Kaiser Health Policy News Index: Special Focus On Ebola

With the Ebola outbreak in West Africa and individual cases in the U.S. and Europe making international headlines, the latest Kaiser Health Policy News Index examines Americans’ attention to the Ebola crisis, awareness of key facts about the disease, and views of the U.S. role in addressing Ebola in Africa and at home. Fielded October 8-14, during which time a nurse in Dallas became the second patient diagnosed with Ebola in the U.S.¹, the survey finds that Ebola tops the list of news stories followed by the public this month, with U.S. airstrikes against Islamic militants the only other story garnering similar levels of attention. While the vast majority of the public knows the basics of how the virus is transmitted –  through direct contact with the bodily fluids of someone who is sick with Ebola – fewer are aware that a person with Ebola must be showing symptoms in order to be contagious. Nearly two-thirds say they are at least somewhat worried the U.S. will see a large number of Ebola cases, and about four in ten are worried that they or a family member will contract the disease. Still, a majority believes the most likely scenario is that Ebola will be contained to a small number of cases in the U.S., and most trust their local, state, and federal health authorities to prevent Ebola’s spread. Most Americans – including majorities of Republicans, Democrats, and Independents – think the U.S. should play a major role in addressing the Ebola outbreak in Africa. Majorities support the U.S. providing financial aid, medical supplies and personnel, and fewer but still a majority support sending troops and military personnel to fight Ebola in Africa, with the public’s top two reasons for providing such support being to protect the health of Americans and to save lives in the African countries affected. The public is divided about whether the U.S. government is doing enough to fight Ebola abroad and at home.

Attention To News

News coverage of Ebola in Africa and the U.S. topped the list of closely-followed news stories this month. Seven in ten (69 percent) say they followed news about the diagnosis of the first Ebola case in the U.S. “very” or “fairly” closely, and nearly as many report closely following the Ebola outbreak in West Africa (63 percent, similar to 62 percent last month). Close attention is somewhat heightened on the home front, with a larger share saying they followed the first U.S. Ebola case “very” closely (32 percent) compared with the outbreak in West Africa (24 percent).

Attention to Ebola at home and abroad was similar to the share who report following the U.S. airstrikes on Islamic militants in Iraq and Syria (68 percent report following “very” or “somewhat” closely). Other non-health news stories captured the attention of large shares of the public this month, including cases of alleged domestic violence by NFL football players (57 percent), an intruder who jumped the fence and entered the White House (53 percent), and the Supreme Court’s decision not to review same-sex marriage cases from 5 states, effectively legalizing such marriages in those states (48 percent).

Besides Ebola, other domestic health policy news stories were followed by much smaller shares of the public this month, including an appeals court decision upholding a Texas abortion law (29 percent), news that some people who failed to verify their immigration status will lose health insurance coverage under the health care law (28 percent), and the release of a database detailing drug company payments to doctors and hospitals (20 percent).

Awareness Of U.S. Ebola Cases And Facts About Transmission

Perhaps not surprisingly given high levels of reported attention to the news, most Americans (89 percent) are aware that there has been at least one case of Ebola diagnosed in the United States.²

While the survey finds that basic information about Ebola transmission is registering with the public, full understanding of the nuances transmission is incomplete. When presented with specific scenarios, the public tends to correctly identify how Ebola is transmitted. Almost all (97 percent) know that a person can become infected with Ebola through direct contact with the blood or body fluids of a person who is sick with Ebola and showing symptoms. Majorities are also aware that a person cannot become infected through the air (66 percent) or by shaking hands with someone who has been exposed to Ebola but does not have symptoms (55 percent). Still, substantial shares are unaware of these facts; 25 percent say Ebola can be transmitted through the air and 9 percent say they don’t know. And 37 percent say it is possible to get Ebola by shaking hands with someone who has been exposed to Ebola but is asymptomatic and another 8 percent are not sure.

When asked more generally whether a person infected with Ebola can transmit the disease to others before they are showing symptoms or only once they are showing symptoms, public awareness is somewhat lower. Fewer than four in ten (36 percent) accurately answer that a person must by showing symptoms to be infectious, while nearly half (48 percent) incorrectly believe that a person can transmit the disease before they are showing symptoms and another 16 percent say they do not know.

Across subgroups, large majorities are aware that a person can become infected with Ebola through direct contact with blood or body fluids of a person who is sick and showing symptoms. However those with lower levels of education are less likely to know that a person cannot become infected with Ebola by shaking hands with someone who has been exposed to Ebola but is not showing symptoms or through the air. Those with lower levels of education are also less likely to correctly respond that a person with Ebola can only transmit the disease to others once they are showing symptoms.

Table 1: Awareness Of How Ebola Is Transmitted By Education
Percent who CORRECTLY answer that…	By Education
	HS GRAD OR LESS	SOME COLLEGE	COLLEGE GRAD OR MORE
… a person CAN become infected with Ebola through direct contact with blood or body fluids of a person who is sick with Ebola and showing symptoms	95%	97%	99%
… a person CANNOT become infected with Ebola by shaking hands with someone who has been exposed to Ebola but does not have symptoms	42	57	71
…a person CANNOT become infected with Ebola through the air	58	67	79
… a person with Ebola can only transmit the disease to others once they are showing symptoms	31	32	48

Personal Concern And Trust In Health Authorities

A majority of the public says they are at least “somewhat” worried that the U.S. will see a large number of Ebola cases in the next 12 months (63 percent), and a robust, albeit smaller, share is worried that they or someone in their family will get sick from Ebola (45 percent). Personal worry about oneself or a family member becoming infected is higher among women (50 percent), African Americans (56 percent), Hispanics (65 percent), and those with a high school education or less (57 percent).

Despite this general level of reported concern about Ebola in the U.S., when asked which is the more likely scenario, about three quarters of the public (73 percent) say it is more likely that Ebola will be contained to a small number of cases in the U.S., compared to two in ten (22 percent) who say it is more likely there will be a widespread outbreak in the U.S.

Overall, a large majority of the American public trusts local, state, and federal health authorities to contain any potential Ebola cases. About three-quarters (73 percent) say that if there were an Ebola case in their area, they would have “a great deal” or “a fair amount” of confidence in the U.S. Centers for Disease Control and Prevention (CDC), to contain Ebola and prevent it from spreading. Somewhat smaller shares – but still over six in ten  – say they have at least a fair amount of confidence in their local hospitals (64 percent) and in their state or local health department (62 percent) to prevent the spread of Ebola.

Surveys usually find differences between Democrats and Republicans on measures of confidence in government, but these differences are less pronounced when it comes to trust in health authorities to deal with Ebola. Democrats are somewhat more likely than Republicans and independents to express at least “a fair amount” of confidence in the CDC to prevent Ebola from spreading, although roughly seven in ten Republicans and independents report confidence as well. Confidence in local hospitals and health departments is similar across Republicans, Democrats, and independents.

TABLE 2: Confidence In Health Authorities To Prevent Spread Of Ebola By Party ID
If a case of Ebola were diagnosed in your area, how much confidence would you have in each of the following to contain the disease and prevent it from spreading?		TOTAL	REPUBLICANS	INDEPENDENTS	DEMOCRATS
The U.S. Centers for Disease Control, or CDC	A great deal/ A fair amount of confidence	73%	70%	72%	79%
	Not too much/ No confidence	25	30	25	19
Your local hospitals	A great deal/ A fair amount of confidence	64	64	60	69
	Not too much/ No confidence	35	35	38	29
Your state or local health department	A great deal/ A fair amount of confidence	62	61	61	67
	Not too much/ No confidence	35	37	37	30
NOTE: Don’t know/ Refused responses not shown

 Views On The U.S. Role In Addressing The Outbreak In Africa

Almost nine in ten Americans (86 percent) think that the Ebola outbreak is NOT under control in West Africa. Most (65 percent) say the U.S. should take at least a major role in addressing it, though just 16 percent say the U.S. should take the leading role. A quarter of Americans say the U.S. should take a minor role (25 percent), and 7 percent say the U.S. should take no role at all. Opinion that the U.S. should take a leading or  major role in addressing the outbreak in Africa is similar across Republicans (67 percent), independents (63 percent), and Democrats (71 percent) alike.

The public is divided on whether the U.S. government is doing enough to fight Ebola abroad and at home. When it comes to fighting the outbreak in West Africa, about four in ten (45 percent) say the U.S. is doing enough and a similar share (40 percent) think the U.S. is NOT doing enough. Opinion of whether the U.S. government is doing enough to protect Americans from Ebola is similar; about half (48 percent) say the government IS doing enough and 44 percent say the government is not doing enough. Republicans (56 percent), women (49 percent), and those with less than a college degree (47 percent) are more likely to say that the U.S. government is NOT doing enough to protect Americans from Ebola.

Most Americans think that U.S. contributions of money, resources, and personnel to fight Ebola in Africa help protect the health of Americans by limiting the spread of Ebola to the U.S. (68 percent) and a somewhat smaller share think these contributions help improve the U.S. image around the world (56 percent). However, when asked if these efforts help the U.S. economy by averting economic crisis in Africa, most (57 percent) said they do not have much impact.

When asked the MOST important reason for the U.S. to contribute to these efforts, the top two are to help protect the health of Americans (39 percent) and to save lives in the African countries affected (37 percent). Much smaller shares say the most important reason for the U.S. to contribute is to help ensure U.S. national security (10 percent), to improve the U.S. image around the world (5 percent), or to help protect the U.S. economy (4 percent).

The main way the public thinks the United States should help to fight the Ebola outbreak in West Africa is by providing medical supplies (93 percent), followed by investing more money in Ebola research (83 percent), sending medical personnel to train and assist doctors (81 percent), and providing financial aid (73 percent). Fewer, but still a majority, think that the United States should send troops and military personnel to help move supplies and set up treatment facilities (54 percent).

Rating The Amount Of Media Coverage

Most Americans think the amount of time the U.S. news media has spent covering the Ebola outbreak is appropriate. Over half (54 percent) say the media has spent about the right amount of time covering the Ebola outbreak in Africa, while about two in ten (19 percent) say the media has spent too much time covering the outbreak and a similar share say say too little (22 percent). Similarly, over half (56 percent) say the media has spent the right amount of time covering the cases of Ebola in the U.S., while 23 percent say the media has spent too much time and 17 percent say it has spent too little.

NOTE: These questions were asked as part of the October 2014 Kaiser Health Tracking Poll. For more results from that survey, including methods, see: Kaiser Health Tracking Poll: October 2014.