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Health officials across the country are stepping up efforts to catch and contain the novel coronavirus, but are facing questions about whether Canada is doing enough to stop the spread.

There is one confirmed and one presumptive case of the virus, known as 2019-nCoV, in Ontario. But other cases are under investigation and federal and provincial health leaders warn that the number of cases will likely grow.

“Given global travel patterns, it would not be unexpected to have more cases reported in our country in the coming days,” said Theresa Tam, Canada’s chief public health officer.

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Health officials emphasize that the overall risk to the public remains low.

On Tuesday, Ontario said it is testing and monitoring 11 patients who may have the new coronavirus, down from 19 patients on Monday.

Dr. Tam said Monday that the Public Health Agency of Canada will be placing more public-health staff at the Vancouver, Toronto and Montreal airports to help border services agents assess passengers and inform travellers returning from China of the potential risks. Earlier this month, those airports introduced new screening measures, including signage and questions for travellers returning from Wuhan, the epicentre of the outbreak in China.

Travellers are seen wearing masks at the international arrivals area at the Toronto Pearson Airport on Jan. 26.

COLE BURSTON/AFP/Getty Images

Ontario also announced Monday it is adopting new measures to protect paramedics. People who call 911 will now be asked about their symptoms and recent travel history in order to allow paramedics to take proper precautions.

Global concern over the new coronavirus have increased substantially in the past week, after health officials confirmed the virus can be transmitted from human to human. It’s still unclear how easily the virus spreads and how many of those infected will become seriously ill.

Despite claims from a Chinese health official that asymptomatic patients can spread the illness, Dr. Tam and other infectious disease specialists say there is no evidence to support the claim.

“So far, we haven’t seen any clear evidence of patients being infectious before symptom onset,” Dr. Tam said.

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As of Monday night, nearly 4,500 people have been sickened by the virus and 106 have died. The vast majority of cases are in China.

In Ontario, the infected individuals are a husband and wife who recently travelled to Wuhan and returned to Toronto on China Southern Airlines Flight 311 from Guangzhou on Jan. 21, during which they may have exposed some passengers to the virus. The Canadian National Microbiology Laboratory confirmed the husband’s case on Monday and is expected to verify his wife’s case in the next day.

The husband experienced a dry cough and muscle aches during the flight to Toronto from Guangzhou, said Eileen de Villa, Toronto’s medical officer of health. According to officials, he and his wife wore face masks during the flight.

Dr. Tam said the man participated in airport screening upon arrival in Toronto last week and informed officials he had recently been to Wuhan. He was questioned by a border services agent, but his symptoms were so mild that they did not trigger any further investigation. The couple was sent home with information about what to do if they felt sick in the next two weeks, Dr. Tam said.

Barbara Yaffe, Ontario’s associate chief medical officer of health, said it’s not unexpected that the man’s symptoms didn’t trigger an investigation.

“I’m guessing that the person may not have felt that ill. And of course, who doesn’t feel lousy after a 16-hour flight?” she said.

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Canada's chief public health officer says officials are trying to track down other passengers on a flight from China to Toronto in the wake of Canada's first case of coronavirus. The Canadian Press

A private school in the Greater Toronto Area confirmed Monday that two parents of students at the school were passengers on the same flight as the Ontario patients. “The parents have been in contact with public health and have voluntarily agreed to keep their families in quarantine for 14 days as a precaution,” said Dionne Malcolm, a spokeswoman at the Toronto Montessori School in Richmond Hill.

In the House of Commons on Monday, Conservative MP Todd Doherty questioned why Canada hasn’t increased its airport screening measures and asked when the government will institute “a real plan.”

In response, Health Minister Patty Hajdu said the government has been well ahead of the World Health Organization’s strategies in terms of screening at ports of entry.

She said there are “multiple measures” to alert travellers from affected regions about what to do if they suspect they have an illness, adding that Canada Border Services Agency officers are also trained to ensure they have the tools they need. Global Affairs increased their risk level for the province of Hubei on Monday, urging Canadians to avoid all travel there.

Partner airlines are also sharing information with passengers, she said.

“We will continue to monitor the situation and add additional measures as necessary,” Ms. Hajdu said.

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Despite growing calls for enhanced airport screening, evidence shows such measures are not effective. For instance, a 2005 study published in the journal Emerging Infectious Diseases found that airport screening in Canada during the SARS outbreak failed to identify a single case in travellers. Canada’s screening measures during that outbreak included detailed questions for travellers to SARS-affected areas, as well as infrared scanning machines to detect heightened body temperature.

Tony Clement: The coronavirus is now in Canada, but thanks to the lessons of SARS we are better prepared

“There’s no perfect screening system in an airport,” said Barbara Yaffe, Ontario’s associate chief medical officer of health.

Isaac Bogoch, an infectious-diseases specialist at Toronto General Hospital, said airport screenings are resource-intensive and will likely miss a lot of illnesses, but could still serve a purpose. But what’s even more important is for all travellers coming from the Wuhan region to be aware of the potential risks, to monitor themselves for any symptoms and to speak with health providers if they become sick, he said.

In the case of the infected Ontario couple, the man called 911 the day after returning home when he developed a fever and other symptoms. He informed the dispatcher of his travel history, allowing paramedics and hospital staff to wear proper protective gear. His wife remained in self-isolation since she returned to Canada last week. Her symptoms are mild and she continues to be treated at home, said David Williams, Ontario’s chief medical officer of health.

Officials said there are no others living at their home. Toronto Public Health is working to contact passengers seated within a two-metre radius of the couple during their flight.

Dr. de Villa said that some passengers have been contacted. If officials are unable to reach all of the passengers, Toronto Public Health may issue a public call to those individuals, she said.

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Passengers are being told that they were seated near an individual who has tested positive for 2019-nCov. Officials say they do not need to be placed under quarantine and are instead being told to monitor themselves for symptoms for the next two weeks and report any illness to their health-care provider.

Foreign Affairs Minister François-Philippe Champagne said Canada has offered its assistance to the Chinese government to deal with this situation. There are 167 Canadians registered in the Wuhan region and eight people have been in contact on consular matters. The government is responding on a case-by-case basis, he said.

Ms. Hajdu declined to say whether Canada is looking at using a plane to evacuate Canadians in China.

“We are working very closely with our counterparts to determine, first of all, if people want to be evacuated and what their particular situation is,” she said. “We are continuing to work out those details.”

With a report from Kristy Kirkup

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