Hey, this is an English text. I want you to translate it into the Tunisian dialect. Please follow these steps:
1. Translate step by step and highlight differences between Tunisian dialect and Modern Standard Arabic.
2. Highlight sections you are confident translating into the Tunisian dialect.
Translate this text into the Tunisian dialect, focusing on capturing the essence of the language nuances:

Since the first US case of coronavirus disease 2019 (COVID-19) infection as identified in Washington State on January 20, 2020, more than 235 000 cases have been identified across the US in just over 2 months. Given the challenges in expanding testing capacity and the restrictive case definition of persons under investigation, the true number of cases is likely much higher. By March 17, the outbreak had expanded from several isolated clusters in Washington, New York, and California to all 50 states and the District of Columbia. As of April 2, there have been more than 5000 COVID-19–associated deaths in the US. With a global total now of more than 1 million cases, the US is now the country with the largest number of reported cases, comprising about one-fifth of all reported infections. With community transmission firmly established, the US epidemic enters the exponential growth phase in which the number of new cases is proportional to the existing number of cases. This phase continues until either enough susceptible individuals become immune as a result of infection, stringent public health measures are followed, or both. Case Fatality A yet unanswered question that adds to uncertainty around the outbreak involves the case-fatality rate (CFR), defined as the percentage of deaths among all cases. Presently, global mortality is reported at 4.7% but this varies widely by location from a high of 10.8% in Italy to a low of 0.7% in Germany. Several factors influence the CFR including a reliable estimate of the total number of cases. Among the first 140 904 cases in the US, 1.7% died; however, given the uncertainty in the denominator, this is not a reliable CFR estimate. For example, the crude CFR in Wuhan, China, was reported to be 5.8% on February 1, whereas more methodologically robust estimates using novel methods to estimate the actual number of cases reported the CFR as 1.4%.1 In the coming weeks, surge capacity at US hospitals will influence the CFR. However, to have reliable estimates, better approximations of the overall population (denominator) are essential, and methods such as serosurveys using statistical sampling generalizable to the populations of interest will inform these estimates. New Clinical and Epidemiological Insights Is PCR Always Positive? What Is the Meaning of a Negative PCR? Several types of tests are being used to identify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).2 These can be classified into 2 general categories: molecular diagnosis/polymerase chain reaction (PCR)–based testing and serological testing. In clinical settings, PCR-based testing remains the primary method of identifying SARS-CoV-2. Given the lack of a reference standard for diagnosing COVID-19, the sensitivity and specificity of diagnostic testing are unknown. In addition, inadequate sample collection may reduce test sensitivity. In a study of 5 patients, individuals with chest computed tomography findings compatible with COVID-19, and a negative reverse transcriptase (RT)–PCR result for SARS-CoV-2, tested positive on subsequent testing, suggesting that certain patients (eg, with compatible radiological findings) might require repeat testing with specimens collected from multiple sites in the respiratory