The authors in this manuscript have reported an increase in the number of vascular emergencies seen during the early phase of the COVID-19 pandemic in the Lombardy region of Italy. A significant increase in the number of acute limb ischaemia was seen during this phase along with other vascular emergencies. In this review, we have tried to examine this association between increase in vascular emergencies and COVID-19 infection. We have also described the differences in presentations, prognosis and procedural outcomes following operative interventions in these patients compared to the non-COVID patients. An attempt has been made to assess the role of adjunctive measures like intravenous heparin to improve outcomes.

Coronavirus can lead to overcoagulation, blood stasis, and endothelial damage resulting in thromboembolic disorders. We report a 22-year-old pregnant woman with coronavirus admitted due to the pulmonary emboli. This case highlights the importance of considering a new category for COVID-19 pregnant patients with venous and arterial thromboembolic disorders.

Euglycemic DKA (euDKA) is a serious side effect associated with SGLT2 inhibitors. We present a case euDKA in a patient on an SGLT-2 inhibitor likely precipitated by COVID-19 infection. We suspect that COVID-19 led to euDKA. We pose the question of whether these medications should be discontinued proactively.

Although children are less affected by Novel coronavirus disease 2019 than adults, it should not be missed, especially in those with underlying diseases. Herein, we report a patient with primary antibody deficiency, who was affected with COVID-19. This infection could be presented mildly in patients with immunodeficiency.

We report a case of Takotsubo cardiomyopathy (TTC) induced by diffuse fear of the COVID-19 pandemia and aggravated to ventricular fibrillation. After succesfull resuscitation the patient developed temporarily a J-wave after event. Though potentially live threatening in the acute phase both J-wave and TTC are reversible with receding of edema.

We studied the psychosocial impact of the start of the COVID-19 pandemic on Dutch children with cancer in outpatient care and their caregivers (n=799) using regular monitoring and screening outcomes. No differences were observed between the pre-COVID-19 and COVID-19 era in health-related quality of life and fatigue of children. Fewer caregivers were distressed during the COVID-19 era than pre-COVID-19. In conclusion, the additional stress of COVID-19 did not deteriorate psychosocial functioning of children with cancer and their caregivers. Results may be explained by alleviating daily life changes, experience in coping with medical traumatic stress and appropriate care and support.

Pediatric pulmonologists, and, indeed, general pediatricians, are exposed to the causative virus of Covid-19 , SARS-CoV2, in their daily outpatient practices from both symptomatic and asymptomatic patients. This risk naturally increases with multiple exposures over time. We have developed a simple equation to calculate the probability of a practitioner remaining Covid free over a specified time interval, given the local population prevalence of virus, the transmissibility of the organism or “attack rate,” the mitigating effects of personal protective equipment (PPE), and the number of patients seen over the time interval. The equation can be used to construct a Kaplan Meier -like plot for remaining Covid free. Since studies of transmission of SARS-CoV2 suggest a spectrum between droplet and aerosol spread, even in asymptomatic patients and absence of aerosol generating procedures, the type of masks protection worn by medical practitioners may mitigate risk to different degrees. Eye protection may mitigate the risk further. While the risk of acquiring Covid-19 in a year of practice is low, it is not negligible. However it can be minimized. These considerations may be helpful in deciding local risk to the practitioner according to practice volume and in choosing the level of PPE that would result in minimizing that risk.

Objective: To present a nation-wide analysis of the workload of urology departments in Turkey week-by-week during Covid-19 pandemic. Methodology: The centers participating in the study were divided into three groups as tertiary referral centers, state hospitals and private practice hospitals. The number of outpatients, inpatients, daily interventions and urological surgeries were recorded prospectively between 9-March-2020 and 31-May-2020. All these variables were recorded for the same time interval of 2019 as well. The weekly change of the workload of urology during pandemic period was evaluated; also the workload of urology and the distributions of certain urological surgeries were compared between the pandemic period and the same time interval of the year 2019. Results: A total of 51 centers participated in the study. The number of outpatients, inpatients, urological surgeries and daily interventions were found to be dramatically decreased by the third week of pandemics in state hospitals and tertiary referral centers; however the daily urological practice were similar in private practice hospitals throughout the pandemic period. When the workload of urology in pandemic period and the same time interval of the year 2019 were compared; a huge decrease was observed in all variables during pandemic period. However, temporary measures like ureteral stenting, nephrostomy placement and percutaneous cystostomy have been found to increase during Covid-19 pandemic compared to normal life. Conclusions: Covid-19 pandemic significantly effected the routine daily urological practice likewise other subspecialties and priority was given to emergent and non-deferrable surgeries by urologists in concordance with published clinical guidelines.

The dynamic of fractional covid-19 epidemic model with a convex incidence rate is studied in this article. Under Caputo operator, existence and uniqueness for the solutions of the fractional covid-19 epidemic model have been ana- lyzed using xed point theorems. We study all the basic properties and results including local and global stability. We show the global stability of disease free equilibrium using the method of Lyapunov function theory while for disease endemic, we use the method of geometrical approach. Moreover, sensitivity analysis complemented by simulations are performed to determine how changes in parameters affect the dynamical behavior of the system.

COVID-19 infection can present with thrombotic manifestations like PE with no ultrasonographic evidence of lung parenchymal affection. BLUE protocol provides excellent step by step approach for diagnosis of acute dyspnoea. Adding FECHO to BLUE protocol complete the picture and help making solid diagnosis especially in sub-massive and massive PE

To the Editor,We read the letter entitled “Acute lymphoblastic leukemia onset in a 3-year-old child with COVID-19 ” by Marcia et al . with great interest and we hereby suggest to start chemotherapy within the same timeline as for non-COVID-19 acute lymphoblastic leukemia (ALL) patients, following our experience managing a 3-year-old boy with concomitant diagnoses of precursor B-ALL and COVID-19. The patient was a previously healthy boy who presented to our hospital with a two-month history of intermittent fevers, night sweats, fatigue and cervical lymphadenopathies. His mother had been tested positive for COVID-19 three months earlier. He had been seen by his family physician by teleconference at the onset of his symptoms, at which point a COVID-19 infection was suspected but not confirmed. The persistence of symptoms and new onset of bone pain led his parents to reconsult at our hospital. At presentation, he had no respiratory symptoms. Physical examination was remarkable for fever, tachycardia and cervical lymphadenopathies. Bloodwork revealed pancytopenia and circulating peripheral blasts. Inflammatory markers were elevated (fibrinogen 7.08 g/L; C-reactive protein 255 mg/L; sedimentation rate 63 mm/h; ferritin 185 ug/L; D-dimers 0.51 ug/ml). Capillary gas, renal function, hepatic function, coagulation studies (INR/aPTT) and cardiac biomarkers (troponin and pro-BNP) were normal. Chest radiograph (CXR) was normal. COVID-19 testing by nasopharyngeal swab was positive. Bone marrow aspiration revealed 80% precursor B lymphoblasts of hyperdiploid subtype.Patient was admitted to a dedicated COVID-19 ward. Given the absence of SARS-CoV-2 infection’s severity criteria, no COVID-19-specific treatment was initiated. Chemotherapy was started promptly once the diagnostic work-up was completed, 6 days following the patient’s confirmed COVID-19 diagnosis. The patient was treated with a three-drug chemotherapy induction based on National Cancer Institute standard-risk criteria consisting of methylprednisolone, vincristine and asparaginase. Supportive treatment consisted of intravenous hydration and allopurinol for tumor lysis prevention, empirical antibiotics, blood transfusions and prophylactic low molecular weight heparin for COVID-19-associated thromboembolic complications. The patient’s clinical course was favorable; fevers, bone pains, peripheral blasts and inflammatory markers resolved quickly following the steroid prophase. Persistent and unexplained tachycardia led to extensive investigations given concerns for COVID-19-related thromboembolic complications. Troponins, pro-BNP, electrocardiogram, echocardiography, CXR and chest CT scan were unremarkable, and the tachycardia improved with packed red blood cell transfusion. The first negative COVID-19 test was obtained on day 4 of induction therapy but came back positive 48 hours later. The patient was discharged on day 13 of induction therapy. Three consecutive nasopharyngeal swabs were negative on days 21, 23 and 38 following COVID-19 diagnosis (Fig.1). End-induction bone marrow aspiration was consistent with morphologic remission and end-induction minimal residual disease by flow cytometry was positive at 0.025%.This case demonstrates the feasibility of treating children with newly diagnosed ALL who tested positive for COVID-19, without chemotherapy delay or modification, nor specific COVID-19 treatments, as done by Marcia et al . The province of Quebec constitutes the COVID-19 epicenter in Canada with half of all Canadian cases; the prevalence of COVID-19-positive cases was 3.3% among children under the age of 10, 5.3% between the age of 10-20 years and 49.2% for people aged 50 years and above.1 Importantly, no death has been reported among children in the province of Quebec, while 97.6% of COVID-related deaths were among individuals over the age of 60 years.1 Children appear to be less affected from COVID-19 infection and exhibit a milder disease course compared to adults, although the impact of COVID-19 infection among pediatric oncology patients remains unknown.2-4 Current published recommendations in the management of pediatric oncology patients during the COVID-19 pandemic emphasize on the importance of pursuing protocol-prescribed chemotherapy regimens based on the curable nature of most pediatric malignancies and the milder COVID-19 disease course observed in the pediatric population.4 However, case reports of severe COVID-19 disease in pediatric oncology patients start to emerge,5 and management of concomitant COVID-19 infection and newly diagnosed ALL can be challenging. First, our patient presented with a multisystem inflammatory syndrome which made it difficult to discern whether he was symptomatic from the COVID-19 infection versus the leukemia itself. Furthermore, we questioned whether the positive COVID-19 test by polymerase chain reaction (PCR) amplification in our patient truly reflects active infection since there was a nearly 3-month period between the first positive test in his family and when our patient was first tested positive. The positive PCR test could result from prolonged viral shedding in an immunocompromised patient affected by his leukemia onset. Alternatively, a positive test does not necessarily indicate the presence of viable virus as Wolfel and colleagues demonstrated that virus could not be grown from samples obtained from hospitalized patients beyond the eighth day of illness.6 Therefore, the general approach to await a negative result prior to begin chemotherapy might cause significant therapy delay and adversely impact outcomes in newly diagnosed ALL patients during the COVID-19 pandemic. Indeed, our patient took over 23 days to have 2 consecutive negative PCR tests 48 hours apart. Furthermore, the use of COVID-19-specific antiviral treatment in non-critically ill children is controversial given the lack of efficacy in this population.7Antiviral treatment may have significant drug interactions with chemotherapy and contribute to additive gastrointestinal and myelosuppressive toxicities. Nevertheless, the benefit of dexamethasone in COVID-19-positive patients requiring respiratory support in reducing early mortality8 and the exquisite sensitivity of lymphoblasts to corticosteroids could be an effective early strategy to safely initiate therapy in newly diagnosed ALL patients affected with COVID-19, particularly for those presenting with oncologic emergencies such as hyperleukocytosis or mediastinal mass. As the COVID-19 pandemic continues to evolve, pediatric oncologists will be confronted with the ongoing challenge to manage newly diagnosed cancer patients with concomitant COVID-19 infection. International COVID-19 registries in pediatric oncology are actively collecting clinical data to comprehensively assess the impact of COVID-19 within this patient population and to develop standardized management guidelines.9 As for now, an assessment of risks and benefits to initiate or delay cancer therapy will need to be carefully balanced on a case-by-case basis according to the patient’s clinical symptoms, type of malignancy, evidence-based treatment options, and emerging knowledge of COVID-19’s impact in our young cancer patients.CONFLICT OF INTEREST: The authors declare no conflict of interest.REFERENCES1. INSPQ. Données COVID-190 au Québec. 2020.2. Lu X, Zhang L, Du H, et al. SARS-CoV-2 Infection in Children. N Engl J Med. 2020;382(17):1663-1665.3. Cruz AT, Zeichner SL. COVID-19 in Children: Initial Characterization of the Pediatric Disease. Pediatrics. 2020;145(6).4. Bouffet E, Challinor J, Sullivan M, Biondi A, Rodriguez-Galindo C, Pritchard-Jones K. Early advice on managing children with cancer during the COVID-19 pandemic and a call for sharing experiences. Pediatr Blood Cancer. 2020;67(7):e28327.5. Stokes CL, Patel PA, Sabnis HS, Mitchell SG, Yildirim IB, Pauly MG. Severe COVID-19 disease in two pediatric oncology patients.Pediatr Blood Cancer. 2020;67(9):e28432.6. Wolfel R, Corman VM, Guggemos W, et al. Virological assessment of hospitalized patients with COVID-2019. Nature.2020;581(7809):465-469.7. Chiotos K, Hayes M, Kimberlin DW, et al. Multicenter initial guidance on use of antivirals for children with COVID-19/SARS-CoV-2. J Pediatric Infect Dis Soc. 2020.8. Group RC, Horby P, Lim WS, et al. Dexamethasone in Hospitalized Patients with Covid-19 - Preliminary Report. N Engl J Med. 2020.9. Sullivan M, Bouffet E, Rodriguez-Galindo C, et al. The COVID-19 pandemic: A rapid global response for children with cancer from SIOP, COG, SIOP-E, SIOP-PODC, IPSO, PROS, CCI, and St Jude Global.Pediatr Blood Cancer. 2020;67(7):e28409.Figure 1. Variation of C-reactive protein (CRP) throughout the hospitalization course (blue line). COVID-19 test results are identified in green when positive and red when negative. The day of ALL diagnosis, the day of chemotherapy start (black arrows), the duration of hospitalization (red box) and the duration of symptoms (green box) are indicated. Induction chemotherapy includes: Methylprednisone/prednisone (Day 1-32), Vincristine (Day 4, 11, 18, 25), PEG-Asparaginase (Day 7) and intrathecal cytarabine (Day 1 & 18).

Abstract: Background: The COVID-19 pandemic in late 2019 quickly stretched health care system across the globe. Mortalities, shortages in health care system capacity, and lack of experience in similar circumstances required innovation in the way health care is delivered. Health care systems changed operating schedules, staff work pattern, and how patients are cared for. The effects of these changes reached patients, staff and training in different ways. Methods: We search the Pubmed and EMBASE for articles related to COVID-19. We also searched local e-mails and information provided to staff during the pandemic Results: The COVID-19 pandemic affected organisations, patients and staff. The organisation and staff had to adapt to the times to provide a safe and appropriate service to our patients. Conclusion: The pandemic challenged and changed the way we work as health care providers, and how we train the future surgeons. Changes in the system was effective.

Coronavirus disease (COVID-19) is n emerging infectious disease. There may be a correlation between heatstroke and severity of COVID-19. In cases where heat stress caused by COVID-19 promotes organ failure, the proactive regulation of body temperature may be considered as an effective treatment option.

A 13-month-old healthy patient without COVID-compatible symptoms and no known sick contacts presented to the emergency department with an esophageal coin. New institutional policy requiring pre-operative SARS-CoV-2 testing was positive for the virus. Additional precautions were taken in the operating room to successfully prevent transmission of the virus.

Aims of the study Patient comprehension is a critical part of meeting standards of informed consent in study designs. The aim of the study was to determine if extant literature exists to require clinicians to disclose the specific risk that COVID-19 vaccines could worsen disease upon exposure to challenge or circulating virus. Methods used to conduct the study Published literature was reviewed to identify extant preclinical and clinical evidence that COVID-19 vaccines could worsen disease upon exposure to challenge or circulating virus. Results of the study Based on the history of coronavirus vaccine development, COVID-19 vaccines designed to elicit neutralizing antibodies may sensitize vaccine recipients to more severe disease than if they were not vaccinated. Vaccines for SARS, MERS and RSV have never been approved, and the data generated in the development and testing of these vaccines suggest a serious mechanistic concern: that vaccines designed empirically using the traditional approach (consisting of the unmodified or minimally modified coronavirus viral spike to elicit neutralizing antibodies), be they composed of protein, viral vector, DNA or RNA and irrespective of delivery method, may worsen COVID-19 disease via antibody-dependent enhancement (ADE) of either infection or disease. Conclusions drawn from the study and clinical implications The specific and significant COVID-19 risk of ADE should have been and should be clearly and emphatically disclosed to research subjects currently in vaccine trials, as well as those being recruited for the trials and future patients after vaccine approval, in order to meet the medical ethics standard of patient comprehension.

Background The theory of “hit and run” raises a possibility of novel COVID19-associated Parkinsonism cases, as well as worsening of symptoms in patients with pre-existing Parkinson’s Disease (PD). Aim/method To demonstrate that the COVID19 infection may lead to long lasting immunological and neurological changes at PD patients.

Introduction The rapid spread of the pandemic caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)(COVID-19) virus resulted in governments around the world instigating a range of measures, including mandating the wearing of face coverings on public transport/in retail outlets. Methods We developed a sequential assessment of risk reduction provided by face coverings using a step-by-step approach. The United Kingdom Office of National Statistics(ONS) Population Survey data was utilised to determine the baseline total number of community-derived infections. These were linked to reported hospital admissions/hospital deaths to create case admission risk ratio/admission-related fatality rate. Results Overall, we show that only 7.3% of all community-based infection risk associates with public transport/retail outlets. The reported weekly community infection rate was 29,400 new cases at the start (24th July). The rate of growth in hospital admissions and deaths for England was around -15%/week, suggesting the infection rate, R, in the most vulnerable populations was just above 0.8. In this situation, average infections over the evaluated 13week follow-up period was 9,517/week. With face covering of 40% effectiveness, this reduced average infections by 844/week, hospital admissions by 8/week and deaths by 0.6/week; a fall of 9% over the period total. If, however, the R-value rises to 1.0, then average community infections would stay at 29,400/week and face coverings could reduce average weekly infections by 3,930, hospital admissions by 36 and deaths by 2.9/week; a 13% reduction. These reductions should be seen in the context of 102,000/week all-cause hospital emergency admissions in England and 8,900 reported deaths in the week ending 7thAugust 2020. Conclusion We have illustrated that the policy on mandation of face coverings in retail outlets/on public transport may have limited value in reducing hospital admissions/deaths. Impact appears small compared to all other sources of risk, thereby raising questions regarding effectiveness of the policy.

Aim: We evaluated the COVID-19 threat in patients receiving intravesical BCG therapy which has immunotherapeutic effects and is of vital importance in most of the individuals with high-risk non-muscle-invasive bladder cancer (NMIBC) and investigated the need for postponement of this therapy. Methods: A total of 71 patients, who were diagnosed with high-risk NMIBC and on intravesical BCG treatment regularly (induction or maintenance), were enrolled in the study. The patients were classified into two groups depending on whether they were diagnosed with COVID-19 during the pandemic period or not. Results: Of 71 patients, 26 underwent a COVID-19 polymerase chain reaction test with clinical suspicion during the pandemic period. Of these 26 patients, 4 were diagnosed with COVID-19. Age of the patients, working status (working/retired), compliance with containment measures against the pandemic, number of BCG courses, adverse effects after BCG therapy, and systemic immune-inflammation index, which is an inflammation-related parameter, were not different between groups (p>0.05). Neutrophil/lymphocyte ratio was significantly higher in the COVID-19 positive group (p<0.05). COVID-19 positivity was higher in age groups 50-64 (6.6%) and 65-80 (5.8%) years than that in similar age groups of the normal population. Conclusion: Every effort should be made to administer intravesical BCG treatment in high-risk NMIBC patients even during the pandemic period. However, increased risk of COVID-19 transmission should be kept in mind and protective measures against COVID-19 for healthcare providers and patients before the procedure should be taken optimally. The procedure should be postponed in patients with lymphopenia in recent complete blood count.

Kikuchi–Fujimoto disease (KFD) is a rare disease characterized by cervical lymphadenopathy, fever, and skin rash. The KFD can be confused with other conditions including lymphoma, autoimmune, and hematological diseases, which can lead to misdiagnosis of KFD as a clinical identity. Another condition can be novel coronavirus disease 2019 (COVID-19).

Acute pericarditis and pericardial effusion are rare extrapulmonary presentations of COVID-19. They can occur without concomitant pulmonary disease or myocardial injury. A high index of suspicion is necessary to assure early diagnosis and treatment.

Background and Aim: Clinical education has been disrupted by the COVID-19 pandemic. We present a standardized remote alternative online cardiothoracic surgery primer to accommodate a shortened clinical calendar. Methods: A week-long cardiothoracic surgery course consisting of virtual case-based lectures and small groups as well as surgical operation walkthroughs was conducted iteratively through April and May 2020 at Emory University School of Medicine, Atlanta, GA for new clinical third-year medical students. Results: Remote learning platforms helped maintain medical student clinical education. Cardiothoracic procedure video walkthroughs were highly demanded for remote learning. Virtual small group discussions were felt to be invaluable in facilitating active problem solving and clinical decision making of cardiothoracic surgery. Conclusion: Our online cardiothoracic surgery curriculum can be a framework for alternative medical student clinical education. Student feedback is necessary as we adapt to teaching during the COVID-19 pandemic and future global disruptions.

Background. To share the results of a web-based expert panel discussion focusing on the management of acute and chronic aortic disease during the COVID-19 pandemic. Methods. A web-based expert panel discussion on April 18th 2020 where 8 experts were invited to share their current experience with COVID-19 disease touching several aspects of aortic medicine, was performed. After each talk, specific questions were asked to the online audience and results were immediately evaluated and shared with faculty and participants. Results. As of April 18 2020, 73.3% of the 87 participants from 26 different countries answered that overall less than 200 COVID positive patients have been treated in their respective institutions. Sixty-five percent reported that their hospital was well prepared for the pandemic. In 57.7 %, the percentage of infected health care professionals was below 5% whereas 23% reported 5-10% and 19.2% reported between 10 and 20%. Three percent reported to have seen aortic ruptures in primarily elective patients having been postponed because of the anticipated need to provide sufficient ICU capacity because of the pandemic. Nearly 70% reported a decrease of acute aortic syndromes since the start of the pandemic. Conclusions. The current COVID-19 pandemic has- led to a decrease of referrals of acute aortic syndromes in many services. The reluctance of patients seeking medical advice seems to be a major driver. The number of patients who have been postponed due to provisioning ICU resources but having experienced aortic rupture in the waiting period, is still low.

Aim: To determine the efficacy of neutrophil/lymphocyte ratio (NLR) as a marker of the severity of COVID-19 pneumonia in the South-Asian population. Methods: This was a prospective, cross-sectional, analytic study conducted at HDU/ICU of District Headquarter Hospital, Faisalabad, Pakistan, from May through July 2020. Sixty-three eligible patients, admitted to the HDU/ICU, were prospectively enrolled in the study. Their NLR, C-reactive protein, serum albumin, and serum fibrinogen were measured. Patients’ demographic characteristics, comorbidities, clinical manifestations of COVID-19 infection, medication use, and history of lung malignancy were retrieved from their medical history. Patients were categorized into either a general group (with mild COVID-19) or a heavy group (with moderate to severe COVID-19). Results: There were significant differences between the two groups in diabetes prevalence, NLR, C-reactive protein, and serum albumin. NLR and C-reactive protein were positively correlated (P < 0.001, P = 0.04 respectively) whereas serum albumin was negatively correlated (P = 0.009) with severe COVID-19. NLR was found to be an independent risk factor for severe COVID-19 pneumonia in the heavy group (OR = 1.264, 95% CI: 1.046~1.526, P = 0.015). The calculated AUC using ROC for NLR was 0.831, with an optimal limit of 4.795, sensitivity of 0.83 and specificity of 0.75, which is highly suggestive of NLR being a marker for early detection of deteriorating severe COVID-19 infection. Conclusion: NLR can be used as an early warning signal for deteriorating severe COVID-19 infection and can provide an objective basis for early identification and management of severe COVID-19 pneumonia.

AIM: We propose the use of in silico mathematical models to provide insights that optimize therapeutic interventions designed to eradicate respiratory infection during a pandemic. A modelling and simulation framework is provided using SARS-CoV-2 as an example, considering applications of both treatment and prophylaxis. METHODS: A target cell-limited model was used to quantify the viral infection dynamics of SARS-CoV-2 in a pooled population of 105 infected patients. Parameter estimates from the resulting model were used to simulate and compare the impact of various interventions against meaningful viral load endpoints. RESULTS: Robust parameter estimates were obtained for the basic reproduction number, viral release rate and infected-cell mortality from the infection model. These estimates were informed by the largest dataset currently available for SARS-CoV-2 viral time course. The utility of this model was demonstrated using simulations, which hypothetically introduced inhibitory or stimulatory drug mechanisms at various target sites within the viral life-cycle. We show that early intervention is crucial to achieving therapeutic benefit when monotherapy is administered. In contrast, combination regimens of two or three drugs may provide improved outcomes if treatment is initiated late. The latter is relevant to SARS-CoV-2, where the period between infection and symptom onset is relatively long. CONCLUSIONS: The use of in silico models can provide viral load predictions that can rationalize therapeutic strategies against an emerging viral pathogen.