COVID-19 remains as a health concern all around the world since World Health Organization (WHO) declared it as a pandemic in March 2020. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) is the pathogen responsible for COVID-19. It belongs to family Coronaviridae, human-to-human transmission happens through droplets and aerosols. As of December 2021 there were around 278.5 million reported cases around the world, majority of which had recovered. However there were some cases in which progression of the disease became uncontrollable resulting in severe pneumonia, acute respiratory distress syndrome (ARDS), multi-organ failure, even death. In mild or moderate cases human innate and adaptive immune responses are enough to fight the virus. Still in some patients immune system runs wild, producing enormous cytokines and other markers resulting in a condition of hyperinflammation and hypercytokinemia called the cytokine storm. Cytokine storm is regarded as the main reason for disease progression to severe COVID19. It involves many pro-inflammatory markers, some of the more notable ones are interleukins and tumor necrosis factors. Interleukin 10 (IL-10) is suggested to have a role as an anti-inflammatory cytokine by a negative feedback mechanism while tumor necrosis factor-α (TNF- α) as a pro-inflammatory cytokine released by mainly monocytes or macrophages. This review highlights cytokine storm as well as IL-10 and TNF- α role in pathogenesis of severe COVID-19

Keywords : COVID-19, Severe Case, IL-10, TNF- α, Cytokine Storm, Pathogenesis