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].