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Autoantibodies against Type I IFNs in patients with life-threatening COVID-19. Bastard P, Rosen LB, Zhang Q, et al., Science 2020;370(6515):eabd4585. Autoantibodies targeting Type I interferon (IFN) impair the ability of the adaptive immune system to neutralize severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) invasion, intensifying the severity of coronavirus disease 2019 (COVID-19). The clinical presentation of SARS-CoV-2 infection is unpredictable. Severity has been associated with a “cytokine storm,” but known risk factors do not wholly explain interindividual variability. Type I IFNs are ubiquitous cytokines that play a role in innate immunity and cell intrinsic immunity against viral infection. Inborn errors of type I IFNs (and associated phenocopies) have been proposed to contribute to the severity of viral disease. In this study, Bastard et al. screened for neutralizing autoantibodies against Type I interferons in patients with life-threatening COVID-19, patients with asymptomatic or mild COVID-19, and healthy controls. Among patients with life-threatening or severe COVID-19 (n = 987), 101 individuals had neutralizing autoantibodies targeting IFN-ω, IFN-α, or both. Of these, 95 (94%) were male, providing a possible explanation for the divergent outcomes between male and female patients. No patients with mild or asymptomatic disease (n = 663) had detectable autoantibodies, and IFN autoantibodies were detected in only four healthy controls (n = 1227). Autoantibodies potently neutralize Type I IFNs, reducing their capacity to block SARS-CoV-2 infection in vitro. Plasma containing the autoantibodies blocked STAT1 phosphorylation in peripheral blood mononuclear cells from healthy controls co-incubated with IFN-α2 or IFN-ω; depleting IgG restored STAT1 phosphorylation. The autoantibodies also blocked IFN-α2-mediated neutralization of SARS-CoV-2 in Huh7.5 cells. Consistent with these observations, patients with IFN-α autoantibodies were discovered to have low or undetectable levels of plasma IFN-α. The existence of autoantibodies before disease onset in patients for whom pre–COVID-19 samples were available (n = 5) suggests a role for these autoantibodies in the course of COVID-19. The findings may shape COVID-19 treatment: In patients with anti-IFN-α antibodies, treatment with IFN-β may be more impactful. If the preexistence of autoantibodies holds up in confirmatory studies, they may have utility as a biomarker to identify at-risk patients and provide a possible target for therapeutic interventions.