Elevated levels of pro-inflammatory markers such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein are characteristic features of COVID-19 and have been strongly associated with autonomic dysfunction and this can be partly explained by the fact that the cholinergic anti-inflammatory pathway, which is vagally mediated, is impaired due to the cascade of pro-inflammatory cytokines6,43. Here, TNF is linked to Abnormal autonomic nervous system physiology.