Introduction:
The coronavirus SARS-CoV-2 has infected more than 250 million people and caused death to over than 5 million, with a worldwide mortality rate of 2%. Many patients who die from COVID-19 suffer from hyper-inflammation caused by cytokine storm syndrome (CSS) and associated acute respiratory distress syndrome [1, 2]. The antiviral Remdesivir was shown to reduce the length of hospital stay for COVID-19 patients, but anti-inflammatory agents have improved survival in these patients [3]. The greatest survival rate has been found with glucocorticoids, which play as immunosuppressive agents, when given to patients with an oxygen requirement. However, patients treated with glucocorticoids may fare worse than those who receive standard care in the absence of an oxygen requirement or systemic inflammation. The selection of patients and timing of glucocorticoids administration is critical for survival benefit. Optimal treatment of targeted anti-cytokine therapy to prevent CSS is suggested earlier without increasing viral replication [4].