>> When our communities need help, Blue Cross and Blue Shield companies step up with partnerships capable of preparing meals for thousands of families in need, because it's not just about health insurance.

We believe it's our responsibility to expand care to rural communities, protect our heroes with safety equipment, support local nonprofits.

These are our stories to help build stronger communities for the health of America.

>> "Second Opinion with Joan Lunden" is produced in conjunction with UR Medicine, part of University of Rochester Medical Center, Rochester, New York.

>> Before the beginning of 2020, many of us had never heard the word "coronavirus," but coronaviruses aren't actually new.

Researchers have been studying coronaviruses for decades.

Today we're going to talk about all coronaviruses, including COVID-19.

Joining us is our primary care physician, Dr. Lou Papa, from the University of Rochester Medical Center... >> Really want to know right there.

They want real-time information about who's infected and who's not infected.

>> ...Dr. Anthony Fauci, the Director of the National Institute of Allergy and Infectious Diseases at the NIH.

>> So this is something that goes from a pure common-cold virus that we've had experience with for a very long time to a brand-new pandemic that's gripping us now in an experience that's historic.

>> ...Dr. David Topham, the Director of the University of Rochester Center for Coronavirus Research... >> Have a responsibility to the people around you, not to be spreading the virus and not putting them at risk.

It's not just about you.

>> ...and Dashauna Ballard, a COVID-19 college academic-accommodation specialist, who also recently recovered from COVID-19.

>> It started with what I thought was like a bad case of allergies, and then it just progressively got worse.

>> I'm Joan Lunden, and it's all coming up on "Second Opinion."

♪♪ As COVID-19 appeared in late 2019, our lives changed forever.

Social distancing, wearing masks, and using hand sanitizer became a normal part of our life.

However, long before the World Health Organization announced the COVID-19 pandemic, coronaviruses had been around making us sick in ways that we hardly even worried about, like the common cold.

Since the start of this year, 2020, Americans have been turning to Dr. Anthony Fauci for trusted information about how we can stay healthy during this pandemic.

And, Dr. Fauci, we know how incredibly busy you are, so thank you for being here and for all the work that you do.

Let's kind of lay the groundwork for our discussion.

Explain to us what coronaviruses are and how they spread.

>> Well, as you said correctly just a moment ago, we've known a lot about coronaviruses in general for decades and decades and decades.

Coronaviruses are a family of viruses, and we should know that there are four of them that actually are responsible for about 15% to 30% of the common colds that all of us, you and I included, experience repetitively almost every year, as they cycle around and cycle around.

And 2002 was our first experience with a pandemic coronavirus, which was the original SARS coronavirus that emanated out of China in 2002, had a pandemic of about 8,000 cases and close to 800 deaths but then burned itself out because it was controlled very well by pure public-health measures, namely identification, isolation, quarantine, things like that.

Then, 10 years after that came the Middle East Respiratory Syndrome, or MERS, which is another coronavirus, which, again, just like the original SARS, jumped species, likely from a bat to an intermediate host to a human.

MERS did the same thing.

And it had an outbreak that wasn't as extensive as SARS was, but had a high degree of mortality, but didn't spread very efficiently.

And then fast-forward to 2019/2020.

You have the third pandemic coronavirus, which is COVID-19, which has two characteristics that make it very formidable and in fact now giving us an historic outbreak.

Namely, it spreads extremely efficiently from human to human, and it has the capability, at least among some populations, of having a high degree of morbidity and mortality.

So this is something that goes from a pure common-cold virus that we've had experience with for a very long time to a brand-new pandemic that's gripping us now in an experience that's historic, in that we've not seen anything like this for 102 years, since the 1918 Spanish flu.

>> Dr. Fauci, you know that there are people who see COVID-19 as, you know, just kind of a mild illness -- "I might as well go over to somebody's house that has it and get it and get it out of the way."

However, talk to us about the long-term effects of having this disease.

>> Well, I mean, that's a dangerous approach to say, "I might as well just get infected and get it out of the way."

Statistically speaking, it is true that younger individuals have much less of an issue with serious consequences of the disease.

If you look at the number of hospitalized individuals per 100,000 population, the curve skews very heavily towards elderly individuals -- 70, 75, 80, 85 years old -- whereas younger individuals generally, with some exceptions -- and we've got to be careful because, the more we learn about this disease, the more we see that there are more and more of these so-called exceptions, that people even who are relatively young -- 30s, 40s, 50s -- can get serious consequences.

Although, the statistics show unquestionably the elderly are more likely to have serious consequence.

But the other issue is that people with underlying conditions of any age are much more likely to get serious consequences.

Those underlying conditions, if you look in the general population, a significant proportion of the U.S. population have some of these underlying conditions, things like diabetes, obesity, hypertension, chronic lung disease, cardiovascular disease.

So although there are people who can get infected -- and in fact we know about 40% to 45% of the people who get infected are without symptoms, and yet the range of symptoms are from very mild to very serious, where you can actually require hospitalization, intensive care, and even death.

One other point to make, the point that you mentioned, Joan, that individuals who are young may say, "Well, what the heck?

Why don't I just get infected?

It doesn't make any difference."

Well, it does, because even though you may not get into serious trouble, by the fact that you're allowing yourself to get infected, i.e.

being careless about being infected, you're actually propagating the outbreak -- you are part of the problem.

We want to get the outbreak under control, but when you get infected, even if you don't have symptoms, it is likely that you are gonna then inadvertently and even innocently infect someone else, who then might infect someone else, and then you're gonna have a person get infected who is either an elderly person or someone who's on chemotherapy for cancer or a child with an immunodeficiency, and so, all of a sudden, your getting infected is not without significant consequences, maybe not for you, but ultimately for someone else.

So you really have to have somewhat of a societal responsibility to take care of yourself, and by doing that, you're helping to take care of society.

>> Dashauna, at the beginning of 2020, you were a teacher, and then in March, like all schools, your school went away for spring break, but like all schools, nobody went back to in-person learning.

At that point in time, what were you thinking about the pandemic and about COVID-19?

>> At that point in time, I realized that it was more serious than I anticipated.

And, honestly, when we didn't go back, I thought it was just gonna be for like a month or two, so we missed for spring break in March, and I thought we were gonna go back the next month, because things were just gonna go back to normal, but we ended up -- we didn't go back for the rest of that school year.

>> You also started feeling not so great.

What were you feeling?

>> So, it started with a headache.

I had a serious headache.

It felt like a sinus headache, because when I would sit in certain positions, it kind of alleviated a little bit, and then it progressed into nasal congestion, and I had sinus pressure, and I experienced fatigue, but I honestly thought that I was just dealing with a bad case of allergies, because at that point in time, when I heard about coronavirus, I just heard about shortness of breath, cough, and fever.

So, I just thought I was having a severe allergic reaction due to the seasons changing, but then I realized it might've been more serious when my symptoms started -- some of them, they came, and then they went away, and then I started getting other symptoms.

I started coughing.

I had pain when I was breathing in, and that's when, later on, I found out I actually developed pneumonia.

>> Mm-hmm.

>> And I had a lot of gastrointestinal issues.

I also had muscle weakness.

I experienced hallucinations, as well, a few times when I was sick.

So it started off with what I thought was like a bad case of allergies, and then it just progressively got worse.

>> So, Lou, let me bring you in.

How many calls have you gotten or how many calls did you start to get at that time from people that had symptoms like Dashauna?

>> So, a lot of professional medical organizations actually developed a flow chart for doctors for phone calls because that's how bad it got -- a flow chart for people that are just worried about the virus, a flow chart for people that had mild symptoms, flow chart for people that had severe symptoms.

And just as Dashauna has laid out, we all told -- Doctors in the beginning, we were learning, as well -- you know, fever, cough, sore throat.

Sounds like you didn't have any of that in the beginning.

Sounds like it was mostly allergy symptoms, so it shows you what a chameleon this is.

And it's not unusual to have that situation where there's that eye of the storm where you kind of get a little bit better and then it can progress into something more serious.

So, we all worry about this.

When you hear this, we were assuming, "Corona until proven otherwise."

>> Right.

>> And those people we would tell to quarantine themselves.

>> So, what did you do?

Like, at what point did you say, "I got to go see a doctor"?

>> It got to the point where I couldn't move around.

I was very weak.

I couldn't shower on my own.

>> Wow.

>> I had trouble standing up for long periods of time, so I was telling my mom about it, because like I said, at that time we were out, and my mom is actually a teacher, as well.

So, she was concerned based on, like, me telling her that, "This is getting progressively worse."

So she was like, "No, I'm driving you to urgent care to see what's going on."

That's when they did the X-ray of my lungs, and they told me at first I had bacterial pneumonia, but then they also gave me a COVID test, and then I had a fever, as well.

>> So, Dr. Topham, she was diagnosed with pneumonia and COVID-19.

Do we see those two come together?

>> Yes.

Well, the virus itself causes a pneumonia, which is fluid in the long, and then as soon as you have fluid in the lung, it's ripe for a bacterial infection.

>> And what's the treatment?

>> So, for COVID, we didn't have anything.

A lot of the times, they were getting antibiotics at the beginning because we didn't know and you just wanted to err on the side of caution, and they would get some antibiotics.

But she gave some very worrisome symptoms where she felt fatigued and lightheaded, which was probably the beginning of her oxygen level getting very low.

A lot of these patients that have COVID-19 actually have oxygen levels -- Ours are supposed to 90% and above.

You worry when it gets down to 93%.

Some of these people were walking around with 75%, 80%, and not even aware of it.

And then they get short of breath.

It's very bizarre.

So, that's a very worrisome set of symptoms.

>> In your lab, you study the coronaviruses and lots of other viruses and how our immune system responds.

That's really what you're looking at, right?

>> That's really what we're looking at, and we're getting a few surprises with this new coronavirus.

It's not behaving and interacting with the immune system in ways that we would consider normal.

It has unusual properties in that, for instance, it infects the cells of our immune system, and it can kill them, and so that may actually affect our ability to mount a long-term immune response.

>> Which kind of explains some of the low white count in the beginning when you see people sick.

>> It does, and that happens in influenza, as well.

But I think it's for a different reason.

In influenza, it's primarily caused by a type 1 interferon, and it makes the lymphocytes what we call apoptose, or die.

But there's evidence that this coronavirus actually suppresses the interferon response and that it may be directly killing lymphocytes.

>> So, if it's killing off immune cells, does that put you in a more compromised position as a person just going on later in your life?

>> It can, and that's why we want to study people that have different degrees of severity, because we don't know where on that spectrum from mild, asymptomatic disease to severe, which part of that is affecting the immune system the most.

Is it all the infections that are like that, or is just the most severe?

The evidence that I just mentioned really came from the most severe cases, so we don't know if there's something different about that than, say, somebody that had just a mild case of the virus.

>> And we do know that viruses can change over time.

I just think about the flu, influenza.

You're getting something new to be vaccinated with every year.

How do viruses change over time?

And where does the COVID-19 fit into that?

>> Well, some viruses do.

Others are very, very stable.

Measles is an extremely stable -- The measles that was going around when I was a child is essentially the measles we're seeing now.

But viruses, particularly RNA viruses -- and in fact COVID-19 virus, SARS-Coronavirus-2, is an RNA virus -- they tend to mutate.

Sometimes, those mutations don't have any functional effect, but sometimes they do, so that we don't know yet whether this particular coronavirus is gonna mutate enough to change over months to years.

If you look at the history of coronaviruses that we've had experiencing with -- for example, with the common-cold coronaviruses, they do not seem to change very much from year to year in the sense of flu, which literally keeps drifting and drifting so that you have to get a new vaccine almost every year.

It doesn't look that way, but, remember, we're dealing with a new virus here, with the COVID-19 virus, so we just have to see what happens as the months and the years go by.

>> Dashauna, it got really bad for you.

Tell us what happened when you -- you ended up going to the hospital.

>> Yes.

So, Wednesday, I tested -- On Wednesday, I ended up going to urgent care, and then they diagnosed me with bacterial pneumonia, and then they ran a COVID test.

Thursday, I was pretty much bedridden, and I couldn't move without just losing my breath and gasping for air.

>> Phew!

>> Friday, it alleviated a little bit, and I had a pretty okay day in terms of dealing with it, but that night, I ended up -- I started feeling a little better, and I feel like I just started being negligent at that point, so I started getting up and sitting down too fast, and then it completely knocked all of the wind out of me.

>> Mm.

Wow.

>> And I got scared because, normally, when I lost my breath, I would sit there for a second and eventually it would come back, but I noticed that it wasn't coming back, and I felt like I started having a panic attack.

And at that point, I went to the hospital, and when I got to the hospital, they tested my blood-oxygen level, so they were kind of concerned, and I told them I had tested positive for COVID-19.

So they took me to ICU, and they monitored me, and I was in the hospital for like a day or so.

>> Does this sound pretty much like what you're... >> Yeah, they were very aggressive with her, which is good.

By then, they probably learned somewhat not to wait for the oxygen level to get lower.

I mean, for a young woman without other medical problems, to get short of breath just walking a couple of steps?

That gives you an idea of how bad her pneumonia was.

And she would probably decline very rapidly if they didn't intervene and monitor the way they did.

>> Well, that kind of tells us something, is that if you have any suspicion that this might be the case, especially if you're older, that you need to seek testing -- medical attention and testing right away.

>> Yeah, testing is very important, and it's also important that you get the results back quickly.

This testing that's being done in some places where you get the results five or seven days later, that's not useful.

You're either sick by then or you've spread it.

>> Yeah.

>> You need the test in a day, and it can be done in a day.

>> And I think some of the problems for some of these places is the availability of the test, availability of the reagent, availability of staffing to do the testing.

But you're right -- you really want to know right there, and you want real-time information.

>> Yeah.

>> You know, and, of course, as everybody's trying to get in and get this test and then they're waiting for the results, they could be infecting a lot of other people.

>> That was a big problem at the beginning, was the availability of the test.

I remember we had such limited availability of the test, we were only to test people that we suspected could be at risk of having COVID-19 with pneumonia.

That's how bad the availability was.

>> It's important to test, because the only way you can get an outbreak under control in the absence of a vaccine is by identifying individuals who are infected, isolating them, and then tracing their contacts to see if they're infected and then isolate them so that you get people out of circulation so that they're not infecting other people.

That's a very well-established public-health measure that we use for a number of infections.

When you have a vaccine, you've sort of solved the problem, like we have with vaccines for diseases that we control very well, like measles, mumps, rubella, polio.

>> And that's the hardest thing to get across to patients, even when you talk about immunizations.

It's very much they're focused on themselves, which it's understood -- it's your health.

But this is really public-health information at it's best, you know, trying to make sure that everybody reduces your chance of getting it and the spread that you can have to others.

>> Actually, one of the things we're eager to do is to study immune responses to the vaccines, because we want to compare that to the immune response to infection.

I think there's actually a chance that some of these vaccines will give you better, longer-lasting immunity than the infection itself.

>> It sounds like what you're saying is that, basically, using the vaccine, you get to bypass all the bad stuff it does to your body and get the immune response.

>> Correct.

In a controlled fashion, right, that we've measured and tested and made sure that it's safe.

>> And for those who have had COVID-19 and then recovered from it, how long will their -- do we know how long their immunity will last?

>> The answer to that, Joan, is we don't know.

We know from experience with the common-cold coronavirus that clearly people get reinfected time and again, which means that, although they are likely protected for a finite period of time, it isn't that years-long, lifelong that you get if you're infected with measles or another of the viruses that give you lifelong protection.

So right now we actually don't know, and we have to be humble enough to admit and recognize that we don't know how long this protection lasts, and it is possible that we could get reinfected with COVID-19 virus.

>> Are you scared that you're going to get it again?

>> Yes, because as was mentioned before, we don't necessarily know whether or not people are immune to catching it again, and I always have that in the back of my head when I'm around people, it's a possibility that I could catch it, and I just -- you know, it's kind of nerve-racking because I don't want to necessarily go through that experience again, so, yeah, I do worry about it.

>> And this virus, though, has so many long-term effects after.

I know that I just heard you talking earlier about little blood clots.

>> Yeah, so this isn't just a respiratory infection.

It's spread by a respiratory route, but in fact COVID-19, or SARS-2 virus, spreads throughout the body.

It infects the cells of the vasculature.

It upsets your coagulation pathways.

I think it's too early to know exactly what's causing that, but we know people that have COVID-19 -- at least severe disease -- have problems with their kidneys, problems with their brains, problems with their hearts, because the virus infects all those organs, and, again, we don't know what the long-term consequences are gonna be from those infections.

>> And blood clots can really -- I mean, are the people coming back in and presenting with these blood clots?

>> People that are dying are dying of blood clots.

>> Really?

>> And so we were talking earlier about people deliberately going to a house to get infected and get it over with.

That's a very dangerous thing to do, knowing that this virus has these other consequences.

You cannot treat it like a normal, seasonal coronavirus infection.

It's far more serious than that, and it's unpredictable.

>> I think that's what Dr. Fauci is getting at, is even though a younger person may have a very mild reaction, you don't know.

>> You have a responsibility to the people around you not to be spreading the virus and not putting them at risk.

It's not just about you.

>> Right, exactly.

>> But even today, don't you think that we've seen, where if people truly wear masks and wash their hands and have physical distancing, we can get people back to normal life?

>> When you look at the pictures that you sometimes see on TV of people crowded at bars without masks or congregating in crowds of entertainment or partying or what have you, that's how the virus spreads.

But unfortunately for us, certain segments of our population ignore that public-health advice.

>> Well, Dr. Fauci, we thank you so much, and we thank you for all the work that you've been doing and for being that trusted source.

Dashauna, what do you know now that you wish you had known back at the beginning of spring break that you want to share with others?

>> So, I wish I would've known how serious it was and what it can do to the body, because for me, my experience was very traumatic.

I don't typically get sick besides getting, like, a cold.

I haven't even had the flu before.

So that was very scary for me to go from that to ending up in the hospital, and then I was really scared, thinking I was gonna die.

But I just wish I would've taken things more seriously.

>> And of course that's where public information becomes so incredibly important.

Dashauna, thank you so much for being here today and sharing your story, because that's how others learn.

And, doctors, thank you so much.

And of course, for all of you at home, thank you for watching.

You can find more information about this series at secondopinion-tv.org.

You can also follow us on Facebook on YouTube, where you can watch today's episode and much more.

So, from all of us here at "Second Opinion," we encourage you to take charge of your healthcare.

I'm Joan Lunden.

Be well.

♪♪ ♪♪ ♪♪ >> When our communities need help, Blue Cross and Blue Shield companies step up with partnerships capable of preparing meals for thousands of families in need, because it's not just about health insurance.

We believe it's our responsibility to expand care to rural communities, protect our heroes with safety equipment, support local nonprofits.

These are our stories to help build stronger communities for the health of America.

>> "Second Opinion with Joan Lunden" is produced in conjunction with UR Medicine, part of University of Rochester Medical Center, Rochester, New York.

♪♪