Patient description: A 39-year-old man came to the clinic with cough and shortness of breath that was not relieved by his inhaler. He had these symptoms for 5 days during the past 2 weeks. He doubled his oral corticosteroids in the past week. He is a chef with a history of asthma for 3 years, suffering from frequent cough, wheezing, and shortness of breath and chest tightness. The symptoms become more bothersome within 1-2 hours of starting work every day and worsen throughout the work week. His symptoms improve within 1-2 hours outside the workplace. Spirometry was performed revealing a forced expiratory volume in the first second (FEV1) of 63% of the predicted. His past medical history is significant for seasonal allergic rhinitis in the summer. He doesn't smoke or use illicit drugs. His family history is significant for asthma in his father and sister. He currently uses inhaled corticosteroid (ICS) and fluticasone 500 mcg/salmeterol 50 mcg, one puff twice daily.

Clinical trial eligibility criteria: eligible ages (years): 18.0-999.0,  COVID Corona Virus Infection Respiratory Failure Respiratory Distress Syndrome, Adult ARDS, Human SARS (Severe Acute Respiratory Syndrome) Patients (age 18 years and older) who have tested positive or suspected/presumed positive for CoViD-19 using PCR real time test 2. Patients with cough, shortness of breath or respiratory compromise (RR>24/min, increased work of breathing.) 3. O2 Saturation less than or equal to 96% on room air or sensation 4. Agrees to use the gammaCore Sapphire device as intended and to follow all of the requirements of the study including recording required study data 5. Permission for early am blood draw to freeze for subsequent lab tests and sequencing as related to CoViD-19 sequelae 6. Patient is able to provide signed and witnessed Informed Consent  On home/therapy oxygen (i.e. for chronic obstructive pulmonary disease (COPD) patients) at baseline prior to development of CoViD-19 2. Already using gammaCore® (nVNS) for other medical conditions 3. A history of aneurysm, intracranial hemorrhage, brain tumors, or significant head trauma 4. Known or suspected severe atherosclerotic cardiovascular disease, severe carotid artery disease (e.g., bruits or history of transient ischemic attack or cerebrovascular accident), congestive heart failure, known severe coronary artery disease, myocardial infarction documented within past 90 days, or current or recent history of life-threatening arrhythmia (sustained ventricular tachycardia, ventricular fibrillation, second or third-degree heart block, uncontrolled atrial fibrillation or uncontrolled atrial flutter) 5. Patients with clinically significant hypertension, hypotension, bradycardia, or tachycardia (as per investigator discretion) 6. Current implantation of an electrical and/or neurostimulator device, including but not limited to a cardiac pacemaker or defibrillator, vagal neurostimulator, deep brain stimulator, spinal stimulator, bone growth stimulator, or cochlear implant 7. Current implantation of metal cervical spine hardware or a metallic implant near the gammaCore® stimulation site 8. Belongs to a vulnerable population or has any condition such that his or her ability to provide informed consent, comply with the follow-up requirements, or provide self-assessments is compromised (e.g. homeless, developmentally disabled and prisoner) 9. Compromised access to peripheral veins for blood sampling. 10. Pregnant women 11. Patients with active cancer or those who have had recent cancer treatment