Patient Zeros

What do Monica Lewinsky, Thomas Eric Duncan, and Elvis Costello have in common? Zero.

By Liesl Schillinger
Illustration by Keetra Dean Dixon


Last week in Philadelphia, at the Forbes Under 30 Summit for young business leaders, Monica Lewinsky received a standing ovation for a public address in which she denounced cyber-bullying and deplored the “empathy crisis” that has arisen since her name went viral, almost 20 years ago. “I was Patient Zero,” she said; “the first person to have their reputation completely destroyed worldwide via the internet.” Portraying herself as the Typhoid Mary of online incivility, she told the audience, “I was the most humiliated woman in the world. What I want to do now is to help other victims of the shame game survive too.” And then she joined Twitter.

Her timing was excellent. Things like #gamergate and the iCloud photo hack of celebrity nude selfies, building on a growing list of suicides provoked by vicious texts and posts on cell phones and social media, have fanned public outrage at web-spread harassment. Still, online reaction to Lewinksy’s speech was mixed and often snarky, prompting the website Upworthy to reprove flamers: “There’s a lot we can learn from her.” But was Lewinksy correct to call herself Patient Zero?

“Patient Zero” is a phrase that was invented by American doctors and epidemiologists in the 1980s, early in the global AIDS crisis, to supplant the less catchy term “index case,” which the Oxford English Dictionary defines as: “The first identified case in a group of related cases of a particular communicable or heritable disease.” As thousands of people began falling sick in North America with a mysterious, incurable illness, a panicked public wanted to know who had brought the contagion to our shores. Experts responded with the user-friendly explanation that the culprit was “Patient Zero” — in other words, the original carrier of the disease, who passes it along to others, who passes it along in turn, and so on and so on and so on — as in the ’70s Fabergé Organics shampoo ad. Figuring out who that was, though, was tricky.

Before Patient Zero was a number, he was a letter: he was “Patient O,” an anonymous “non-Californian” bearer of the virus, whose case was discussed in an American Journal of Medicine study about AIDS, in March 1984. As news of the study circulated, “Patient O” morphed into “Patient Zero,” and was declared to be Gaëtan Dugas — a gay Canadian flight attendant who infected many partners with HIV before he knew he was sick. Dugas died of AIDS-related kidney failure the same month the article appeared. Later, though, a prior Patient Zero emerged, a Missouri teenager named Robert Rayford, who died of AIDS in 1969, before anyone knew what it was. In recent decades, as science has made HIV-AIDS more manageable for those who can afford the medication, the words “Patient Zero” have escaped their medical quarantine and invaded the culture, attaching themselves to novels, songs, video games, computer virus outbreaks, and now, the blight of cyber-bullying. But in the last few months, the advent of another epidemic, the Ebola virus, has brought back the phrase’s original potency. In Africa, Patient Zero is thought to be a two-year-old baby named Emile Ouamouno, from Guinea, near the Sierra Leone and Liberia borders, who died last December. His relatives caught the disease from him and passed it on. In North America, Patient Zero for Ebola was Thomas Eric Duncan, who died earlier this month.

AIDS has killed 36 million people since its emergence in 1981, and about the same number are living with HIV-AIDS today. The 2014 Ebola outbreak has killed nearly five thousand people, thus far. Can cyber-bullying, as reprehensible and destructive as it is, be compared to a plague? Perhaps, metaphorically, it can; it’s a reasonable imaginative leap, even if it’s in questionable taste (which is an affliction that has no cure). But if so, strictly speaking, Patient Zero would not be Lewinsky, who “caught” the plague, but Matt Drudge, who originated the infection on the Drudge Report in January of 1998, when he exposed Lewinsky’s affair with President Clinton, and ushered in the age of aggressive, salacious online gossip-mongering. Still, all’s fair in love, war, and public shaming; and if Lewinsky wants to claim the title, she might as well. Speaking still more strictly, however, Patient Zero might be better understood as “Patient One.” Why is that? To paraphrase President Clinton, it depends upon what the meaning of the word “zero” is. The nature of “zero,” a non-number, the hold-all for “nothing,” has bedeviled philosophers for millennia. Zeno of Elea, wrestling with the concept in the fifth Century B.C., mused that “if it were added to another thing, it would not make it larger.” The notion of a Patient Zero implies not only addition, but multiplication, which, paradoxically, hints that the “zero” it bespeaks is something, not nothing.

As recently as the 1980s, “zero” still lacked a positive value; a “zero,” in a social context, was “a nonentity,”or “nil” or “irrelevant.” Less Than Zero, Bret Easton Ellis’s 1985 novel about a loathsome, privileged, cocaine-sniffing college student from L.A., took its name from an Elvis Costello song about the reprehensible Oswald Mosley, the former British Fascist leader — a “slandering fantasy,” Costello called it. The chorus went: “They think that I’ve got no respect but/ Everything means less than zero.” But since the ’80s, the word “zero” has come to mean more than zero, gaining stature and valence in American discourse. Beginning in the 1990s, “zero tolerance” became a catchphrase for admirably stringent policies against everything from drunk driving to sexual harassment to violence in schools; while in the last decade, the invention of Coca-Cola Zero put a positive twist on the idea of zero calories, at least for those who aspired to wear size zero jeans — or size triple-zero jeans — seeing zero as a virtue, at least in denim. And, more significant: In lower Manhattan, in the wake of 9/11, Ground Zero has become a national monument.

In September, while James Franco was shooting Zeroville in Venice, Italy — a movie based on a novel about film, identity, and time, and which one critic described as a “Möbius strip that turns from alpha to omega and back again”—New York’s Mayor Bill DeBlasio was finalizing his Vision Zero campaign for the city, which kicks off in November. It’s a public safety initiative intended to reduce the number of traffic fatalities (to zero). Last week, during a visit to Queens, Vice President Joe Biden misspoke at a press event and called the mayor’s project “Zero Vision” before correcting himself; but everyone knew he intended only praise. After all, what could be more visionary, or forward-looking, at the current cultural moment, than rooting for “zero”? The same day that the Vice President was hailing Vision Zero in Queens, Ms. Lewinsky was proclaiming her patient zero status in Philly — advancing the program of turning zero to hero.

One may still be the loneliest number; but these days, zero not only has company, it has fans; and, if you visit Twitter, you will see that cyber-bullying’s newly minted Patient Zero already has 78,000 followers (and counting) on her fledgling feed. Parmenides may have argued that nothing comes from nothing; Parmenides didn’t know about the internet.

Please email suggestions for turns of phrase or words you would like to see explored in the next News of the Word to Liesl Schillinger.

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