IL6 and acute respiratory distress syndrome: Given the hyper-inflammatory state associated with COVID-19, immunomodulatory approaches, including steroids and anakinra (or tocilizumab) should be considered for children with ARDS and those with progressive deterioration of respiratory function after at least 7 days from symptom onset, as well as for children with MIS-C and/or with a markedly elevated or tendency to increasing serum levels of IL-6 and/or D-dimer and/or ferritin and/or CRP (155, 156).