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Role of Reactive Oxygen Species (ROS)

Reactive Oxygen Species (ROS) are critical signaling molecules essential to optimal function of innate and adaptive immunity (Jain et al)
ROS and subsequent airway inflammation are produced/increased from both:-

tissue hypoxia
Administration of supplemental O2 (Auten et al, Carpagnano et al, Phillips et al)

Thus pts with COVID-19 on supplemental O2 are at increased risk of increased production of ROS and possible incitement of cytokine storm:

ROS = Reactive Oxygen Species. High ROS levels are associated with exaggerated inflammatory response. Low levels can lead to immunosuppression. Jain et al.

Antioxidants such as N-acetylcysteine scavenge ROS, decreasing their signaling levels:
Timing of NAC administration should be after the body has enough ROS to trigger an immune response because the efficacy of an antioxidant such as NAC is dependent on ROS levels (NAC is unlikely to be prophylactic)

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