Inclusion Criteria:  Adult (≥18 years of age) at time of enrolment Present COVID-19 (infection confirmed by RT-PCR or antigen testing) Postive pressure ventilation (non-invasive or invasive) or need supplemental oxygen with non-rebreather mask Admission to ICU in the last 24 hours  Exclusion Criteria:  1- Underlying disease requiring chronic corticosteroids 2- Any dose of dexamethasone during the present hospital stay for COVID-19 for ≥5 days before enrollment 3- Systemic corticosteroids during present hospital stay for conditions other than COVID-19 (e.g. septic shock) 4-Any contraindication for corticosteroid administration 5-Cardiac arrest before ICU admission 6-Pregnancy or breast feeding 7- Immunocompromised patients as cancer (active) patients, patients on chemotherapy or radiotherapy, HIV, and transplant patients