A demonstration against the epidemic in the 1980s in San Francisco
The exoneration of “Patient Zero” of America’s AIDS epidemic in the 1980s raises ethical questions about confidentiality. French Canadian airline steward Gaétan Dugas was named as the centre of the epidemic in the 1987 book And the Band Played On. He and his family were vilified after his death of AIDS complications in 1984. The New York Post even fingered him as "The Man Who Gave Us AIDS."
But according to a study of the spread of the virus published recently in Nature, Dugas was just one of the early victims of AIDS, not its cause. Investigators from the Centers for Disease Control contacted him because he was at the centre of a cluster of men who had Kaposi’s sarcoma or others illnesses characteristic of late-stage AIDS. Dugas had kept a diary and gave the CDC researchers the names of 72 of his hundreds of sexual contacts. This enabled them to see how the disease spread.
The authors of the Nature article analysed blood samples from the 1970s and found that AIDS was already widespread in the 1970s, demonstrating that Dugas had not been the epicenter of AIDS.
An article in the New York Times raises the question, “Is it right to hunt down the first case in any outbreak, to find every Patient Zero?” Journalist Donald G. McNeil Jr points out that finding Patient Zero has become a staple of reporting about epidemics and of B-grade films about disease. Steven Sonderbergh’s film Contagion, for instance, opens with the death of a Minneapolis woman who turns out to be the centre of a catastrophic epidemic.
Although some bioethicists believe that singling one person out is stigmatizing. But McNeil says that mapping the spread of a disease is absolutely necessary to contain it. Beside, some people are “superspreaders”, like “Typhoid Mary”, an Irish cook who spread the disease wherever she worked but refused to obey public health authorities.
He concludes that sometimes naming Patient Zero, or at least releasing his or her hygiene habits, sexual practices, age or race may be necessary. It’s “all about the need to know,” says Dr William Darrow, the CDC investigator who found Dugas. “You weigh the potential harm against the potential benefit.”
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