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Ontario has identified seven schools with elevated levels of carbon monoxide that will require re-tests of all the schools and one of the Ontario hospitals, while seven homes and motels have entered the state’s first known Enterovirus (EV-D68) outbreak. The outbreak is linked to 25 people across Ontario and British Columbia who have died, and there is now a separate event in Fort Smith, Alaska, where two children have died.

The Medical Officer of Health for Ontario says every school and hospital in the province will require re-test because of higher levels of carbon monoxide than the records and systems for detection can handle. They also say there were 52 cases of acute carbon monoxide poisoning in the province in June. Meanwhile, almost 900 people have complained of a similar condition, known as AFM.

Eligible Ontario residents would be eligible for expedited screening as well.

The infections, are believed to be tied to the common RV equipment and some of the vehicles’ spigots and heating systems. The Centers for Disease Control and Prevention is stepping up its investigation.

“It’s different from the other respiratory problems that we see,” Dr. Bechara Choucair, the chief medical officer of health for the city of Toronto, said at a news conference Wednesday. “These guys are gasping for air.”

One of the other states with exposure issues is Maine, where two school districts have noticed cases and the hospital has been seeing an increase in children presenting with respiratory problems.

The U.S. Attorney for Oregon, Billy Williams, is also looking into reports of exposure in that state. A news release says an infectious disease team from the U.S. Department of Health and Human Services’ Immunization and Respiratory Disease Branch has been working on case counts in Oregon, while an infectious disease unit from the U.S. Justice Department is working on an ongoing investigation.

Late on Tuesday, CDC Director Dr. Tom Frieden said he was “gutted” to learn about the deaths in northern California. The CDC hasn’t been made aware of any deaths outside the northern California outbreak, but it’s investigating.

It is uncertain whether the other 49 states that have seen symptoms for the last 15 years, such as AFM, CFV, CKDu and Dengue fever, have any cases to show for. There is still no way to tell how many cases could exist, because reporting of the disease isn’t standard and people may not report their illnesses, Frieden said.

The world’s first documented case of Enterovirus is from Germany, and no one in the U.S. has ever been infected with the rare strain. However, a study published in The New England Journal of Medicine, linked to a number of Japanese children in 2009 and 2010 who experienced symptoms similar to a form of Enterovirus.

It isn’t clear how many people could have become infected, and whether the new infection is linked to a similar illness in Germany. However, related diagnoses are less common, Frieden said.

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