Non-invasive vagus nerve stimulation is a neuromodulatory technique that is able to intervene with our body's immune system by activating the so-called cholinergic anti-inflammatory pathway and in this way block the release of immune modulators such as cytokine IL6. In COVID-19 patients with severe disease, a hyperinflammatory state is found where a cytokine storm worsens patients' clinical condition. It has been found that all dying COVID-19 patients have increased cytokine IL-6, while none of the survivors do. Currently there are no drug treatments that have proven successfull against SARS-Cov-2 or its pathophysiological mechanism of which the cytokine storm is an important one causing the most severe evolution of the disease. Apart from using drugs to solve tackle the immune reponse, targeting the nervous system is an unexplored avenue in this field. The vagus nerve is our tenth cranial nerve and known to play an important role in informing the brain about the inflammatory status of the body, and in this way activating pathways involved in immune responses in an ultra-rapid fashion. Activating the fibers in this nerve affects the so-called cholinergic anti-inflammatory pathway that is able to interfere with the bodies immune system. Vagus nerve stimulation by means of a implanted device has been demonstrated to dampen immune responses in immune-related disorders. Recently, non-invasive vagus nerve stimulation through the skin has become available and provides a non-invasive way to intervene with immune responses. We propose to investigate the potential of non-invasive vagus nerve stimulation to affect the hyperimmune response in COVID-19 patients and interfere in this way with the worse evolution of the disease. This approach is novel, non-invasive and could be delivered in add-on to other drugs. Inspiration: years of research in the field of vagus nerve stimulation and the knowledge about its potential effects on the immune system in addition to current knowledge of treatment gap for severely ill COVID-19 patients Challenges I ran into: convincing the community that interfering with the nervous system (neuromodulators approach) may prove successful in contrast to using pharmacotherapy, or at least pharmacotherapy alone Accomplishments that I'm proud of: putting the team's effort into a hackathon youtube movie! What's next for vagus nerve stimulation for cytokine storm in COVID-19: A randomised controlled trial with auricular VNS in patients with COVID-19 at the beginning of the phase characterized by hyper inflammation ie. cytokine storm as indicated by known increase in biomarkers such as ferritin and D-Dimers

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