The term “patient zero” refers to the first patient that is an indicator to the existence of an outbreak. Generally, patient zero is the first cited case in a population regardless of whether or not the scientist believes that this was the first person to actually get infected.
Patient zero is also referred to as index case or primary case. Terms like index case or patient zero are only applied in diseases that move from human to human.
Misinformation Causes False Claims of Patient Zero’s Identity
In the case of the HIV/AIDS pandemic, a man named Gaetan Dougas was believed to be the patient zero in the AIDS pandemic. Randy Shilts wrote about him in his 1987 bestseller novel, “And the Band Played On” that identified Gaetan Douglas as patient zero. Shilts really vilified Dougas as the person responsible for the spread of the HIV virus in the 1980’s. He even suggested that Gaetan had deliberately spread the virus in America. This obviously has a very negative effect on Gaetan and his family.
Gaetan Dougas was a French Canadian flight attendant. However, the idea that he had brought the virus to America was all a mixture really. It all began in 1982 when Professor William “Bill” Darrow and his colleagues from the US Center for Disease Control and Prevention set off from Georgia to California to investigate the explosion of Kaposi Sarcoma. This is a form of skin cancer among homosexual men. Darrow had suspicions and had made allegations that the carcinogenic agent was transmitted sexually; however, he lacked proof.
This carcinogenic agent was discovered later to be a complication brought about by HIV infection. He did not find this proof until the following April, when three different men from different countries with the infection told Darren that they had interacted sexually with the same man, Gaetan Dougas.
Dougas was tracked down in New York undergoing treatment for Kaposi sarcoma. After agreeing to cooperate with the agency, the CDC was able to link HIV with sexual activity.
Dougas was initially named patient O (out of California) by the CDC as he was an HIV patient from outside California, where flags were being raised for HIV infection explosion. The O was eventually misconstrued as 0 (zero) and hence he was mistaken to be patient zero or the index patient in regards to the HIV pandemic.
Origins in America
A study on HIV led by Richard McKay led him to collecting more than 2000 blood serum samples from homosexual men in 1978 and 1979 whilst testing for Hepatitis B. They found enough HIV genetic information that they could reconstruct three distinct samples from San Francisco and five samples from New York.
Upon study of the genetic detail of the samples, they were discovered to be decisively similar to strains found in the Caribbean Islands, especially the Island of Haiti in the early 1970s. However, the strains of the viruses were different suggesting that the virus had been spreading in the two cities individually, causing them to mutate.
So, as it turns out, AIDS had been in circulation in the United States since the 1970’s. That is way before the first cases were identified in California in 1981. Dougas was just one of the thousands who were infected with the virus before the symptoms were associated with the virus that we now know as AIDS. Furthermore, the strain that was found to have killed Dougas was not the same as the others.
These facts therefore exonerate Dougas as patient zero and debunk the myth that he was the one that brought AIDS to North America. The virus would appear to have moved from the Caribbean islands to New York in 1970 or 1971. New York was a proper hub for the transmission of the virus.
The virus was initially identified in New York in 1971 but it was not until 1984 that it was associated to AIDS. Outbreaks in California made people press the panic button on AIDS, but these are believed to have been offsets to the earlier outbreak in New York.
HIVs True Beginnings
Dr. Michael Worobey, an associate professor who teaches in the University of Arizona, used a painstaking method to reconstruct HIV DNA from older tissue samples preserved in kerosene. These tissues are from Kinshasa dating between 1958 and 1962. By then, Kinshasa was called Leopoldville after a Belgian king. A lymph node tissue taken from a 28-year-old woman in 1960, infected with HIV, aided the scientists in their analysis of the HIV genome.
The only earlier case of infection was a Bantu man from Kinshasa in 1959. The virus from the woman was so fragmented that it only made up about a hundredth of the virus structure, but with help from the earlier sample they pieced it together. The two samples differed by twelve percent, showing that the HIV virus had evolved in the time took it to travel between the two patients.
Dr. Worobey’s theory suggests that the disease first existed in non-human primates. It might have even been spreading among them for decades, even centuries. It spread to humans when they cut themselves while butchering the animals.
Initially, the disease did not become a pandemic. This was because the human population density in forests was quite low, so the few viral infections did not cause an epidemic among people. The ancestral source of the virus has been tracked to a tributary of the Congo River 500 miles from Kinshasa. An infected person must have moved to the trading village of Leopoldville and began infecting people.
From there, the spread of the virus paralleled the growth of Kinshasa. It began slowly and then sporadically around the 1940s. It must have been undetectable in those days when people died of malaria and tuberculosis regularly, so it was hard to trace the new disease that we now know as AIDS.
Moving Forward
French speaking professionals that came to the country spread it to Haiti and elsewhere around the world. Dr. Worobey says that we changed the landscape for the spread of the virus. By building cities and transportation routes, we gave AIDS the power to become an epidemic.
However, we have the same power to change the landscape to foil the spread of the virus. By such practices as sexual fidelity and regular medical visits, we reduce the chances for widespread infection. Dr. Worobey suggest that if we ensure that each infected person on average infects less than one person, the pandemic will eventually die away.
