(CNN)Some friends thought Donna Wade was crazy for taking her teenage son to a baseball tournament in the Dominican Republic this week and staying at the same hotel complex where several Americans died mysteriously.
"Everybody has heightened their level of alert," said Wade, a resident of Bunn, North Carolina. "But we've had a great time sitting by the pool, walking around and hanging out at the beach."
The concerns among tourists and tourism officials comes as seven deaths have gotten recent attention and families have raised questions about the circumstances. The unease also follows Sunday night's shooting of former MLB star David Ortiz -- one of the country's most beloved personalities -- at the Dial nightclub in Santo Domingo.
"Maybe this is not the best time to go," said Demetrius Lockwood, a Florida corrections officer who canceled a late-summer vacation with friends to the Dominican Republic.
Tourism Minister Francisco Javier Garcia has insisted his country is a safe destination. He said the deaths were unrelated.
"These cases are very regrettable, but isolated," he said in a statement. "Investigation into them is a top priority for us and for the National Police. We are asking them to deploy all resources to help provide answers as quickly as possible."
Dominican government spokesman Roberto Rodriguez Marchena and others this week started reusing the hashtag #BeFairWithDR -- which the officials have used before to counter negative publicity.
"Cheerful, welcoming and hospitable, our Dominican Republic, the economy that grows the most in America, with its beautiful beaches and mountains, its tasty gastronomy and hardworking people invites you to know and love it," he tweeted.
Tourism last year represented more than 17% of the country's economy, according to the World Travel & Tourism Council.
About 6.5 million tourists visited the Dominican Republic last year, more than any other Caribbean nation, according to the Caribbean Tourism Organization. The United States accounted for 2.2 million of those tourists -- more than any other country in the region.
Forty-eight Americans died in the Dominican Republic between 2016 and 2018, according to statistics available on the US Department of State website. The statistics, which do not cover deaths from natural causes, include drownings, homicides, suicides, vehicle and other accidents.
At least seven US citizens have died in the last year
US State Department and family members have confirmed the deaths at least seven American citizens in the Dominican Republic in the last year.
• Nathaniel Holmes, 63, and Cynthia Day, 49, missed their scheduled checkout time at the Bahia Principe La Romana on May 30. Their hotel is located at the same resort. When hotel employees checked on the Maryland couple, they were dead, police said.
The couple had internal bleeding, including in their pancreases, according to Dominican authorities. Holmes had an enlarged heart and cirrhosis of the liver -- both signs of significant pre-existing disease, the Dominican authorities said, and Day also had fluid in her brain. The couple also had fluid in their lungs, Attorney General Jean Alain Rodriguez Sanchez's office said in a statement. Authorities wouldn't provide more details on the cause of death until toxicology results are completed.
• Miranda Schaup-Werner of Whitehall township, Pennsylvania, suffered from a heart attack, pulmonary edema and respiratory failure, according to a preliminary autopsy cited by the Attorney General's Office of the Dominican Republic. Toxicology results are pending and the death remains under investigation.
She had checked into the Bahia Principe resort in La Romana on May 25 and excitedly took pictures in the room she shared with her husband, Dan Werner. They were celebrating a wedding anniversary. She had a drink from the minibar and suddenly felt ill, family spokesman Jay McDonald told CNN affiliate WFMZ. Shortly afterward, she collapsed and died.
• John Corcoran died at the end of April in his hotel room in the Dominican Republic, according to a statement from his sister, businesswoman and "Shark Tank" TV star Barbara Corcoran. "He passed away from what is believed to be natural causes," the statement said. "He loved and frequently visited the Dominican Republic."
• Robert Wallace, 67, a resident of Turlock, California, died after becoming ill at the Hard Rock Hotel & Casino in Punta Cana on April 12, relatives told CNN affiliate KTXL-TV. More than two dozen members of his family were in the Dominican Republic for a wedding. Tommy Tickenhoff, his son in law, told the station that Wallace became sick after drinking scotch from a minibar.
The US State Department confirmed the death. The Hard Rock Hotel & Casino Punta Cana, in a statement, did not discuss the particulars of the case but confirmed the death. It said it was awaiting official reports in the death and added, "The safety and wellness of our guests ... is now, and has always been our highest priority. We are confident that all operational protocols were followed to ensure the safety of our guests. While we are deeply saddened by these incidents, and our thoughts go out to all of those affected, we, along with the general public, will be monitoring the facts as they unfold surrounding these events."
• David Harrison, 45, of Brandywine, Maryland, died at the Hard Rock Hotel & Casino in Punta Cana on July 14, according to his wife, Dawn McCoy. They were celebrating an anniversary. She said her husband returned from a snorkeling excursion one day earlier and he said he wasn't feeling well. Early the next morning, she said, he was sweating and unable to get up before he died. The cause of death was listed as a heart attack and pulmonary edema by local authorities.
• Yvette Monique Sport died in June 2018 at the Bahia Principe in Punta Cana, her sister, Felecia Nieves, told CNN. She had traveled there June 22 with a group of friends, her first vacation in eight years, Nieves said.
Sport, a resident of Pennsylvania, took a shower and went to bed after having drinks with her fiance, Nieves said. Sport also had a drink from the minibar, she said. Her fiance heard her make "a gurgling sound" in her sleep, Nieves said. The next morning, Nieves said he discovered that she was dead. The family is still awaiting toxicology reports. The US State Department confirmed the death.
Health inspectors to visit hotels
Health inspectors, including environmental health and epidemiology specialists, visited the hotels, according to Carlos Suero, spokesman for the Ministry of Public Health.
"In the last five years, over 30 million tourists have visited the Dominican Republic, but this is the first time the international media report such an alarming situation," Garcia said last week, seeking to downplay the deaths. "These are isolated incidents and the Dominican Republic is a safe destination."
In a statement, the US Embassy in Santo Domingo said Tuesday it is "actively working" with Dominican authorities Republic to ensure that American citizens are safe. It said Dominican officials have asked for FBI assistance for further toxicology analysis on the recent Bahia Principe,La Romana cases.
The State Department has not issued a travel warning, and American officials have not said the deaths were connected.
"The safety and security of U.S. citizens that live in, work in, and visit the Dominican Republic remains our highest priority. These incidents are tragic and we offer our deepest condolences to those personally impacted," the State Department said.
Matthew Bradley, regional security director for the risk management firm International SOS, said in a statement that the Dominican Republic is still a safe destination.
"These incidents, while recent, in my mind don't indicate Dominican Republic is any less safe than it was before," Bradley said. "I would tell people to continue with trips."
Dr. Robert Quigley, senior vice president and regional medical director for International SOS, said travelers should visit a doctor before their trip, "especially if they might have a chronic medical condition or cardiovascular disease." He said sleep deprivation and stress can "exacerbate underlying, and sometimes asymptomatic, serious cardiovascular diseases."
Arrests in shooting of baseball star
Ortiz is recovering in the intensive care unit at Massachusetts General Hospital after being flown to Boston to continue his treatment, his wife, Tiffany, said in a statement.
Ortiz, 43, and a friend were shot Sunday night in the Dominican capital. The bullet went through Ortiz's stomach, a national police spokesman said. The motive is unclear. The alleged gunman, Rolfi Ferreira Cruz, 25, has confessed to shooting Ortiz, police said in a statement.
Authorities believe Ferreira Cruz and six other men were involved in the shooting of the former MLB all-star.
'Nothing but great experiences'
Bobby Minor, head of baseball operations for the Cepeda Caribbean Classic, which has brought about 60 families from throughout the United States to the Dominican Republic for a youth tournament, said only one mother decided not to make the trip with her son.
"Out of 60 families, we had maybe five or six that wanted to know what's going on," he said. "We talked to them and shared things objectively with them and they've had no issues."
Minor said the tournament also had 60 families in the Dominican Republic in June 2018, at the Grand Bahia Principe Hotel La Romana.
A Colorado couple who stayed at the same resort at the same time claimed they became violently ill after being exposed to what they suspect were insecticides spread through the air conditioning system.
Kaylynn Knull, 29, and her boyfriend Tom Schwander, 33, filed a lawsuit earlier this year against the owners of the hotel, blaming them for causing their sickness. A spokeswoman for the hotel would not comment on the allegations, citing the pending litigation.
But Minor says his group experienced no issues.
"We didn't have anyone get sick," he said. "We didn't have any problems with anything."
More than 150 players and their family members have traveled to Dominican Republic for the tournament, Minor said.
"We've had nothing but great experiences," he said. "We've left the resort. I never felt unsafe. I drink from the minibar."