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
high flow oxygen devices) to 4 (Hospitalized, requiring supplemental oxygen).

AND o A respiratory SOFA >=1 and increased oxygen requirement compared to baseline among
those on home O2, a blood oxygen saturation of 93% or less on room air, a ratio of the
partial pressure of oxygen to the fraction of inspired oxygen (PaO2/FiO2) of less than
300 mm 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
a positive 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
Disease Severity Score >5 (requiring extracorporeal membrane oxygenation (ECMO),
invasive mechanical ventilation, or all)

- Known hypersensitivity to fenofibrate

- For female subjects:

1. Pregenant, determined by a human chorionic gonadotropin (HCG) rapid detection
kit or 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
of enrollment

- Acute pre-renal azotemia at the time of enrollment in the opinion of the
investigator or 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 24
hours 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 authorized
representative

- Enrollment in another blinded randomized clinical trial for COVID