a high number of them in a relatively short period of time is alarming, shocking, sad,” Inglesby told the Post. “It’s something that investigators should be able to get to the bottom of.”

What would cause fluid in the lungs?

Some causes of pulmonary edema include:

  • Congestive heart failure
  • Heart attacks
  • Abnormal heart valves
  • Acute respiratory distress syndrome (ARDS) caused by severe infections, trauma, lung injury, inhalation of toxins, lung infections, cocaine smoking, or radiation to the lungs
  • Brain trauma or bleeding in the brain

Could it be the hotels?

No official has said that something at the hotels could have caused the deaths.

Of the nine U.S. tourists who died, four stayed at Bahia Principe resorts: Schaup-Werner, Holmes, Day and Sport.

Two died at the Hard Rock Hotel and Casino: Harrison and Wallace.

Two of the other three who died were staying at different hotels: Curran at the Dreams Resort; Allen at the Terra Linda Hotel. Corcoran was reportedly staying at a private home.

Have others reported being sick?

On Tuesday, reports surfaced about a group of fans of singer Jimmy Buffett falling ill after attending a concert in the DR in April.

Nearly 50 Buffett fans suffered from vomiting, diarrhea and fever.

A group of around 40 Oklahoma high school graduates on a trip in early June fell ill after eating at a Japanese restaurant managed by the Hard Rock Hotel & Casino in Punta Cana.

A couple from Colorado – Kaylynn Knull and Tom Schwander — told CNN they became violently ill while staying at the Grand Bahia Principe La Romana in June of 2018. They claim they were exposed to chemicals that are found in pesticides and have sued the hotel.

Another couple, Doug Hand and Susie Lauterborn, reported getting sick while staying at the Bahia Principe La Romana in January 2018. Hand told the Washington Post he noticed a “mildewy” smell from the air conditioning system.

More than 1,000 people have claimed on the website iwaspoisoned.com, that they became sick while visiting the Dominican Republic, the Post reported.

What do authorities in the Dominican Republic say?

Local officials say the deaths are "unrelated and isolated", and likely the result of natural causes.

However, Dominican authorities asked for help with toxicology analysis in investigating the deaths of Schaup-Werner, Holmes and Day, according to the FBI.

“The U.S. Embassy in Santo Domingo is actively working with the Government of the Dominican Republic and the private sector at the highest levels to ensure that U.S. citizens are safe and feel safe while in the Dominican Republic,” the embassy said in a statement.

The FBI should have toxicology reports back within 30 days, the statement said.

Should I be concerned about traveling to the Dominican Republic?

The U.S. State Department has issued a "Level 2" (out of four) warning for tourists considering traveling to the Dominican Republic. The warning is based on a high level of crime, not for possible health risks.

How many Americans visit the Dominican Republic each year?

Around 2 million U.S. residents travel to the Dominican Republic each year. That number represents about a third of all tourist visiting the country each year.

A golf course at Punta Cana in the Dominican Republic.
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