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The letter by Villar et al. suggests that our publication ‘The performance of the National Early Warning Score in hospitalised patients infected by Covid-19’1 did not emphasise the ‘main’message of the Royal College of Physicians (RCP) guidance on NEWS2 and deterioration in patients with COVID-19. 2 We disagree. The RCP’s ‘main’message is that “... NEWS2 should be used when managing patients with COVID-19...” This was accompanied by the recommendation that “... ANY increase in oxygen requirements should trigger an escalation call to a competent clinical decision maker...”, 2 based on a concern that in patients with COVID-19 infection, treated with oxygen, oxygen requirements “... might increase rapidly if their respiratory function deteriorates but this may not result in any significant increase in the NEWS2 score...” 2 The wording of the RCP’s qualifying statement indicates a possible but not certain …