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How do you stop a disease from spreading in a country where millions have no health insurance? As the U.S. government takes steps to manage the COVID-19 outbreak — including an $8.3-billion funding package — its decisions may have implications for Canada.

2:01 Canadians wait for next steps on Grand Princess cruise after 21 people test positive for COVID-19 Canadians wait for next steps on Grand Princess cruise after 21 people test positive for COVID-19

After all, the U.S. is the number one travel destination for Canadians.

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Residents of Canada made 43.8 million trips to the States last year and Americans travelled to Canada 25 million times.

Whether gaps in health care access could exacerbate the outbreak in the U.S. — and therefore leave Canada vulnerable as well — “is all really a matter of probabilities,” said one epidemiology expert.

“I think the idea is that if the prevalence [of COVID-19] goes up in the United States, in the country next to us, then there’s potential for it to spread into Canada just by virtue of travel back and forth,” said Todd Coleman, an assistant professor of health sciences at Wilfrid Laurier University in Waterloo, Ont.

In Canada, more than 50 people have been diagnosed with COVID-19, an illness caused by a new coronavirus that has infected more than 100,000 people since it emerged in China late last year.

At least four Canadian cases are tied to U.S. travel. One man recently visited Las Vegas. Three others, an Ontario couple and an Alberta woman who has been presumptively diagnosed, were on a cruise ship that sailed out of San Francisco. A Seattle woman who was visiting family in B.C. also has the virus.

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5:02 AMA Travel: Cancellation travel insurance in light of coronavirus AMA Travel: Cancellation travel insurance in light of coronavirus

The new coronavirus has spread to roughly half of the states and caused 14 deaths. More than 200 people have been infected and there are cases without any known origin.

Experts in the U.S. have called on governments to eliminate financial barriers to health care and testing in order to protect the most vulnerable and stop the virus from spreading further.

As the New York Times reported earlier this week, more than 800 groups and individuals — including public health officials — signed an open letter with a list of recommendations for the U.S. response.

“It will be critical for policymakers to ensure comprehensive and affordable access to testing, including for the uninsured,” they wrote.

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They also called for a ban on immigration enforcement at health-care facilities so individuals can seek care regardless of their citizenship status.

1:08 Coronavirus outbreak: New York officials confirm 33 reported cases of COVID-19 Coronavirus outbreak: New York officials confirm 33 reported cases of COVID-19

About 8.5 per cent of Americans — or 27.5 million — did not have insurance coverage as of 2018, according to the U.S. Census Bureau.

Coleman said that generally speaking, research shows those who are uninsured are less likely to seek medical care than those who have insurance.

Making sure these individuals don’t fall through the cracks is crucial to containing the virus.

“The only way that you can actually prevent an infectious disease is to know who has it and to prevent them from passing it on,” Coleman said.

“And right now … in terms of that, I’m not very optimistic that that’s being done properly at the moment,” he said.

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This week, Congress approved $8.3 billion to help tackle the outbreak.

The legislation will provide federal public health agencies with money for vaccines, tests and potential treatments, including $300 million to deliver such drugs to those who need it.

More than $2 billion would go to help federal, state and local governments prepare for and respond to the coronavirus threat. An additional $1.3 billion will be used to help fight the virus overseas. Another billion in funding will allow the U.S. government to provide up to $7 billion in loans to small businesses.

In California, Gov. Gavin Newsom asked health insurance companies to waive out-of-pocket fees for coronavirus testing. Similar measures are in effect in Washington state and New York.

There are also concerns, however, that the U.S. doesn’t have enough tests to assess its population for the virus.

BREAKING: we have ordered health insurance companies to waive ALL out-of-pocket costs for preventive coronavirus testing. https://t.co/5LWWoOqx2r — Gavin Newsom (@GavinNewsom) March 6, 2020

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U.S. Vice President Mike Pence, tasked by Trump to lead the coronavirus response, said Friday that more than 900,000 swab tests have been distributed across the country, with an additional 4 million expected to be shipped by the end of next week.

“We have the testing necessary to be able to provide tests to all the states that have requested it,” he said.

Anthony Fauci, the director of the U.S. National Institute of Allergy and Infectious Diseases, acknowledged issues that slowed distribution of coronavirus tests but said the overall response was going well.

“There were certainly some missteps in the beginning,” he told NBC’s Today show. “In the next couple of weeks, we should be ratcheted up to get many more out.”

Canada’s chief public health doctor was asked Friday whether Canada would consider heightened screening measures for passengers arriving in Canada from the U.S.

#UnitedStates: Cases of #COVID19 have been reported. Take precautions against respiratory and other illnesses, and seek medical attention if you become sick. Read our travel health advice for updates: https://t.co/FxiROC0RGK pic.twitter.com/uFY7MR7swT — Travel.gc.ca (@TravelGoC) March 6, 2020

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Dr. Theresa Tam said that the government is recommending that all international travellers be on the lookout for symptoms for two weeks after returning home from their destination.

“We have instituted at our land borders, not just our international airport … the necessary questions and the posters and handouts related to COVID-19 to remind that travellers crossing that land border to self-monitor for symptoms,” she said.

On Friday evening, the Canadian government updated its online travel information about the U.S. but did not raise the risk level.

“The states of Washington, California, and Oregon have confirmed limited community spread of COVID-19 in some areas, meaning that it is unknown how or where some of the cases became infected,” the web page states.

“At this time, the Public Health Agency of Canada is closely monitoring the situation and will provide updates as more information becomes available. Travellers are reminded to follow usual precautions to protect themselves from respiratory illnesses.”

–With files from the Associated Press and Reuters