Patient description: The patient is a 15-year-old boy with asthma diagnosed a year ago. He presents with shortness of breath, chest tightening and cough. According to his mother, he didn't respond to the usual corticosteroid inhaler. He was admitted to the emergency department with diagnosis of severe asthma exacerbation. He is a candidate for general corticosteroid therapy. Spirometry revealed a forced expiratory volume in the first second (FEV1) of 60% of the predicted. His past medical history is non-significant. His family history is significant for asthma in his mother and his uncle. He used to be treated with combination of inhaled corticosteroids and Zafirlukast.

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