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Patient Zero and the Early North American HIV/AIDS Epidemic

Class 6: New Patient Zeroes
Introduction

Following the recognition of HIV/AIDS in the 1980s, epidemic disease re-emerged as a serious global health issue, a concern which stretches into the early 21st­century amidst anxieties of a world increasingly connected through air travel, trade, and immigration. Newly emerging diseases, like Ebola, Severe Acute Respiratory Syndrome (SARS), and swine flu (H1N1), as well as familiar but resurgent ones like tuberculosis, have drawn heightened scrutiny, and a focus on an epidemic’s “patient zero” is now a well-established feature of a response. True to the imprecise origin of the term itself, “patient zero” has come to be used interchangeably as a synonym for both the epidemiological “index case”—the first case to come to investigators’ attention—and the “primary case”—the earliest known individual to become infected.

Tomes’s article compares the late 20th-century anxiety about deadly microbes to an earlier “germ panic” from the turn of the century, and offers an analysis of the cultural dynamics that can focus attention on public health concerns. Barnes demonstrates how advances in medical technologies have expanded molecular epidemiologists’ abilities to trace the spread of an infection far beyond what was possible for the CDC researchers investigating the Los Angeles cluster in 1982. Some investigators maintain that finding the first human case of a newly emerging disease can yield important insights for risk avoidance. Yet concerns remain about the costs associated with imagining epidemics narrowly in terms of viruses, patient zeroes and individualized, person-to-person contact. In their respective chapters, Barnes and Wald point out that such a narrow focus may obscure equally important determinants of sickness during an epidemic—including poverty, malnutrition, co-infections, and substance use disorders. The tensions between these perspectives play out in Seijas’s radio report on the young Mexican boy identified in 2009 as “patient zero” of the global H1N1 epidemic.

Two chapters on the SARS epidemic make up this class’s supplemental readings. Duffin reflects on the role of history and historians during the SARS epidemic in Toronto, suggesting that the lessons historians were able to offer were frequently unwelcome ones. Carmichael explores the links between responses to SARS in 2003 and those accompanying the Black Death from the 14th century onward. In her chapter, Carmichael reproduces a “patient zero”-like cluster of cases that featured in many media accounts of the outbreak, raising the possibility that such a narrative and analytical device will continue to be of use to historians of epidemics in the future.

Readings

Barnes, David S. “Targeting Patient Zero.” In Tuberculosis Then and Now: Perspectives on the History of an Infectious Disease. Edited by Michael Worboys and Flurin Condrau. London: McGill-Queen's University Press, 2010, pp. 49-71.

Brownlee, Shannon, Eric Ransdell, Traci Watson, Fred Coleman, and Viva Hardigg. “Horror in the Hot Zone: A Killer Virus in Zaire Reminds the Human Species of its Vulnerability.” U.S. News & World Report, May 14, 1995, p. 57.

Hinsliff, Gaby, Mark Townsend, Ed Helmore, and John Aglionby. “The SARS Outbreak: The Day the World Caught a Cold.” The Observer, April 27, 2003, p. 16. http://www.guardian.co.uk/world/2003/apr/27/sars.johnaglionby

Tomes, Nancy. “The Making of a Germ Panic, Then and Now.” American Journal of Public Health 90, no. 2 (February 2000): 191-98.

Wald, Priscilla. Introduction and epilogue to Contagious: Cultures, Carriers, and the Outbreak Narrative. Durham and London: Duke University Press, 2008, pp. 1-28, 264-70.

Additional Resources

Carmichael, Ann C. “SARS and Plagues Past.” In SARS in Context: Memory, History, Policy. Edited by Jacalyn Duffin and Arthur Sweetman. Montreal, Kingston, London, and Ithaca: McGill-Queen’s University Press, 2006, pp. 43-68.

Duffin, Jacalyn. “Introduction: Lessons and Disappointments.” In SARS in Context: Memory, History, Policy. Edited by Jacalyn Duffin and Arthur Sweetman. Montreal, Kingston, London, and Ithaca: McGill-Queen’s University Press, 2006, pp. 1-15.

Seijas, Susana. “Swine Flu – Patient Zero,” Outlook radio program broadcast on BBC World Service, 22:59. October 30, 2009. http://www.bbc.co.uk/programmes/p004t2d7.

Discussion Questions
  1. What aspects of the “patient zero” narrative were replicated in the media coverage of later epidemics like Ebola, SARS and swine flu (H1N1)?
  2. What can be gained from employing the concept of a “patient zero” in stories of disease emergence and outbreaks? What might be obscured? How much of a difference would an infection’s incubation period make to the concept’s utility?
  3. What are the relative advantages of a preventative public health approach versus a strategy that focuses on patient zeroes and person-to-person contact?
  4. Listen to Seijas’s radio report on Édgar Hernández, the young boy identified in the international news media as the “patient zero” of the H1N1 epidemic. In what ways do Édgar’s mother and the state governor challenge this media narrative? How do their positions relate to this week’s readings?
  5. Many of the readings in this course which dealt with historical responses to epidemics were themselves written as their authors’ societies wrestled with the challenges posed by the emergence of HIV/AIDS. How might the authors’ research have been influenced by the debates taking place in their historical present? What can you infer about the perceived role of history’s contributions to these debates? Or about the history-writing process more generally?

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