Patient Zero, Typhoid Mary and Blaming the Sick
Last week, DNA sleuthing disproved a widely held belief about the HIV/AIDS epidemic: that one person single-handedly brought the illness across the Atlantic to North America. That man, a gay flight attendant named Gaetan Dugas, was mistakenly identified as “Patient Zero” by journalists in the 1980s. Not long after his name became public, the crisis had a villain: In a screaming headline, the New York Post called Dugas “The Man Who Gave Us AIDS,” while the National Review deemed him “the Columbus of AIDS.” The accusation stuck for some two decades.
The scientific findings, published last Wednesday in the journal Nature, went beyond the clearing of one person’s reputation. They also shed light on society’s often irrational way of blaming people for getting sick.
The researchers analyzed blood samples drawn from gay urban men in the 1970s, and found that HIV was spreading in North America since 1971, long before Dugas, who died in 1984, could have been infected. NPR reported Dugas was “exonerated,” and the New York Times said scientists “declared him innocent” -- wording which suggests he would have been “guilty” had the DNA confirmed he was actually Patient Zero. But guilty of what?
Why should the guilt or innocence of Mr. Dugas -- or anyone -- pivot on something over which he had no control? It wasn’t up to him whether he was first or fifth or 5,000th person to spread HIV in the United States. Whoever was first -- and somebody was -- couldn’t possibly have known that the virus would become an epidemic. That wouldn’t have happened yet.
Dugas’s story illustrates an unfortunate fact: People have a tendency to play the blame game when it comes to disease, according to Columbia University medical ethicist Arthur Caplan. The concept of blaming people for chance events is called “moral luck,” and it has posed a puzzle for philosophers for some time. Imagine a case in which two drivers, both equally careless, blow a stop sign. One harms no one, and the other kills a pedestrian. Is the second driver more immoral or irresponsible than the first, even though only luck separates the consequences of both drivers’ actions?
Caplan, for one, says the public is far too eager to assign blame for bad health luck, and the “Patient Zero” story offers a case in point. Indeed, by declaring Dugas exonerated, news outlets implied that being Patient Zero was a matter of guilt. While it might be useful for health authorities to trace carriers of infectious diseases, Caplan said, Dugas’s story was exploited for gossip.
Dugas’s case is reminiscent of the story of “Typhoid Mary” -- the unfortunate nickname that stuck for eternity to a young Irish-born cook named Mary Mallon a century ago. AIDS was going to spread or with or without Dugas, and typhoid fever was going to kill with or without Mallon. But to a fearful public, each became a symbol of danger.
Mallon was born in 1869, and came from Ireland to the United States as a teenager, after which she found work as a cook. She traveled from household to household, and between 1900 and 1907, some two dozen people she had cooked for fell sick with typhoid fever, a potentially deadly disease. What made her case special was that she was the first person identified who carried the virus but hadn’t gotten sick, according to historian Judith Walzer Leavitt, who teaches at the University of Wisconsin and is the author of “Typhoid Mary: Captive to the Public’s Health.”
In 1907, Mallon was tested as part of an investigation into an outbreak in New York and identified as a carrier. Authorities quarantined her by imprisoning her on an island off the Bronx. She was later allowed back into society under the promise never to work again as a cook. But she went back to her profession, was apprehended, and then forced to spend the rest of her life in isolation.
What Leavitt learned from researching the story is that to get cooperation from patients, health authorities need to treat them with fairness. “They weren’t fair when they whisked Mallon off to quarantine,” said Leavitt. “That rose her ire.” Mallon resisted the health officials’ orders because she deemed their behavior unjust. “She had a good life -- she was a good cook, and that was taken away from her,” said Leavitt.
And while some news coverage of Mallon was sympathetic, much was not: As Leavitt recounts in “Typhoid Mary,” the first article to identify her by name ran with an illustration of a cook dropping human skulls like eggs into a flaming skillet, and the press only grew more hostile with time.
Just as historians today view Mallon as more a victim than a villain, the news media now is singing a chorus of sympathy for Dugas. But it wasn’t always so. In 1987, for example, Time magazine ran a highly judgmental piece titled “The Appalling Saga of Patient Zero,” detailing his active sex life. The article quoted a doctor saying that Dugas continued to engage in casual sex after he was warned that he might be spreading a disease. But this would have been after the fact and independent of his status as Patient Zero.
Why were these people singled out when so many others spread AIDS and typhoid? Perhaps because they both came from stigmatized communities. Dugas was an out-of-the closet gay man at a time of rampant homophobia, and Mallon was an unmarried, working-class Irishwoman at a time when immigrants and single women were viewed with distrust. “They were people health departments and newspapers could identify as expendable on some level,” Leavitt said.
The latest round of news has shifted the finger of blame to journalist Randy Shilts, for identifying Dugas as “Patient Zero” in his 1987 history of the AIDS crisis “And the Band Played On.” 1 The researchers of the new paper say this was an error based on a misinterpretation: In the early 1980s, California-based epidemiologists had labeled Dugas “patient O” -- the letter “O” standing for “Outside Southern California.” But in the Time article, a prominent AIDS researcher is quoted confirming Dugas as “Patient Zero.”
The origin of the Patient Zero narrative may be more complicated than it’s been presented. Instead of shifting blame, this latest twist should prompt people to reconsider blame in the first place -- and to be mindful of conflating bad behavior with bad luck.
While Shilts was the first to publicly describe Dugas as “Patient Zero,” he was careful not to claim he definitely brought the virus to North America, calling the matter “a question of debate.” Other journalists weren’t so cautious.
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