1. Recieved high flow nasal cannula, non-invasive mechanical ventilation or invasive mechanical ventilation 2. High risk for cortiosteroid such as current active infection or poor glycemic control 3. Immunocompromised host such as end stage liver disease, end stage renal disease without renal replacement therapy, HIV CD4 less than 200 or cancer with on going chemotherapy 4. Pregnant women 5. Psychiatric problems 6. Current use of corticosteroid (more than 20 mg of prednisolone equivalent dose and consecutively more than 14 day)

1. Recieved high flow nasal cannula, non-invasive mechanical ventilation or invasive mechanical ventilation 2. High risk for cortiosteroid such as current active infection or poor glycemic control 3. Immunocompromised host such as end stage liver disease, end stage renal disease without renal replacement therapy, HIV CD4 less than 200 or cancer with on going chemotherapy 4. Pregnant women 5. Psychiatric problems 6. Current use of corticosteroid (more than 20 mg of prednisolone equivalent dose and consecutively more than 14 day)