Summer is winding down, but when members of Congress return to Washington from their vacations next week, many of their constituents want them to do something about the mosquitoes — the ones carrying Zika virus, to be specific.

A new survey shows that three quarters of Americans say Congress should make the allocation of more money to deal with the Zika outbreaks in Florida and Puerto Rico an “important” or “top priority” when they return to Washington.

“People generally do value spending money when there is sort of a public health emergency,” says Mollyann Brodie, executive director of public opinion and survey research at the Kaiser Family Foundation, which conducted the survey.

About half those surveyed said they’d be uncomfortable traveling to the areas of Florida where people have been infected by Zika. And 77 percent said pregnant woman are not safe in those areas.

“It is something that the local officials have to take really seriously,” Brodie says, “because in many of those areas the tourism industry is a big part of those communities.”

President Obama asked for $1.9 billion in emergency federal funding back in February to fight Zika. So far, Congress hasn’t allocated anything.

So the administration has been using money shifted from other accounts — including money that had been specified for studying and fighting Ebola, and for state-level emergency preparedness — to address the Zika threat, instead.

Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, says his agency will be out of funds to fight Zika by the end of the month. Health and Human Services Secretary Sylvia Burwell issued a similar warning in August.

But Mark Harkins, a senior fellow at Georgetown University’s Government Affairs Institute, says that — at least technically — the Obama administration could move even more money from other programs to fight Zika.

Even though lawmakers usually allocate money for specific purposes, the federal budget allows for some shifting of funds, Harkins says.

“As part of the appropriations bills themselves there’s always a provision that says you may transfer money or reprogram money, based on certain levels,” he says. “And then they put in a little out that says, you can move money at any point, at any amount, as long as you give 15 days notice.”

Some lawmakers seem to be daring the administration to do just that.

Senators Charles Grassley, R-Iowa, and James Lankford, R-Oklahoma, wrote a letter to Burwell, dated Aug. 26, that pointed to $20 billion that is sitting unspent in the HHS and State Department budgets. It could be spent on Zika, the senators say.

Lankford’s staff provided NPR with a list of the accounts the letter refers to. They included Food and Drug Administration salaries and expenses, the State Department’s diplomatic and consular programs and programs in nonproliferation and anti-terrorism.

The Senators simply added up all the money that remains unspent in the accounts Obama specified as needing additional funds, Harkins says.

Grassley “doesn’t care that that money is supposed to be used for multiple different things,” says Harkins. “He’s just saying, ‘If you think money should come out of that account, take any money that’s left in that account.'”

Meanwhile, as the White House and Congress debate the budget, state health officials are scrambling.

Frank Welch, the head of community preparedness at Louisiana’s health department, says his federal grant to prepare for all kinds of health emergencies was cut, and replaced with money that can only be used for Zika.

“But none of those other threats or emergencies that are very real possibilities have gone away,” he says, “and we took about a $700,000 dollar cut.”

Louisiana is using the Zika money for mosquito control, to do public outreach and education about how to recognize and prevent infection. The state is also updating its lab to be able to do Zika testing.

Welch says they’ve done a good job with prevention and preparedness, but there just isn’t enough money left to deal with a Zika response if there’s an outbreak in that state.

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When a young African-American man dies in the city of Philadelphia, more than half the time there’s one main reason why, says Scott Charles.

“It’s because somebody pointed a gun at him and pulled that trigger. It’s not because of cancer; it’s not because of car accidents; it’s not because of house fires. It’s because somebody pointed a trigger,” he says.

Charles is trauma outreach coordinator at Temple University Hospital. The medical center now offers bystander first-aid training, called Fighting Chance, to give friends and family something to do in the minutes before help arrives.

At 6 o’clock one evening, kids run around while their parents and neighbors gather in an elementary school cafeteria. There are training stations set up, and at the back a nurse is showing people how stop blood flow from a gunshot wound.

“The pressure point is located on the inside of the arm,” he explains. “And basically, you’re going to take your hand and get up underneath the inside of the arm and clamp it down.”

Each person takes a turn, taking an old towel or T-shirt and wrapping it around the fake bloody arm tight until help arrives.

Everyone’s talking, but emergency medicine doctor Tim Bryan’s voice is the loudest. He’s a Navy veteran, a former combat medic, and he’s used to giving commands. A shooting scene is chaotic and frightening, but Bryan says in just two hours of training, people get enough of the basics so they will know how to respond.

“You have that ‘aha’ moment and people are like, ‘Wow, I can do this. I can control the scene. I can remember to call 911 and tell the person to put direct pressure on even if I don’t do anything else.’ And it does make a difference,” he says.

The topic is serious, but the mood isn’t. Alice Kellam, 63, wears a camouflage tracksuit and rhinestone hoop earrings. She’s chatty and laughs with friends all evening — except when she talks about her husband, who was murdered in 1990. She doesn’t have a lot to say about that, except that it was senseless.

“They took his sneaks and his hat. That was it,” she says.

Many people in this North Philadelphia neighborhood have a story about someone and remember a moment when they felt helpless.

Louise Smith (“Everybody calls me Miss Midge,” she says) is a perpetual volunteer, and at the big summer block party at 12th and Cambria, she’s the lady who hands out the flavored water ice.

“About a year ago, we seen a shooting around here,” she says. “It was a shame the two boys died right on the sidewalk, there wasn’t nobody there to help them.”

A severely injured person can bleed to death in less than 10 minutes. But it can take much longer for police to arrive and calm the situation, so the trainers teach the class how to move a victim away from danger and flying bullets.

Registered nurse Maureen Quigg explains how to do a two-person lift-and-carry.

“The knee closest to the victim is down and the other knee is up, and that’s what you stand up with, the power from your legs and not your back,” she says.

Quigg reassures the smaller women that they indeed can help a 200-pound person.

“If it’s someone you care about or in a situation where there’s a lot of activity your adrenaline is going — you have all this extra energy, you have all this extra power,” she says. “And if you focus on doing it and doing it the right way, you can lift someone you’d never think you could lift, and you can do it without hurting yourself.”

Advocates say learning first-aid skills to stop bleeding is the essential step in bystander education, not unlike learning CPR or making sure a defibrillator is nearby to jump-start someone’s heart. The federal Department of Homeland Security provides an introduction to these lifesaving techniques online in its Stop The Bleed program.

At the end of the evening, the trainers stage a minidrama to test the group.

Bryan sets the chaotic scene and calls out directions. One person is the victim. There’s a pretend shooter.

“Remember, you can ask somebody: ‘Help me control the scene.’ That’s good,” he calls out.

Charles helped develop the first-aid education program after a local resident came to him to complain that he was sick and tired of hearing about young men who died before getting to the ER.

“As we wait for laws to be changed, many people are going to find themselves on the wrong end of a gun,” Charles says. “While those things are certainly important, we have to we have to put the power in people’s hands to address this issue.”

The goal is to saturate one neighborhood with people who have basic lifesaving skills. About 250 people have been trained so far.

This story is part of a reporting partnership with NPR, WHYY’s health show The Pulse and Kaiser Health News.

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Most Americans who screen positive for depression don’t receive treatment, a study finds, while most who did receive treatment don’t appear to have the disorder.

“Over the last several years there has been an increase in prescription of antidepressants,” says Mark Olfson, professor of psychiatry at the Columbia University Medical Center and lead author of the study, which was published Monday in JAMA Internal Medicine. “In that context, many people assumed that undertreatment of depression is no longer a common problem.”

But Olfson found the opposite to be true after analyzing data from Medical Expenditure Panel Surveys in 2012 and 2013 that asked people if they had been screened for depression. Of the 46,417 adults surveyed, 8.4 percent answered in ways that suggested they had depression, but only 28.7 percent of the people who appeared depressed received any treatment for it.

“The findings highlight that there are continuing challenges in aligning depression care with patient needs,” Olfson says.

Those in the lowest-income group were five times more likely to appear to have depression compared with those in the highest income group, with 18.2 percent of lowest-income adults screening positive compared to 3.7 percent of the highest-income group. But higher-income people were more likely to get treatment.

People who were female, white, non-Hispanic, had at least a high school education or had health insurance were more likely to get treatment if they were depressed, the study found. People with low incomes, uninsured adults, racial and ethnic minorities and men were less likely to be treated.

Though 8 percent of people surveyed got some form of treatment, most of the people who got treatment probably didn’t need it. Only 29.9 percent of the people treated had screened positive for depression; 21.8 percent of them appeared to have serious psychological distress. People with public insurance such as Medicaid and people who were separated, widowed or divorced were most likely to be treated, while uninsured adults, racial and ethnic minorities, and men were least likely.

Antidepressants were far and away the most common treatment, and people with either less serious distress or no depression were more likely to receive them. That could be a problem, Olfson says, because studies have shown that antidepressants are not more effective for patients with mild depression than a placebo.

“Being a little less aggressive in medication in mild depression would be beneficial,” he says. “There are simpler forms of psychological interventions that can be adapted for primary care.”

Patients with mild depression could first be given nondrug treatments ranging from counseling and exercise to yoga, the researchers say.

And although the study found that those with serious psychological distress are more likely to be treated by psychiatrists instead of general medical professionals, that wasn’t the case for older patients, African-Americans, the uninsured or those with less education.

Most people with untreated depression make at least one visit to a primary care doctor annually, and Olfson says those visits could be used to screen people in disadvantaged populations, and ideally offer them mental health treatment at the primary care clinic.

“If you give them a referral to a mental health clinic, they simply won’t go if they don’t think they have a mental health disorder,” he says. “By embedding the services within primary care, it becomes more accessible and less stigmatized.”

It’s an idea Benjamin Cook, director of the Health Equity Research Lab and an assistant professor at Harvard Medical School, agrees on, but he says increasing access for minorities would require professionals who speak their languages and understand what type of treatment they are open to. Cook was not involved in the study.

“African-Americans and Latinos prefer antidepressants less than whites,” Cook says. That might be an underlying reason “not to go for mental health treatment, why they might not stay at treatment for as long.”

It can be hard for primary care doctors to find mental health professionals to refer patients to, particularly in rural areas, Olfson says; prescribing antidepressants might be their only option. “Depression really is a serious condition and we’re finding that so many Americans aren’t receiving care,” he adds. “I hope that [this study] brings attention to this situation.”

Kaiser Health News is an editorially independent news service supported by the nonpartisan Kaiser Family Foundation.

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Doctors describe 16-year-old Sebastian DeLeon as a walking miracle — he is only the fourth person in the U.S. to survive an infection from the so-called brain-eating amoeba.

Infection from Naegleria fowleri is extremely rare but almost always fatal. Between 1962 and 2015, there were only 138 known infections due to the organism, according to the Centers for Disease Control and Prevention. Just three people survived. This summer, two young people, one in Florida and one in North Carolina, became infected after water recreation. Only one had a happy ending.

DeLeon is a 16-year-old camp counselor. The Florida Department of Health thinks he got the infection while swimming in unsanitary water on private property in South Florida before his family came to visit Orlando’s theme parks.

So many things had to go right for DeLeon to survive. On a Friday, he had a bad headache. The next day, his parents decided this was way more than just a migraine and took him to the emergency room at Florida Hospital for Children.

Doctors persuaded the family to do a spinal tap to rule out meningitis, even though he didn’t have a stiff neck, the telltale symptom. Sheila Black, the lab coordinator, looked at the sample and assumed she saw white blood cells. But then she took a second, longer look.

“We are all detectives,” Black said. “We literally had to look at this and study it for a while and watch for the movement because the amoeba can look like a white cell. So unless you’re actually visually looking for this and looking for the movement, you’re going to miss it.”

That movement triggered the alarm: This was an amoeba case. And that’s when the pharmacy reached out to a small Orlando drug company called Profounda, which has a drug called Impavido that was originally developed as a cancer treatment and approved by the FDA in 2016 to treat the tropical parasitic disease leishmaniasis. It has been used in several cases to treat amoeba infections as well.

Profounda CEO Todd MacLaughlin got the call from the pharmacy, but he was out of town so his son drove the drug to Florida Hospital.

“Within 12 minutes he had picked up the product and was on the way to the hospital,” MacLaughlin said. “Everybody was in the right place at the right time.”

DeLeon was given the drug along with others. Doctors put him into a coma and lowered his body temperature to give the drugs time to work and slow the infection.

Dr. Humberto Liriano was emotional talking about the experience. They knew the odds were not in DeLeon’s favor when he was placed into a coma.

“The family when they came to me, immediately within four hours, I had to tell them to say their goodbyes,” Liriano says. “I had to tell them, ‘Tell him everything you want to tell your child, because I don’t know from the time I put him to sleep to the time I take the tube out, [if he will] wake up.’ “

DeLeon’s mother, Brunilda Gonzalez, thanked doctors at a press conference.

“We are so thankful that God has given us the miracle through this medical team and this hospital for having our son back and having him full of life,” Gonzalez said. “He’s a very energetic adventurous, wonderful teen. We’re so thankful for the gift of life.”

Central Florida has coped with amoeba infections before, including the death of Jordan Smelski, who died at the same hospital where DeLeon was saved. Smelski’s parents started a foundation to raise awareness of the disease in the medical community and to advocate for hospitals to stock the drug in case of an infection.

Profounda says seven hospitals have taken it up on stocking the drug at no cost, charging them only when the drug is used. The drug costs $48,000 for a full round of treatment. MacLaughlin said the company will provide the drug free if someone doesn’t have insurance.

DeLeon will soon head to South Florida for rehab, and doctors are optimistic he’ll make a full recovery.

But in North Carolina, an 18-year-old Ohio woman died from the amoeba in mid-June, stoking fear in the community. She had been rafting at the U.S. National Whitewater Center in Charlotte, which is among a handful of facilities in the country that have man-made rapids coursing through concrete channels. Its CEO, Jeff Wise, pointed out the lower part of the channel in mid-July.

“This is the bottom pond,” he says, “where all of the water in our essentially 12 million-gallon system rests while it’s ready to be pumped back up into the top pond, where it’ll float back down through the channels.”

But there was no whitewater between late June and Aug. 10, because CDC tests found the amoeba after the woman died.

Mecklenburg County Health Director Dr. Marcus Plescia encouraged people to keep perspective.

“This organism, Naegleria fowleri, is actually quite a prevalent or commonly occurring organism in open bodies of water,” he said. “We find it in lakes. We find it in ponds. It’s very common for people to come into contact with, but it’s very uncommon for people to develop this kind of infection with it.”

It’s harmless if swallowed, because stomach acid kills it. But if it’s in water forced up the nose, it can cause the brain infection, which is difficult to diagnose and treat.

The Whitewater Center uses city water that it treats with UV radiation, a filtration system and some chlorine. Still, it’s a large, open body of water, and exists in a regulatory no-man’s land because it’s neither swimming pool nor local river or lake.

North Carolina Gov. Pat McCrory said the state should re-examine whether the center should be treated like a swimming pool. But testing for the amoeba is not part of swimming pool regulations, because chlorine used in pools is effective at killing it. And the county and the state don’t have the ability to test for it. It’s usually up to the CDC.

As part of its lease agreement with the county, the center does weekly tests for common contaminants such as fecal coliform bacteria.

County health leaders point out that people are much more likely to die from drowning or boating accidents in area lakes and rivers than they are from Naegleria fowleri. In fact, there have already been at least eight of those deaths in the greater Charlotte area this summer.

But people just don’t get as worked up about those. David Ropeik, a risk management consultant in Concord, Mass., explains why.

“We worry about things not only based on the likelihood of them happening but the nature of the experience itself,” Ropeik says. “The odds may be low of brain-eating amoeba eating your brain, but the nature of a brain-eating amoeba eating your brain sounds pretty scary, doesn’t it?”

Ropeik is the author of How Risky Is It, Really? He says the media coverage of rare risks is part of the problem.

“Anything that makes a risk feel scarier like, ‘This is the zombie amoeba!’ is going to subconsciously interest journalists as something that will get people’s attention,” he says. “Because the viewer, reader, listener is likely to pay attention to a story that could portend their death.”

Dr. Jennifer Cope, an infectious disease epidemiologist at the CDC, said 11 out of 11 tests for the amoeba were positive at the rafting center, which does sound alarming. She called that significant but noted this is the first time the CDC has encountered the amoeba in this type of setting.

Whitewater Center CEO Wise says roughly 1.5 million people have rafted there over the past decade, and this is the first health issue it has had tied to what’s in the water.

The CDC says there are ways to make the water less conducive to the amoeba’s growth, including bulking up the amount of chlorine. The Whitewater Center worked with consultants to figure out a more effective way of doing that, and it reopened this month with a revamped chlorination system. So far, county health leaders say it is working the way it is supposed to.

This story is part of a reporting partnership with NPR, local member stations and Kaiser Health News.

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Orientation at Arkansas Tech University this year included a surprising topic for a Bible Belt state that pushes abstinence-only in high school. Every freshman was shown a newly produced video in which real students talk about the struggle of an unplanned pregnancy, and the challenge of staying in school as a parent.

“I lost a lot of friends,” says one young woman in the video who had dreamed of becoming a surgeon. A young man says he “went from not having any responsibility to having a full-time responsibility,” while another laments that Friday nights are no longer spent with friends but at home “watching Dora. A lot of Dora.”

The message is clear, and it will come up again throughout the year: in a college success course, in group chats in dorms, at a slew of events during Sexual Health Week.

Why in college? Arkansas has the nation’s highest rate of teen births, but most of them — here and nationally — are actually to young adults, 18 and 19 years old. Last year, the Arkansas Legislature passed a law directing the state’s public colleges and universities to tackle unplanned pregnancy. Schools have each been crafting their own plans for how to do that, and they launched the effort during orientation this month.

After watching the video at one session at Arkansas Tech in Russellville, nearly every student said it hit home.

“I think there was anywhere between five to 10 girls in my grade that got pregnant,” says freshman Sydney Blackwell. “I remember in eighth grade there was a girl that never made it to ninth grade because she got pregnant.”

Only 4 of 20 students in this group say they had sex ed in high school. Brooklynn Evans says she didn’t get much guidance at home, either, not even the basic birds and bees. “My parents were too uncomfortable to talk about it,” she says.

Same with Carlos Morales. He thinks it’s great that his college is bringing this up, but “it would have been better to have a class earlier, during our middle school.”

‘The problem in the room that nobody wants to discuss’

Arkansas’ law is modeled on one that took effect last school year in Mississippi. Both had bipartisan support and were amazingly uncontroversial.

“It was surprisingly easy; it shocked me,” says Rep. Deborah Ferguson, the Democratic co-sponsor of the Arkansas law. Still, she says it would not be politically possible to mandate sex ed in earlier grades. The legislation’s Republican co-sponsor believes that’s best left to local districts.

But that co-sponsor, Rep. Robin Lundstrum, had an early job in family planning. She says she heard from high school students over and over that they had nowhere to turn for information on how to not get pregnant. “It’s the problem in the room that nobody wants to discuss,” she says.

At Arkansas Tech, student wellness dean Kristy Davis says it makes sense to target those in college, many of whom are away from home for the first time. She says faculty can help “make sure that they’re prepared and they have the information to make good decisions for themselves.”

The mandate is so far unfunded. Angela Lasiter, a program specialist with the Arkansas Department of Higher Education, is creating a nonprofit and hopes to attract money to keep the effort going. At community colleges, which usually lack a health center, she’s also making sure nearby clinics are stocked with the most effective contraceptives. A substantial share of students at some two-year colleges are already parents, and Lasiter says the state’s push can help prevent them from having a second child.

Some universities are even weaving the topic into their curriculum. Lasiter says it’s easy to drop into classes like statistics, English, “or, say, Speech 101. ‘We would like for you to write a 10-minute speech on how to prevent unplanned pregnancies.’ Boom.”

The goal, she says, is to get students talking. And if they also talk with their little sisters and brothers, all the better.

There’s also a broader benefit for the state, Lasiter says. When young parents drop out of college, or never get there in the first place, it costs Arkansas $129 million a year in “lower income, more people on welfare, a less higher quality of living.” That economic hit is compounded because the children of teen mothers are more likely to have an early, unplanned pregnancy themselves.

But is college too late to teach sex ed?

Magical thinking

“They don’t know as much as they think they do, and they don’t know as much as we wish they did,” says Andrea Kane, vice president for policy and strategic partnerships at the National Campaign to Prevent Teen and Unplanned Pregnancy. She says research shows young adults think they know how to not get pregnant, but when pressed for details they’re prone to myths and misinformation. For instance, she says, “4 in 10 young adults in this country believe it does not matter if you use birth control or not; when it is your time to get pregnant, you will.”

The National Campaign has been pushing for more prevention efforts at the college level, and Kane says other states are showing interest in the new laws in Arkansas and Mississippi. She says even students who had sex education in high school might have forgotten the information, or may find it more relevant now that they’re older.

Marie Sandusky has been counseling students at the University of Arkansas at Little Rock since well before the state’s law. She directs health services there, and says it’s a challenge to help students understand the risk of pregnancy.

“There’s this 18- and 19-year-old brain thing that’s kind of like magical thinking,” she says. “Sort of like, ‘It’s not going to happen to me.’ “

With the new law, the university is being more proactive. This year, incoming freshmen had to complete an online lesson on preventing unplanned pregnancy. In their dorm rooms, they found a postcard with the health services phone number and the tag line, “Plan to postpone parenting.”

Sandusky also drove home the risk factor at a recent orientation event. In an auditorium of 300 students, 22 of them found a red star under their seat. They received a rag doll on a string that they had to wear around their neck the rest of the evening. “And then we say, ‘If you choose to become sexually active, and don’t choose to practice safe sex or get on birth control,” says Sandusky, “this many people will have a baby by the end of the year.’ “

Of course, the hope is that Arkansas’ push to prevent unplanned pregnancy will eventually bring down that number.

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The EpiPen, an injectable drug that reverses severe allergic reactions, just got a little cheaper for some consumers.

The device’s manufacturer, Mylan NV, announced Thursday that it will offer coupons worth as much as $300 off a two-pack.

The move is a reaction to harsh criticism from consumers and several lawmakers over repeated price increases that have boosted the cost of the medication to more than $600 from less than $100 just a few years ago.

The company says it will offer the discounts to patients whose insurance doesn’t cover the costs because of high deductibles or limited pharmacy benefits.

But coupons may not be enough to tamp down anger over the price hikes.

“This step is much more a PR fix more than a real remedy,” Sen. Richard Blumenthal, D-Conn., said in an interview Thursday. “What’s needed is robust, real action to lower the price for everyone, not just a select few.”

He says the EpiPen has such enormous market share that the company may be violating antitrust laws by exploiting that. A report by the health care website Stat says some of Mylan’s contracts to give schools free or discounted EpiPens may have done just that, because they bar the schools from buying competitors’ products.

Mylan told Stat that the provision restricting school purchasing has since been discontinued, but did not say when it was halted.

Blumenthal is just one of several lawmakers who have called for investigations into Mylan’s business practices and have asked for justifications of its price increases in recent days. He and a few others say the discounts aren’t enough.

Blumenthal sent a letter to the company earlier this week demanding that it lower the price.

Sen. Charles Grassley, R-Iowa, sent a letter to Mylan demanding an explanation for the increase. And Sen. Amy Klobuchar, D-Minn., has asked the Federal Trade Commission to investigate whether Mylan has violated antitrust laws in its marketing of the EpiPen.

Rep. Elijah Cummings, D-Md., says his Oversight and Government Reform Committee would hold hearings. “Offering a meager discount only after widespread bipartisan criticism is exactly the same tactic used by drug companies across the industry to distract from their exorbitant price increases,” Cummings said in a statement.

And Democratic presidential hopeful Hillary Clinton weighed in on her Facebook page. “It’s wrong when drug companies put profits ahead of patients, raising prices without justifying the value behind them,” she wrote.

The wholesale price of a single pen was about $47 in 2007. It rose to $284 this summer, according to Richard Evans, a health care analyst at SSR. But consumers can no longer buy a single pen, so the retail price to fill a prescription today at Walgreens is about $633, according to GoodRX.

Blumenthal says a solution could require new laws.

“At the end of the day there may need to be stronger legal protections against these types of price gouging and profiteering at the expense of people who need a lifesaving drug where the company has a stranglehold on the market,” he says.

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A major study about the best way to treat early-stage breast cancer reveals that “precision medicine” doesn’t provide unambiguous answers about how to choose the best therapy.

“Precision doesn’t mean certainty,” says David Hunter, a professor of cancer prevention at Harvard’s T.H. Chan School of Public Health.

That point is illustrated in a large study published Wednesday in the New England Journal of Medicine, involving decisions about chemotherapy.

As is true for many cancers, breast cancer responds best to treatment when it is caught early, before it has spread throughout the body. Dr. Fatima Cardoso, the study’s lead author and a breast cancer specialist at the Champalimaud Clinical Center in Lisbon, Portugal, says that creates a conundrum for doctors and patients alike.

Because it’s the only opportunity to cure the cancer, “when in doubt we tend to treat” women with early-stage breast cancer, she told Shots. “So we know that we overtreat the patients with early breast cancer.”

That means that women could end up undergoing chemotherapy even if it wouldn’t really improve their survival odds.

Hoping to refine those treatment decisions, Cardoso helped organize a huge study throughout Europe to see whether a commercially available genetic test called MammaPrint could help reduce that overtreatment. More than 6,600 women participated at 112 institutions in nine nations.

Scientists identified women with breast cancer whose physical exams suggested they were at relatively high risk for having the cancer return eventually after surgery, but who seemed to be at low risk of recurrence based on the genetic test results.

They were invited to participate in the study, which would randomly assign them to have chemotherapy or not. “You know that chemotherapy is a treatment that scares people, so overall and for the majority of patients, it was not difficult to convince them,” Cardoso says.

The genomic test, which studies 70 distinct features of a tumor, did a pretty good job of predicting who was at low risk for recurrence of breast cancer and could therefore avoid the pain, discomfort and risks of chemotherapy. (The test, priced at $4,200, is covered by some insurance in the United States.)

The scientists found that 46 percent of women who were deemed to be at high risk of recurrence based on physical symptoms could actually skip chemotherapy with little consequence to their long-term survival.

But the test results weren’t always definitive. About 95 percent of women who skipped chemotherapy as a result of the genetic test results were free of metastasis five years later, but those who had the additional treatment did about 1.5 percentage points better, give or take.

“It’s possible that the benefit is zero, and it’s possible that’s 2 percent or maybe even a little more, you can’t be sure,” says Dr. Clifford Hudis, chief executive officer of the American Society of Clinical Oncology. He was not involved in the European study but co-wrote an editorial accompanying it. It would take another huge clinical trial to figure out whether chemotherapy does in fact add a small survival advantage.

But the study raises a bigger point here: The genomic test, as precise as it is, offers only probabilities, not absolute guidance. And that’s a lesson that applies to the whole new realm of precision medicine, which is billed as potentially transformative for medical care.

“The new tools will definitely be helpful, but they often will pose challenges about what the right decision is,” says Hunter, who wrote a perspective piece noting that people will need to develop a tolerance for uncertainty when using precision medicine tests.

Is it worth all the trouble of chemotherapy for women who are found to be at low risk for recurrence in this genomic test? That’s a tough call, because it requires grasping the rather abstract idea of improving survival odds by maybe just 1 percentage point.

“As humans, we’re notoriously poor at assessing risk and making those calculations,” Hunter says.

He says doctors and patients need better tools to understand and communicate the subtleties that are inherent in precision medicine.

Cardoso is already seeing this play out in her clinic. Women shown to be at low genetic risk on the MammaPrint test are usually opting not to have chemotherapy after their surgery. “But there always [are] some patients for whom 1 percent benefit is enough — and you need to respect the wishes of each individual patient.”

She says the women clearly benefit from the new information, even though it doesn’t provide an absolute answer.

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After Rory Staunton fell at the gym and cut his arm in March of 2012, the 12-year-old became feverish. He vomited during the night and complained of a sharp pain in his leg. When his parents called his pediatrician the next day, she said there was a stomach virus going around New York City, and his leg pain was likely due to his fall.

But she did advise his parents, Orlaith and Ciaran Staunton, to take Rory to the emergency department because of possible dehydration. The hospital workers did some blood work, gave him fluids and sent him home.

The next day, Rory’s pain and fever were worse. His skin was mottled and the tip of his nose had turned blue. The Stauntons raced back to the hospital, where he was admitted to intensive care. The diagnosis: septic shock. Rory was fighting an infection that was turning his skin black and shutting down his organs.

On Sunday, four days after he dove for the ball in gym class, Rory died.

Sepsis, which is a body’s overwhelming response to infection, kills more than 250,000 people in the U.S. every year. People at highest risk are those with weakened immune systems, the very young and elderly, and patients with chronic conditions such as diabetes, cancer or kidney disease. It is also risky for people with pneumonia or those who use catheters that can cause infections. But it can strike anyone, even a healthy child like Rory.

Sepsis typically occurs when germs from an infection get into the bloodstream and spread throughout the body. To fight the infection, the body mounts an immune response that may trigger inflammation that damages tissues and interferes with blood flow. That can lead to a drop in blood pressure, potentially causing organ failure and death.

“It was frightening to think that something could kill my son so fast and it would be something that I had never heard of,” said Orlaith Staunton.

She’s not alone. Many people don’t know about sepsis. Health care providers struggle to identify it early, but there’s no simple diagnostic test. Many symptoms — elevated heart and respiratory rates, fever or chills, pain — are common ones that are present in many conditions.

A growing number of doctors, hospitals, patient advocates and policymakers are pushing to educate consumers and clinicians about sepsis. The goal is to ensure that procedures that focus on prevention and early detection are followed.

The Stauntons established a foundation to raise awareness about the deadly infection, and in 2013 New York became the first state to require all hospitals to implement procedures for early recognition and treatment. This month, Illinois Gov. Bruce Rauner signed a law requiring similar actions by hospitals in that state.

The Centers for Disease Control and Prevention released a study Tuesday about sepsis as part of an effort to draw attention to the importance of prevention and early detection.

“Early treatment is vital,” says Dr. Anthony Fiore, chief of the epidemiology research and innovations branch at the CDC’s Division of Healthcare Quality Promotion. “It’s an emergency that you need to deal with, like heart attack and stroke.”

When sepsis advances to septic shock, characterized by severely low blood pressure, each hour of delay in administering antibiotics decreases the odds of survival by an average 7.6 percent, one study found.

In 2013, sepsis (sometimes called septicemia) accounted for nearly $24 billion in hospital costs, the most expensive condition treated. Up to half of people who get it die. Many cases are related to health care, such as catheter use or an infection acquired in the hospital. But contrary to the common perception, approximately 80 percent of cases develop outside the hospital or at a nursing home, according to the CDC.

As the front line in identifying these cases, emergency departments typically have sepsis protocols in place to screen for it.

“The work you do in those first three to six hours in the emergency department makes more difference in cost than the whole next several weeks in the ICU,” said Dr. Todd L. Slesinger, who co-chairs a task force on sepsis at the American College of Emergency Physicians, which has developed a tool to help emergency department staff screen and treat the condition.

Last fall, the Centers for Medicare & Medicaid Services started requiring hospitals to measure and report on screening and treatment efforts. In addition, Medicare sets penalties for a variety of hospital-acquired conditions, including high rates of post-operative sepsis.

Patient advocates and policymakers agree that patients themselves are key to improving prevention and early detection. Good hygiene can help prevent sepsis, including cleaning wounds. If someone gets injured, look for signs of sepsis, including rapid breathing or heart rate, confusion, fever or chills and pale or discolored skin.

Don’t assume health care providers have it covered, experts advise. If you or someone you’re caring for has these symptoms, ask the health care provider directly: “Do you think it might be sepsis?”

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter:@mandrews110.

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Students returned to school on Monday in Miami amid a new concern: the threat of Zika. Nine schools in Miami-Dade County are in or near a zone where nearly a month ago health officials confirmed that mosquitoes are spreading the virus.

One of them, Jose de Diego Middle School, is in Miami’s Wynwood neighborhood, an area known for its restaurants, cafes and street art. It’s also home to middle-class and low-income families, many newly arrived from Venezuela, Cuba and Haiti.

Over the weekend, school officials distributed cans of mosquito repellent to parents and made long-sleeved shirts and pants available to students. For the past month, the county has conducted intensive spraying and outreach. While health officials are optimistic about their efforts to control mosquitoes in this neighborhood, on Friday they said that Zika has now spread to another neighborhood several miles away, on Miami Beach.

The start of the school year is always hectic. The principal of Jose de Diego Middle School, April Thompson-Williams, says Zika leaves parents with even more questions. “They just want to know how to protect their children and to ensure that they’re safe when they come to school,” she says.

Kenyanna Darden brought her daughter, Jaynela, to school today. She says the school district seems to have a good plan in place to protect students. “They sent text messages, emails, voicemail, all that, all day, every day,” she says. The message? “Protect yourself, wear ‘Off’ spray.”

Another parent, Nicole Pugh, still has some worries after dropping her daughter off at school. “Yeah, I worry about it,” she says. “But I made sure she was sprayed and everything. So hopefully, they’ll take care of the situation.”

Superintendent Alberto Carvalho was visiting schools in both of Miami’s Zika transmission zones today, spreading the message that students should wear repellent, long-sleeved shirts, long pants — and that they should be in school. “Every single school is air-conditioned. Every single bus is air-conditioned,” he says. “There is no contact with areas that have standing water. And kids are well-protected in air-conditioned areas. They’re going to be fine.” Carvalho says recess and sports will go on as usual.

Cyd Browne began her 7th-grade engineering class today with a challenge. She asked her students to design a plan to protect an area from mosquitoes that carry Zika. “We’re going to look to see the science behind this, do our research and then come up with a solution to make sure everyone knows to spill the water wherever there’s standing water and to drain and cover,” she says. Every teacher at Jose de Diego Middle school started today with a Zika information session.

For children and anyone who’s not pregnant, the symptoms associated with Zika are usually mild. Most people don’t even know they’ve had the disease. But the chief of Emergency Medicine at Miami’s Jackson Memorial Hospital, Bobby Kapur, says that from a public health standpoint it’s crucial that students be protected. “We have hundreds, maybe thousands of students clustered in one area,” he says, adding that any student infected through a mosquito bite could bring that infection back into their homes and communities.

Controlling the spread of Zika is a major challenge. Along with the two zones already identified, health officials say they’re investigating possible cases of Zika transmission in several other areas in South Florida.

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