When Randy Shilts came across the CDC diagram while
researching his book, his attention was drawn to Dugas. ‘In the
middle of that study was a circle with an O next to it, and I always
thought it was Patient O,’ he later recalled. ‘When I went to the CDC,
they started talking about Patient Zero. I thought, “Ooh, that’s
catchy”.’[67]
It’s easier to tell a story when it has a clear antagonist. According
to historian Phil Tiemeyer, it was Shilts’s editor Michael Denneny who
suggested they make Dugas the villain in the book and
accompanying publicity. ‘Randy hated the idea,’ Denneny told
Tiemeyer. ‘It took me almost a week to argue him into it.’ The decision
- which Denneny later said he regretted – came because the media
seemed to have little interest in otherwise. ‘They were not going
to review a book that was an indictment of the Reagan administration
and the medical establishment.’[68]
When discussing outbreaks that involve superspreading events,
there is a tendency to place all attention on the people apparently at
the centre of them. Who are these ‘superspreaders’? What makes
them different from everyone else? However, such attention can be
misplaced. Take that story of the Belgrade teacher who arrived in
hospital with smallpox. There was nothing intrinsically unusual about
him or his behaviour. He had acquired the disease through a chance
encounter, had tried to get medical care at an appropriate place – a
hospital – and the outbreak spread because nobody initially
suspected smallpox was the cause. This is true of many outbreaks:
it’s often difficult to predict in advance what role a specific individual
will play.
Even if we can identify situations that create a risk of disease
transmission, it won’t necessarily lead to the outcome we expect. On
21 October 2014, at the height of the Ebola epidemic in West Africa,
a two-year-old girl arrived at a hospital in the city of Kayes, Mali.
Following the death of her father, who had been a healthcare worker,
the girl had travelled over 1,200 km from neighbouring Guinea with
her grandmother, uncle and sister. At the Kayes hospital, the girl
tested positive for Ebola, and would die of the disease the next day.
She was Mali’s first case of Ebola, and health authorities began to