Pemziviptadil (PB1046), a Long-acting, Sustained Release Human VIP Analogue, Intended to Provide Clinical Improvement to Hospitalized COVID-19 Patients at High Risk for Rapid Clinical Deterioration and Acute Respiratory Distress Syndrome (ARDS).

Inclusion Criteria:

1. Written or witnessed verbal informed consent from patient or remote legal authorizedrepresentative (LAR) or remote family member as permitted by governing local orcentral Institutional Review Board (IRB)/independent Ethic Committee (IEC).
2. Male or female 18-85 years old hospitalized COVID-19 patients (positive localSARS-CoV2 test)
3. Receiving oxygen (O2) by face mask or nasal cannula/prongs and/or with elevatedmarkers of cardiac injury or dysfunction (hsTnI or NT-proBNP) as assessed by localtesting

Exclusion Criteria: Subjects will be excluded from the study if they meet any of the following criteria:

1. Patients considered unsalvageable or expected to expire within 24 hours
2. On mechanical ventilation or imminent need for mechanical ventilation expected in thenext 24 hours
3. Evidence of acute end-organ injury in 2 or more organ systems (not including cardiacor pulmonary), such as, renal, hepatic, or CNS injury
4. Receiving another investigational therapy for treatment or prevention ofCOVID-19-related hypoxemic respiratory failure or ARDS other than antiviral therapy
5. Systolic blood pressure (SBP) < 95 mmHg and/or diastolic blood pressure (DBP) < 50mmHg or overt symptomatic hypotension during screening
6. Resting heart rate > 110 BPM (beats per minute) during screening
7. Severe chronic renal failure as measured by the estimated glomerular filtration rate (eGFR) of < 30 mL/min/1.73m2 using the local laboratory calculation of eGFR.
8. Significant liver dysfunction as measured by any one of the following at screening:

• ALT (Alanine transaminase) > 3.0 times ULN (upper limit of normal)
• AST (Aspartate transaminase) > 3.0 times ULN
• Serum bilirubin ≥ 1.6 mg/dL

9. Any in-patient surgical procedure or hospitalization (defined as > 23 hours) within 30days of subject screening except for prior hospitalization for COVID-19
10. Known hypersensitivity to study drug or any of the excipients of the drug formulation
11. Pregnant or lactating female subjects
12. Any other condition which, in the opinion of the Investigator, would place the subjectat increased risk or would preclude obtaining informed consent or confound theobjectives of study