TNF and viral pneumonia: These additional risk factors include chronic respiratory airway abnormalities such as COPD or bronchiectasis; decompensated cirrhosis; HIV; treatment with recognized immunosuppressants (e.g., calcineurin or mammalian target of rapamycin [mTOR] inhibitors, blockers of tumor necrosis factor [TNF] and similar antifungal immunity pathways, alemtuzumab, ibrutinib, or nucleoside analogs) during the previous 90 days; glucocorticoid treatment with prednisone equivalent of 20 mg or more per day; and severe viral pneumonias such as influenza and COVID-19 [22].