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As COVID-19 spreads in the United States, what does that mean for Canada?

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U.S. officials reported the country’s sixth COVID-19 death Monday afternoon as an outbreak continues to spread, with 91 cases reported in at least 10 states.

With an increasing number of cases not linked to travel, what does a U.S. outbreak mean for us across the border in Canada?

Nothing good, experts say.

“The larger the burden of illness in the United States would just translate to a larger probability that we could see imported cases from the United States,” said Dr. Isaac Bogoch, an infectious disease specialist at Toronto General Hospital.

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It’s actually hard to say how large the burden of illness is, he said.

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Part of the problem is that doctors across the country have had a hard time getting tests. The first batch of COVID-19 tests sent out by the Centers of Disease Control and Prevention had problems, delivering inconclusive results.

“There’s been quite a few issues about the diagnostic assays that have been released from the CDC to the various states,” said Dr. Matthew Oughton, an attending physician at Montreal’s Jewish General Hospital, and an assistant professor with the McGill University Department of Medicine.

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“This has not gone as smoothly as we would have liked,” said Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Disease, on Friday.

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It’s hard to come up with a reliable test, Oughton said, as you don’t want to make it too sensitive and get a lot of false positives, or go the other way and end up with false negatives.

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On Friday, Oughton said, the province of B.C. alone had done more COVID-19 tests than the entire U.S.

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U.S. officials plan to continue to ramp up testing, in order to get a better picture of how the virus is spreading.

The CDC recently broadened its guidelines for who should be tested for the new virus to include people with symptoms but without a travel history to virus hot zones.

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More testing will bring more confirmed cases, experts said, but they cautioned that does not mean the virus is gaining speed. Instead, the testing is likely to reveal a picture of the virus’ spread that was previously invisible.

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It could shed light on a spate of recent cases in Washington state, including in a nursing home. Many of these are seemingly unconnected to travellers, which points to a potential larger problem, Bogoch said.

“We know that the underlying burden of infection in that region is probably larger than what the numbers suggest,” he said.

If the U.S. is having community-acquired infections, then they can no longer rely on a travel history in order to refer people for testing, he said.

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And as more countries report cases, travel histories become less relevant in Canada too, Oughton said.

“You’re already talking about 30 per cent of countries in the world have confirmed cases,” he said. Even if it only seems to be spreading in a few of those countries, he said.

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“At some point you stop using a geographic-based definition as the geography becomes less and less relevant.”

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Public education, like telling people to report their symptoms, will continue to be important, he said. Many of Canada’s cases so far have been among travellers who consulted health authorities when they developed symptoms after getting home.

With all of the travel between Canada and the U.S., Bogoch said, it’s likely that we could start importing cases as the virus spreads in the U.S.

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“I think it’s still in its very early phases in North America, but it’s here. It’s certainly here,” he said.

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“And with community transmission, we have to be mindful that we’ll see more of it.”

— with files from the Associated Press

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