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Only Half Of Patients Take Their Medications As Prescribed

Here is what we know: If people take medications prescribed to them, they usually get better. But only about half of all patients prescribed medication take it according to directions. Here is what we don’t know: We don’t know how to get patients to take their medications, despite many studies looking at the issue.

Researchers doing a review for the international Cochrane Library for health information reviewed 182 trials that were testing different approaches to increasing medication adherence and patient health. Even though the review included many of the best quality studies, there were no clear winning solutions. In fact, many of the studies had problems in their design.

“The studies varied so much in terms of their design and their results that it would have been misleading to try to come up with general conclusions,” said lead researcher Robby Nieuwlaat of the Department of Clinical Epidemiology and Biostatistics of the Michael G. DeGroote School of Medicine at McMaster University. “Based on this evidence, it is uncertain how adherence to medication can be consistently improved. We need to see larger and higher quality trials, which better take in account individual patient’s problems with adherence.”

Most trials were unreliable casting doubt on the validity of the results instead. Out of 182 trials, only 17 were of high quality and each of these tested combinations of several different approaches, such as support from family members or pharmacists, education and counseling. Still fewer, only five of these 17 showed improvements in health outcomes for patients, as well as in medication adherence.

“This review addresses one of the biggest challenges in health care,” said Dr. David Tovey, Editor in Chief of the Cochrane Library. “It’s a real surprise that the vast amount of research that has been done has not moved us further forward in our understanding of how to address this problem. With the costs of health care across the world increasing, we’ve never needed evidence to answer this question more than we do now.”

The authors have now decided to turn to the research community to help understand the issues. They have created a database of the relevant trials and made this available to other researchers in the field in order to encourage collaboration and more in-depth analyses on smaller groups of trials.

“By making our comprehensive database available for sharing we hope to contribute to the design of better trials and interventions for medication adherence,” said Nieuwlaat. “We need to avoid repeating the painful lessons of adherence research to date and begin with interventions that have shown some promise, or at least have not produced repeatedly negative results.”

Universal Health Coverage For US Military Veterans Within Reach, But Many Still Lack Coverage

Over a million US military veterans lacked healthcare coverage in 2012, according to new estimates published in The Lancet. While many people believe that all veterans are covered by the Veterans Affairs health care system, less than half (8.9 million) of the 22 million veterans in the US are covered by VA health benefits, and most veterans are covered by private health insurance. Uninsured veterans are more likely to be young, single, African American, and veterans of Iraq and Afghanistan.

However, the authors of this viewpoint estimate that universal health coverage for veterans is within reach, thanks to the Affordable Care Act and its Medicaid expansion and subsidies for private health care. According to the authors, 87% of currently uninsured veterans could be eligible for health coverage through the Medicaid expansion, via the subsidized private health insurance market, or by enrolling in VA health benefits. Uninsured veterans are more likely to be clustered in states that have rejected the ACA’s Medicaid expansion. Of the top five states with the highest number of uninsured veterans, four [1] are states that have rejected the expansion (the fifth, California, has accepted the expansion, but is also the most populous state in the union).

“Largely on account of the Affordable Care Act, the goal of universal health coverage for veterans is closer than ever,” explains author Dave A Chokshi. “There remain political hurdles to achieving this goal, both in the false impression that the VA already provides universal coverage, and the decision by several states to reject the ACA’s Medicaid expansion. While eligibility for insurance is not tantamount to access to care, universal coverage is an important first step towards high-quality healthcare.”

[1] There are an estimated 126000 uninsured veterans in Texas, 95000 in Florida, 54000 in North Carolina, and 53000 in Georgia


Your Kaiser Permanente Doctor Will See You Now—At Target – OpEd

I am a pretty severe critic of hospitals. Nevertheless, I like innovation wherever we find it happening, and it is happening in some large systems:

In a move that reflects the increasing wave of consumer-driven healthcare, Target Corporation is teaming up with Kaiser Permanente to open four in-store Target Clinics in Southern California, taking a host of services directly to thousands of customers.

The clinics opened at Target stores in Vista, San Diego and Fontana, and a fourth clinic will open in West Fullerton Dec. 6. They will be staffed by nurse practitioners from Kaiser.

While Target has maintained clinics for the past 10 years at a number of stores, the partnership will allow for a much broader array of services than it typically offered at retail outlets. Expanded services include telemedicine consultations, prescription reviews, pediatric primary care visits, OB-GYN services, vaccinations and flu shots, pediatric and adolescent care and management of chronic illnesses like diabetes and high blood pressure, according to John Holcomb, vice president of healthcare for Target. (Dan Verel, MEDCity News)

I have not been to one of these Targets, but I saw something similar in Charlottesville, Virginia, last weekend. I went to the Walmart and saw one of those convenient clinics that we like (because of their transparent pricing and—well—convenience). However, it was not operated by a national chain of convenient clinics, but Augusta Health, an integrated health system based in the Shenandoah Valley. Like other convenient clinics, it offered a range of services for listed, reasonable prices. I learned that Augusta Health had teamed up with Walmart in the Shenandoah Valley in 2011.

I also like independent physicians. However, when those physicians gripe about convenient clinics and try to block their expansion, they let an opportunity go by—one that large health systems are learning to exploit.

Oregon’s Rate Of Unneeded Antibiotics Use Remains Nation’s Lowest

Oregon’s rate of unneeded antibiotics use remains nation’s lowest, but dangerous resistance is still a problem due to continued misuse.

Oregon public health officials are seeing less resistance in bacteria most responsible for serious respiratory infections such as pneumococcus, thanks to the state’s low antibiotic prescribing rates, they say.

But people continue to misuse antibiotics, and that can lead to dangerous and potentially deadly drug resistance, says Ann Thomas, M.D., a public health physician in the Oregon Health Authority’s Public Health Division, and medical director of its Alliance Working for Antibiotic Resistance Education (AWARE) program.

“While Oregon is doing well compared with other states, we’re still seeing antibiotics being used to treat bronchitis and the cold, which is not appropriate,” Thomas says. “Such misuse promotes the development of antibiotic resistance to common respiratory infections, which can turn them into difficult-to-treat infections.”

In a 2013 report, the U.S. Centers for Disease Control and Prevention (CDC) estimated that each year in the U.S., resistant pneumococcus causes 1.2 million infections, about 19,000 hospitalizations and 7,000 deaths.

Oregon health care providers are doing their part to reduce excessive antibiotic prescriptions and keep levels of resistance low in Oregon. In 2012, only 1 percent of serious pneumococcal infections in the Portland area were resistant to penicillin, Thomas says. Clinicians can continue to help keep Oregon’s rates low by taking time to educate patients about antibiotic resistance and the possibility of serious side effects, including allergic reactions that result in a rash and anaphylaxis, that send thousands of patients to the emergency room every year.

However, Thomas is concerned about continued misuse of antibiotics for certain common infections. Oregon’s medical and pharmacy claims database shows that broad-spectrum antibiotics – drugs that can be used to treat a wide variety of different bacterial infections – were used on 55 percent of upper respiratory infections in 2011. They also were used in a majority of cases of bronchitis and the common cold – 90 percent and 66 percent, respectively – although those conditions rarely require treatment.

And the older you get, the more likely you are to be inappropriately prescribed these types of antibiotics. Only 34 percent of children 5 and younger in Oregon received broad-spectrum antibiotics for upper respiratory tract infections, compared to 40 percent of kids ages 5 to 17, and 72 percent of people aged 18 to 64.

As part of its ongoing effort to urge consumers to help reduce inappropriate use of antibiotics, AWARE, with CDC funding, is taking part in “Get Smart About Antibiotics Week” this week – November 17-21. AWARE is partnering with the Oregon State University College of Pharmacy to offer educational information and activities promoting appropriate antibiotic use and hand hygiene during a free public event called “AWARE on the Square,” set for 8 a.m. to 5 p.m. Friday, November 21, at Pioneer Courthouse Square, 701 SW 6th Avenue in downtown Portland. They also are providing free flu vaccinations for uninsured adults from 7 a.m. to 4 p.m.

Antibiotics are ineffective for treating viruses such as colds and the flu. Taking them when they’re not needed or not as prescribed increases a person’s risk for later antibiotic-resistant infections, which are more difficult to treat. These infections also require stronger antibiotics that may cause serious side effects.

Consumers also should avoid pressuring their providers to prescribe antibiotics for colds and the flu. Those who are appropriately prescribed antibiotics for bacterial infections, however, should take every dose, even if symptoms improve, since not doing so contributes to drug resistance. And they should not share antibiotics with others; someone who takes antibiotics not prescribed to them can experience adverse reactions.

Doctor With Ebola Dies At Nebraska Hospital

Dr Martin Salia, a surgeon who contracted the Ebola virus while working in Sierra Leone, has died at a hospital in Nebraska.

The 44 year-old was taken to hospital in Omaha on Saturday, but passed away on Monday according to hospital officials.

“We are extremely sorry to announce that the third patient we’ve cared for with the Ebola virus, Dr. Martin Salia, has passed away,” the hospital said in a statement, as reported by AFP. The other two patients who were treated at the facility were given clean bills of health.

The 44 year-old, who was a permanent US resident, contracted the virus while working at a hospital in Freetown, the capital of Sierra Leone, according to his relatives. He was already suffering from advanced symptoms, including kidney and respiratory failure when he arrived at the Nebraska Medical Center, which is one of four US hospitals equipped to handle treatment of the disease, and has the largest bio-containment unit in the country.

While at the medical facility in Omaha, he was treated by Dr Phil Smith. Writing, on his Twitter page, the doctor explained that Salia had received a dose of convalescent plasma and ZMapp therapy. “We used every possible treatment available,” said Dr Smith.

Salia’s wife, Isatu Salia, said on Monday that she and her family were grateful for the efforts made by her husband’s medical team. “We are so appreciative of the opportunity for my husband to be treated here and believe he was in the best place possible,” Salia said, according to AP.

Salia, who was based in the state of Maryland, but spent a significant amount of time in Freetown, had originally been tested for the disease in early November. His test came back negative leading to jubilant celebrations and embraces from worried colleagues, the Washington Post reported. However, his symptoms did not go away and he took another test on November 10, which was positive forcing everyone who had been in physical contact with the 44 year-old into quarantine

“We were celebrating. If the test says you are Ebola-free, we assume you are Ebola-free,” said Komba Songu M’Briwa, who cared for Salia at the Hastings Ebola Treatment Center in Freetown, the Washington Post added. “Then everything fell apart.”

In an interview in April, Dr Martin Salia talked about how important it was for him to work in the land of his birth and help others. He worked as a surgeon at the United Methodist Kissy Hospital in Sierra Leone.

“I took this job not because I want to, but I firmly believe that it was a calling and that God wanted me to. That’s why I strongly believe that God has brought me here…and I’m pretty sure and confident that I just need to lean on him because he sent me here. And that’s my passion,” he said in a video posted on YouTube.

Salia, who was originally from Sierra Leone, was the 10th patient to be treated on US soil for the virus. He is the second person to have died in the United States from Ebola. In October, a Liberian man, Thomas Eric Duncan, died at a Texas hospital from the virus, which has killed thousands of people in West Africa.

The current outbreak of Ebola is the worst on record. It has so far killed at least 5,177 people, mostly in Liberia, Sierra Leone and Guinea, according to the latest figures from the World Health Organization, as reported by Reuters.

OSU Professor Helps Develop Promising Ebola Drug

As the Ebola crisis in Africa continues and concern ramps up in the United States, a pharmaceutical company with a Corvallis connection is ready to respond with a limited amount of a potentially promising new drug.

Sarepta Therapeutics can provide an anti-viral drug if more people in the U.S. become infected, according to Patrick Iversen, a professor in the College of Agricultural Sciences at Oregon State University, adjunct professor in the College of Science and former senior vice president of the biotech company.

There is enough of the drug now available for about 20 treatment courses, with the promise of enough to treat more than 250 additional patients within a few months, if the company receives the funding to complete the manufacturing of the remaining drug materials.

However, to produce tens of thousands of doses of the drug, which slows down the Ebola virus in order for the body to eliminate it, it could take a year or more due to the time and staff it takes to acquire the raw materials and combine them into the drug.

“Just finding enough facilities to synthesize the drug is a challenge,” said Iversen, who is now a consultant with Sarepta. “Our scale reduces the number of options. And there’s always the bottom line. It would take a significant investment, possibly in the hundreds of millions of dollars, to manufacture drugs at the scale and rate they’re needed.”

Iversen, who led the team that came up with the treatment, has 200 medical patents and came to Corvallis 18 years ago to work with James Summerton, who was an OSU professor in the biochemistry and biophysics department from 1978 to 1980. When Summerton left to start biotech company AntiVirals, he asked Iversen to lead its pharmacology research. AntiVirals later became AVI BioPharma, changing its name again in 2012 to Sarepta Therapeutics.

The company has completed Phase 1 of the three-phase process for approval of the drug – known as AVI-7537 — by the U.S. Food and Drug Administration. In Phase 1, healthy human volunteers took the drug at doses expected to be therapeutic and experienced no ill effects. In addition, the drug was tested in multiple studies involving infected monkeys. All subjects in the control group died, but 60 to 80 percent of those in the treatment groups survived.

By the very nature of Ebola, drug development must be accomplished through the FDA animal rule, which requires efficacy established in a well-characterized animal model and safety in healthy humans. But because of the outbreak, Sarepta expects emergency approval from the FDA to use it if more people in the U.S. become infected.

The classic approach to fighting viral infections is to inhibit the function of viral enzymes and other proteins produced by infected cells. Sarepta uses its proprietary RNA-based, gene-blocking agents to target specific genes, which is more efficient and much quicker.

“By knowing the gene sequence,” Iversen said, “it can be targeted to find a therapeutic approach to a specific disease.”

Since Ebola only has seven genes, he targeted those and found VP24, the gene that makes the protein that blocks the host’s immune response, to be the most effective gene to inhibit.

“That response is the thing that makes antibodies that attack the virus,” said Iversen, who published a peer-reviewed paper on the success of Phase 1 in the November issue of the journal Antimicrobial Agents and Chemotherapy. “The reason the virus is so successful is that it goes faster than the immune system, which doesn’t have the chance to catch up.”

Once the protein was identified, it was possible to synthesize a strand of nucleic acid, called an oligonucleotide, that can bind to the viral RNA that leads to the viral VP24 protein.

“What we did is put a little clamp on the cell so it can’t make the virus’ protein,” Iversen said.

For official approval of the drug by the FDA, Sarepta needs to conclude Phase 3 human trials.

The Wellcome Trust, a global health charitable foundation, is supporting a number of humanitarian and medical efforts in West Africa in response to this Ebola outbreak, including the preparation of select treatment centers that can conduct Ebola clinical trials, Iversen said. Sarepta has positioned itself to participate.

“If they can prepare for the conduct of a quality clinical trial, we can get over there before the outbreak ends and gain valuable information about our drug in a controlled study,” he said. “That’s critical.”

Canada flag

Canada Bans Travelers From Ebola-Hit Countries

Canadian federal citizenship ministry on Friday announced that it is suspending visa applications from anyone, who has recently visited Ebola-hit countries.

“Effective immediately, Canadian visa officers have temporarily paused the processing of visa applications from foreign nationals, who have been physically present in a country, designated by the World Health Organization (WHO) as having widespread and intense transmission of the Ebola virus,” the official statement, published on Canadian government’s website, said.

According to the document, the new measures have been introduced to protect the health and safety of Canadians.

The current Ebola epidemic, one of the current global security threats, started in southern Guinea in February and later spread to other West African countries, with several Ebola cases, having been reported in Europe and in the United States.

Over 4,900 people have died from the current Ebola outbreak, with more than 13,700 confirmed, probable, and suspected cases of the virus.

What West Africa Can Teach The US About Ebola – OpEd

By Kwei Quartey

When the Texas Health Presbyterian Hospital missed a crucial diagnosis of the Ebola virus and released Liberian Thomas Eric Duncan to go home, it unleashed a sequence of events that is still unfolding rapidly.

As in the great AIDS panic, the introduction of the Ebola infection into the American populace has resulted in confusion, speculation, and hysteria. Even perfectly healthy individuals, such as American reporters who have been to the West African region, find themselves being shunned because of irrational fears.

For better or worse, the response of the authorities to this crisis will go down in history. Certain categorical declarations will particularly stand out—and in some cases return as painful ironies. As an example, in late July, Stephen Monroe—the deputy director of the CDC’s National Center for Zoonotic Infectious Disease—stated, “Ebola poses little risk to the U.S. general population,” adding that, “the likelihood of the outbreak spreading outside of West Africa is very low.”

In an effort to tamp down fears over Ebola, CDC director Thomas Frieden asserted in October that “Ebola is scary. It’s a deadly disease. But we know how to stop it.” It is unclear whether the “we” refers to the CDC, health facilities more generally, or some other entity, but this firm and sweeping assertion was called into question as news broke of the first and then a second case of Ebola transmission to Thomas Duncan’s caregivers at Texas Presbyterian Hospital.

Earlier this month, David Lakey, commissioner of the Texas Department of State Health Services, famously said of Dallas, “This is not West Africa. This is a very sophisticated city.” Still not sophisticated enough, apparently, to prevent one fumble after another.

U.S. Lapses

The supposed “mystery” as to how these caregivers contracted Ebola when they were supposedly shielded from transmission by their personal protective equipment (PPE) is actually no mystery at all.

As a physician at a wound care center in Southern California, I go through 10 to 20 units of protective gear every day, one for each patient. A quick, self-administered test on removing my PPE revealed that I did it with less than 100 percent safety. It is, quite frankly, not easy.

With Ebola, even 99 percent safety is not good enough. Many hospitals in the United States use PPE for procedures such as wound repair and colonoscopies. And in many wards and intensive care units, healthcare staff don PPE for cases of MRSA or VRE. But not only does the care required in such “ordinary” protection pale beside the vigilance involved in Ebola exposure, the PPE itself is quite different.

So the answer to whether “we,” as Frieden put it, know how to stop the virus here in the United States might well be a “no” at worst and a “sort of” at best.

Indeed, National Nurses United Executive Director RoseAnn DeMoro has claimed that there is an absence of any protocol at the Texas Presbyterian hospital on how to deal with the deadly virus. Other hospitals have opted for the World Health Organization’s Ebola protocol instead of the CDC’s because of its extra guidelines for hand sanitation.

The CDC poster for removal of PPE shows the use of only a single pair of gloves and appears highly lacking compared to the painstaking measures described by Australian nurse Sue Ellen Kovack at a Sierra Leonean Ebola treatment center. Of note in her account is the liberal dousing with a chlorine (or bleach) spray from head to toe, a chlorine hand rinse, hand washing at least eight times during the procedure, and the use of two pairs of gloves instead of just one as recommended by the CDC. On October 16, the CDC effectively admitted that its own guidelines were lax and has moved to the more exacting guidelines.

Ironically, rough-and-ready Ebola treatment centers like the tents constructed by agencies like Doctors Without Borders are much better equipped for safety procedures like the chlorine bath than many modern Western facilities. To do this in a technologically advanced U.S. hospital, separate alcoves would need to be built in designated spaces to accommodate a “spraying area.” That could be extremely complicated in the average intensive care unit.

Learning from Africa

Perhaps we in the United States are learning a small lesson in humility.

Is it possible, for example, that Nigeria, of all places, might have some wisdom to convey to the United States? Both Nigeria and Senegal moved quickly to quell an Ebola outbreak through meticulous contact tracing, coordinated national action, exhaustive interviews, and activation of an Ebola Incident Management Center. Both countries are now reportedly free of the disease.

Although the story is not yet over, the U.S. government has lauded Nigeria’s initial management of the outbreak. Indeed, the CDC has now ordered dozens of high-tech, infrared, no-touch thermometers to be used in screening procedures at U.S. gateway airports—the same ones that are already being used in West Africa.

David Lakey is right: Texas is not West Africa. But every once in a while, the West African example is worth following.

Kwei Quartey M.D. is a crime novelist and physician who grew up in Ghana. He is now based in Los Angeles. A former columnist at Foreign Policy in Focus and a contributor to The Huffington Post, he travels frequently to Ghana. His fourth novel, GOLD OF THE FATHERS, will be published in February 2016.

Court Orders Movement Restrictions On Maine Nurse Over Ebola Fears

Hickox, 33, arrived in New Jersey last Friday from Sierra Leone after volunteering there with Doctors Without Borders amidst a historically tragic Ebola outbreak. Officials in the Garden State immediately quarantined the nurse over concerns that she could spread the highly contagious disease, but subsequent tests suggested she never contracted the disease; because it may take upwards of 21 days to show symptoms, officials in Maine have insisted Hickox isolate herself from others since she returned home to the town of Fort Kent on Tuesday.

The court order — signed Thursday but not published until Friday morning — says Hickox must submit to direct active monitoring; coordinate her travel with public health authorities; not use public transportation; avoid public places, such as malls and movie theatres; avoid workplaces; stay within Fort Kent’s boundaries unless told otherwise; and “maintain a 3-foot distance from others when engaging in non-congregate public activities (i.e., walking or jogging in the park).”

According to the document, a full hearing will be held sometime between this Sunday and next in order to assess Hickox’s situation further.

Earlier this week, the nurse said she would reject the state’s attempt to have her adhere to voluntary restrictions, and Thursday morning she went for a bike ride in Fort Kent, defying officials’ orders.

That same day, the National Nurses United and an affiliated union, California Nurses Association, announced they’d be protesting next month to demonstrate against the treatment of health care workers returning from Africa.

US Issues New Ebola Guidelines For Health Workers

By Luis Ramirez

The U.S. Centers for Disease Control has issued a new set of guidelines on how to handle health care workers returning from Ebola-affected countries of West Africa. The new guidelines come as the Obama administration clashes with state governments that have recently imposed quarantines on doctors and nurses who have been in Ebola zones.

White House spokesman Josh Earnest did not go as far as openly criticizing the governments of states like New York and New Jersey for requiring health workers coming from Ebola zones to be quarantined.

But he said any policy meant to protect Americans from Ebola should be based on science and should also consider the wider implications.

“We want to make sure that whatever policies are put in place in this country to protect the American public do not serve as a disincentive to doctors and nurses from this country volunteering to travel to West Africa to treat Ebola patients,” said Earnest.

Earnest said people like Kaci Hickox are heroic. Hickox is the nurse who was quarantined in a tent by the U.S. state of New Jersey after she came back from working with Ebola patients in West Africa.

The case triggered outrage among some medical experts who criticized the measure as inhumane and unnecessary.

Meanwhile, a 5-year-old boy in New York tested negative for Ebola after arriving from Guinea with a low-grade fever.

The Obama administration has resisted calls for a travel ban or quarantines, saying the measures would hinder efforts to fight the disease at its source in West Africa.

The guidelines released by the Centers for Disease Control and Prevention are only recommendations, and the federal government cannot force the states to adopt them.

Under U.S. law, federal authorities can detain, examine, and release people arriving in the U.S. who are suspected of carrying communicable diseases, but only the states have authority to enforce isolation and quarantine laws.

The question came up Monday on whether Samantha Power, the U.S. Ambassador to the United Nations, will be scrutinized upon her return after visiting Ebola-afflicted nations.

Officials said Power will abide by the health laws of the state in which she lands, but they noted she may not be subject to quarantine since she is not a health worker.

State Department spokeswoman Jen Psaki on Monday said Ambassador Power’s delegation did not have contact with people infected with Ebola.

“She is not visiting any Ebola treatment units. They are observing all hand-washing protocols and doing temperature screenings multiple times a day,” said Psaki.

Also Monday, Pentagon officials said a small number of U.S. army soldiers deployed to help West African nations fight Ebola were put under quarantine at a base in Italy. Officials said none of the soldiers are exhibiting symptoms and are being watched only as a precaution.

White House officials continue to say the likelihood of a widespread outbreak on U.S. soil is extremely low.

Rare Footage Captures Ebola Discovery In 1976 (Video)

As the largest recorded Ebola epidemic in West Africa has infected over 10,000 people, a Belgian newspaper publishes rare footage from 1976 when the deadly virus was first identified in Congo, or in Zaire as it was then known.

The three videos were recently released by the Institute of Tropical Medicine and were published by the Belgian newspaper Het Laatste Nieuws on Tuesday.

In 1976, a group of researchers headed by Belgian scientist Peter Piot who travelled to the remote village of Yambuku in the Republic of Zaire (currently the Democratic Republic of Congo). The scientists went to Africa to study what they thought to be the Marburg virus – a hemorrhagic fever virus that was discovered a few years earlier.

However, what they found was a virus we know today as Ebola, which was named after the small river that flows near the Yambuku village.

The videos show how the researchers tending to the Ebola-infected residents wearing protective gear – gas masks and white suits – similar to the ones used today. The doctors would burn their clothing to prevent further spread of the disease.

“An epidemic of unknown origin and transmission…is really frightening. Then you ask, is this transmitted by mosquitoes, food, by water, by shaking hands, sex—the usual ways?,” Dr. Piot said in an interview to The Wall Street Journal in October.

“The first known case, a 44-year-old male instructor at the Mission School, presented himself to the outpatient clinic at Yambuku Mission hospital on 26 August 1976 with a febrile illness thought to be malaria,” according to the 1978 bulletin of the World Health Organization (WHO).

Following the man’s death in September nine more cases occurred in the first week of the same month. During this outbreak 280 deaths out of 318 cases were recorded.

Since 1976 there have been several outbreaks of the deadly virus, with the largest epidemic currently ongoing in West Africa. According to the WHO, 10,141 cases of the Ebola virus have been registered through Thursday with 4,922 deaths from the disease.

Eight countries have been affected, with Liberia, Guinea and Sierra Leone suffering the most. The virus is transmitted through blood or bodily fluids, according to the WHO. Persons infected with the Ebola may start showing symptoms – such as fever, sore throat, vomiting, diarrhea and internal and external bleeding – as soon as two days after contracting the virus.

The average EVD case fatality rate in the current epidemic is around 50 percent, while case fatality rates have varied from 25 percent to 90 percent in past outbreaks, the WHO said.

President Barack Obama convenes a meeting with cabinet agencies coordinating the government's Ebola response, in the Cabinet Room of the White House, Oct.15, 2014. (Official White House Photo by Pete Souza)

Obama: Focused on the Fight Against Ebola – Transcript

In this week’s address, the President discussed the measures we are taking to respond to Ebola cases at home, while containing the epidemic at its source in West Africa. This week we continued to focus on domestic preparedness, with the creation of new CDC guidelines and the announcement of new travel measures ensuring all travelers from the three affected countries are directed to and screened at one of five airports. The President emphasized that it’s important to follow the facts, rather than fear, as New Yorkers did yesterday when they stuck to their daily routine. Ebola is not an easily transmitted disease, and America is leading the world in the fight to stamp it out in West Africa.

Remarks of President Barack Obama
Weekly Address
The White House
October 25, 2014

Hi everybody, this week, we remained focused on our fight against Ebola. In Dallas, dozens of family, friends and others who had been in close contact with the first patient, Mr. Duncan, were declared free of Ebola—a reminder that this disease is actually very hard to catch. Across Dallas, others being monitored—including health care workers who were most at risk—were also declared Ebola-free.

Two Americans—patients in Georgia and Nebraska who contracted the disease in West Africa—recovered and were released from the hospital. The first of the two Dallas nurses who were diagnosed—Nina Pham—was declared Ebola free, and yesterday I was proud to welcome her to the Oval Office and give her a big hug. The other nurse—Amber Vinson—continues to improve as well. And in Africa, the countries of Senegal and Nigeria were declared free of Ebola—a reminder that this disease can be contained and defeated.

In New York City, medical personnel moved quickly to isolate and care for the patient there—a doctor who recently returned from West Africa. The city and state of New York have strong public health systems, and they’ve been preparing for this possibility. Because of the steps we’ve taken in recent weeks, our CDC experts were already at the hospital, helping staff prepare for this kind of situation. Before the patient was even diagnosed, we deployed one of our new CDC rapid response teams. And I’ve assured Governor Cuomo and Mayor de Blasio that they’ll have all the federal support they need as they go forward.

More broadly, this week we continued to step up our efforts across the country. New CDC guidelines and outreach is helping hospitals improve training and protect their health care workers. The Defense Department’s new team of doctors, nurses and trainers will respond quickly if called upon to help.

New travel measures are now directing all travelers from the three affected countries in West Africa into five U.S. airports where we’re conducting additional screening. Starting this week, these travelers will be required to report their temperatures and any symptoms on a daily basis—for 21 days until we’re confident they don’t have Ebola. Here at the White House, my new Ebola response coordinator is working to ensure a seamless response across the federal government. And we have been examining the protocols for protecting our brave health care workers, and, guided by the science, we’ll continue to work with state and local officials to take the necessary steps to ensure the safety and health of the American people.

In closing, I want to leave you with some basic facts. First, you cannot get Ebola easily. You can’t get it through casual contact with someone. Remember, down in Dallas, even Mr. Duncan’s family—who lived with him and helped care for him—even they did not get Ebola. The only way you can get this disease is by coming into direct contact with the bodily fluids of someone with symptoms. That’s the science. Those are the facts.

Sadly, Mr. Duncan did not survive, and we continue to keep his family in our prayers. At the same time, it’s important to remember that of the seven Americans treated so far for Ebola—the five who contracted it in West Africa, plus the two nurses from Dallas—all seven have survived. Let me say that again—seven Americans treated; all seven survived. I’ve had two of them in the Oval Office. And now we’re focused on making sure the patient in New York receives the best care as well.

Here’s the bottom line. Patients can beat this disease. And we can beat this disease. But we have to stay vigilant. We have to work together at every level—federal, state and local. And we have to keep leading the global response, because the best way to stop this disease, the best way to keep Americans safe, is to stop it at its source—in West Africa.

And we have to be guided by the science—we have to be guided by the facts, not fear. Yesterday, New Yorkers showed us the way. They did what they do every day—jumping on buses, riding the subway, crowding into elevators, heading into work, gathering in parks. That spirit—that determination to carry on—is part of what makes New York one of the great cities in the world. And that’s the spirit all of us can draw upon, as Americans, as we meet this challenge together.