Fenofibrate for Patients With COVID-19 Requiring Hospitalization

Inclusion Criteria:

• Presumptive positive laboratory test for SARS-CoV-2 based on local laboratory standard
• Age greater than or equal to 18 years of age
• Severe COVID-19, defined by:
• A disease severity score of 3 (Hospitalized, on non-invasive ventilation or highflow oxygen devices) to 4 (Hospitalized, requiring supplemental oxygen). AND o A respiratory SOFA >=1 and increased oxygen requirement compared to baseline amongthose on home O2, a blood oxygen saturation of 93% or less on room air, a ratio of thepartial pressure of oxygen to the fraction of inspired oxygen (PaO2/FiO2) of less than 300mm Hg, respiratory rate >30 breaths/min, or lung infiltrates >50% on chest CT

• Enrollment within 72 hours of presentation of hospital admission or within 72 hours of apositive test result, whichever is later

Exclusion Criteria:

• Enrollment > 72 hours of admission order or positive test result, whichever is later
• Admission to the hospital with a respiratory SOFA >=5 , Critical COVID-19, or DiseaseSeverity Score >5 (requiring extracorporeal membrane oxygenation (ECMO), invasivemechanical ventilation, or all)
• Known hypersensitivity to fenofibrate
• For female subjects:

1. Pregenant, determined by a human chorionic gonadotropin (HCG) rapid detection kitor a blood test
2. Breastfeeding
3. Undergoing fertility treatments

• Patient-reported history or electronic medical record history of kidney disease,defined as:

1. Any history of dialysis
2. History of chronic kidney disease stage IV
3. Estimated Glomerular Filtration Rate (eGFR) of < 30ml/min/1.73 m2 at the time ofenrollment

• Acute pre-renal azotemia at the time of enrollment in the opinion of the investigatoror bedside clinician
• Most recent mean arterial blood pressure prior to enrollment <65 mmHg
• Patient-reported history or electronic medical record history of severe liver disease,defined as:

1. Cirrhosis
2. History of hepatitis B or C
3. Documented AST or ALT > 10 times the upper limit of normal measured within 24hours prior to enrollment

• Patient-reported history or electronic medical record history of gallbladder disease
• Potassium >5.0 within 24 hours prior to enrollment unless a repeat value was <=5.0
• Treatment with coumarin anticoagulants (e.g., Warfarin), immunosuppressants (e.g.cisplatin), bile acid resins, or sulfonylurea.
• Inability to obtain informed consent from participant or legally authorizedrepresentative
• Enrollment in another blinded randomized clinical trial for COVID