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Patient Zero
Defeat Helya while all raid members but one are afflicted with Fetid Rot, in Trial of Valor on Normal difficulty or higher.
Patient Zero requires defeating Helya in Trial of Valor with all but one raid member afflicted by Fetid Rot when she dies, and can be earned solo at max level as long as you do not have the Fetid Rot debuff on yourself at the moment of the kill.
Enter Trial of Valor
Enter Trial of Valor on Normal difficulty or higher and proceed through Phase 1 normally, as nothing about the achievement changes during that phase.
Handle Fetid Rot in Phase 2
When Phase 2 begins, the Grimelord spawns and casts Fetid Rot on random players. Place a marker on the ground where Fetid Rot players should stack to bounce stacks between only two designated people, while all other raid members stay away from that marker entirely. Once those two players have accumulated stacks, pull everyone else away from the marker, then kill remaining tentacles without letting any other player approach the stacking spot.
Prepare the Achievement in Phase 3
Burn Helya to around 20 million health, then have the Fetid Rot-carrying players stop dealing damage and any pet-based players dismiss their pets before the final application — Affliction Warlocks must both stop casting and dismiss pets. Stack the rest of the raid on the marked tank so Fetid Rot spreads to all but one player, then burn Helya down immediately, since Fetid Rot reduces healing taken and the group needs enough health to survive the over 550k damage dealt when stacks are removed.
Solo the Encounter
At max level, soloing Helya as any class grants the achievement automatically as long as you do not personally carry the Fetid Rot debuff when she dies — an Affliction Warlock at 227 item level confirmed this works by applying full dots and instant-killing the Grimelord when it spawns to the left as you face Helya in Phase 2.