Not patient zero

October 26, 2016 10:41 AM

More than thirty years after his death, Canadian flight attendant Gaetan Dugas — who has been dubbed “Patient Zero” of the AIDS epidemic in the United States, has been exonerated by medical evidence, a new study published in Nature today.
posted by roomthreeseventeen (26 comments total)

I'm not sure that being Patient Zero of anything is something one can be guilty of. It's just something that happens to one, just before it happens to everybody else.
posted by Grangousier at 10:44 AM on October 26, 2016 [16 favorites]

So HIV was circulating in Kinshasa by the sixties - was it the same sort of HIV as people got later, so people were progressing to AIDS but no one put the pieces together? Or did the virus change some time later?

I've always thought "blaming" Dugas was pretty dumb - even if it were all true and he was a terrible person who really was patient zero. It's not like the absence of Dugas would have prevented the epidemic.
posted by Frowner at 10:54 AM on October 26, 2016 [4 favorites]

Dugas was placed near the center of this cluster, and identified as patient O for “Outside of California.” But when investigators numbered the cases according to the date when each patient’s symptoms started to appear, the letter O was mistaken for the number 0, and the Canadian flight attendant entered the literature with that dubious label.

So it comes down to either somebody's ambiguous handwriting or the fact that 0 and O were nearly indistinguishable on early computer monitors and dot-matrix printouts.
posted by Flannery Culp at 10:55 AM on October 26, 2016 [13 favorites]

Just to clarify, there has long been a consensus among epidemiologists and specialists that there was no "patient zero" in the sense that was used to describe Dugas by Randy Shilts.
posted by latkes at 11:17 AM on October 26, 2016 [12 favorites]

One of the earlier (artistic) repudiations of the Patient Zero myth was John Greyson's Zero Patience.

As a musical film, it's received mixed reviews.

The NYT review:

"Zero Patience," which parodies the story of Scheherazade, begins with Patient Zero, stuck in the primordial void, pleading for someone to save his life by telling his story. His wish is granted, and he appears to Burton, who has achieved eternal life after an encounter with the Fountain of Youth. Alive and well and working as a taxidermist in a Canadian museum, Burton is preparing an exhibition called the Hall of Contagion. One of its proposed displays is a sensationalistic look at AIDS that focuses on Patient Zero's promiscuity.

It includes musical treatment of the topic with such numbers as "Butthole Duet" (likely nsfw) performed by, well, a couple of literal assholes.
posted by mandolin conspiracy at 11:32 AM on October 26, 2016 [5 favorites]

So HIV was circulating in Kinshasa by the sixties - was it the same sort of HIV as people got later, so people were progressing to AIDS but no one put the pieces together?

Most likely, yeah. NPR's show "Radiolab" did a whole episode on the "Patient Zero" concept, and they had a segment on AIDS which touched on these earlier examples - and even provided a credible argument that the "birth" of the AIDS virus happened long ago in a monkey.
posted by EmpressCallipygos at 11:35 AM on October 26, 2016 [5 favorites]

Especially in computing the letter O and the number 0 are often confused.
The problem is even more confused by the fact that this confusion is recognised and when coding (in particular) the difference is signified by extra pen strokes.
The problem then arises that different countries use different pen strokes and, even worse, the same strokes with the opposite meaning.
posted by Burn_IT at 11:37 AM on October 26, 2016 [2 favorites]

Too bad Shilts (and we) were robbed of his life by this horrible virus, because I'm sure he would love to update And the Band Played On with this more accurate information. This article shades him a bit in a way I find a bit unfair (not that he is free from blame for his portrayal of Dugas).
posted by sallybrown at 11:40 AM on October 26, 2016 [7 favorites]

Correct me if I'm wrong, though: isn't this confirming something that's been suspected for a good while?
posted by listen, lady at 11:50 AM on October 26, 2016

Yeah, I never read And the Band Plays On so not clear exactly how much Shilts should shoulder the blame for this mythology vs the media that picked up the story from him. I read that the publisher pushed him to play up this fiction for narrative hook reasons...
posted by latkes at 11:55 AM on October 26, 2016

the account of AIDS emergence in David Quammen's Spillover is unequaled in popular reading. deep genetic analysis narrows the specific time and place - within a few years and a few kilometers. second is Laurie Garrett's account in The Coming Plague.
posted by j_curiouser at 12:21 PM on October 26, 2016 [4 favorites]

The new work makes clear that this strain first jumped from the Caribbean to New York City in 1970 or 1971. By the late 1970s, when the eight serum samples were collected, the five from New York already had a high degree of genetic diversity; the three from San Francisco did not. This indicates the virus probably was in New York much longer than it was in San Francisco.

Robert Rayford [NYT] very likely died of AIDS in St. Louis in 1969, although his cause of death wasn't identified until 1987.

How many other Rayfords were there? Minimally, his death suggests either several incursions by AIDS into the US, or that the epidemic was simmering, unrecognised, for longer than Shilts understood.
posted by ryanshepard at 12:23 PM on October 26, 2016 [5 favorites]

identified as patient O for “Outside of California.”

I can only guess that someone first suggested "patient O.C."...
posted by supercres at 1:54 PM on October 26, 2016

Wow, poor Robert Rayford. All AIDS deaths are tragic but that one seems extra unfair.
posted by Frowner at 1:57 PM on October 26, 2016 [1 favorite]

Among the many things that Randy Shilts got wrong in his book. And, yes, epidemiologists have been pointing this out for quite some time, but this study uses better technology to provide definitive evidence.
posted by gingerbeer at 1:57 PM on October 26, 2016 [4 favorites]

There were a two cases of Scandinavians contracting HIV in the 60s, Arne Vidar Røed and Grethe Rask. Very sad stories both, though not quite the barely imaginable tragedy of Robert Rayford's life.
posted by Kattullus at 2:27 PM on October 26, 2016

So HIV was circulating in Kinshasa by the sixties - was it the same sort of HIV as people got later, so people were progressing to AIDS but no one put the pieces together?

My uncle was a UN worker in Africa in the 50s, maybe the 60s. I remember him musing to me that AIDS sounded a lot like a then-unidentified disease that he had observed while he was there.
posted by Joe in Australia at 3:31 PM on October 26, 2016 [1 favorite]

I'm an epidemiologist/toxicologist who met his husband in a bathhouse in the early 2000s. Randy Shilts is a very popular punching bag in all of this mess, but he died in 1994 (and we just visited his grave three days ago). In all things that have been better understood since 1994, especially in epidemiological circles, it's that the messenger (Shilts) is not to blame for the piss-poor response to the situation of the public health community. That community, which includes the U.S. federal government, still perpetuates damaging, incomplete information about the historic understanding of HIV.

Hat tip to sallybrown for ruminating on the idea that a person who died at HIV's chopping block would be keen to revise his theses if granted the luxury of time and information. I'm not willing to revise what life was like at the time of Shilts' death to have the convenience of pointing a finger at (another) an imagined villain, when none of the villains lived in communities impacted by the virus.
posted by late afternoon dreaming hotel at 4:20 PM on October 26, 2016 [21 favorites]

Yeah, I never read And the Band Plays On so not clear exactly how much Shilts should shoulder the blame for this mythology vs the media that picked up the story from him.

In the movie I got the impression that Gaetan Dugas was just the center of a single cluster studied to prove sexual transmission, not that he was solely responsible for the HIV/AIDS epidemic in America. However, I may have gotten that impression because I had a prior interest in epidemiology and viewed the scene with that bias.
posted by xyzzy at 9:41 PM on October 26, 2016

I remember him musing to me that AIDS sounded a lot like a then-unidentified disease that he had observed while he was there.

Perhaps he was referring to Karposi's Sarcoma , but did not know the name?

...the disease accounts for up to 9 percent of all cancers in a belt across equatorial Africa, where it commonly affects children and young adults.

In the United States, it has primarily affected men older than 50 years. But in the recent cases, doctors at nine medical centers in New York and seven hospitals in California have been diagnosing the condition among younger men, all of whom said in the course of standard diagnostic interviews that they were homosexual.

1981... first article about HIV/AIDS in the New York Times, though the disease had not yet been identified.
posted by Mister Bijou at 9:47 PM on October 26, 2016 [1 favorite]

Shilts wrote in AtBPO that KS appeared only in older Jewish and Italian (Mediterranean might be more accurate) men before the AIDS epidemic.
posted by brujita at 10:08 PM on October 26, 2016

I don't think he was referring to KS (I wish I could still ask him). As I recall, it would have been a reaction to the grab-bag of AIDS symptoms as they were popularly reported: weakness, ill-health, loss of weight and so forth; and heightened susceptibility to other illnesses. He wasn't a doctor himself but he had a lot of medical people in his family, and was at a level where he presumably mixed with other senior aid workers. Mind you, there may be nothing in it; it just occurred to him that there was a resemblance.
posted by Joe in Australia at 10:35 PM on October 26, 2016 [1 favorite]

So HIV was circulating in Kinshasa by the sixties

I heard they've found the virus in preserved tissue samples of French colonial soldiers who died in the 30's (pathologists had saved them, since they could not determine cause of death).
posted by thelonius at 3:01 AM on October 27, 2016

so people were progressing to AIDS but no one put the pieces together?

This is a world where people relied on personal contacts, letters, a limited international phone network, telegrammes, telex.

You know, the pre-Metafilter world.
posted by Mister Bijou at 3:41 AM on October 27, 2016 [1 favorite]

This is a world where people relied on personal contacts, letters, a limited international phone network, telegrammes, telex.

Yes, but people put the pieces together about HIV and AIDS in the early eighties in the US and Western Europe, when there was more international communication but certainly nothing at all like the internet in widespread use.

My assumption was that it would have been a medical infrastructure problem caused by poverty and colonialism rather than a mere communication problem.
posted by Frowner at 8:47 AM on October 27, 2016

It looks like it's complicated...

Our story begins sometime close to 1921, somewhere between the Sanaga River in Cameroon and the Congo River in the former Belgian Congo. It involves chimps and monkeys, hunters and butchers, “free women” and prostitutes, syringes and plasma-sellers, evil colonial lawmakers and decent colonial doctors with the best of intentions. And a virus that, against all odds, appears to have made it from one ape in the central African jungle to one Haitian bureaucrat leaving Zaire for home and then to a few dozen men in California gay bars before it was even noticed — about 60 years after its journey began.

That's the opening paragraph from what is a long and excellent review of “The Origins of AIDS” by Dr Jacques Pépin (NYT)
posted by Mister Bijou at 9:40 AM on October 27, 2016 [3 favorites]