Ramipril for the Treatment of COVID-19

Inclusion Criteria: * Age ≥ 18 years * Willing and able to provide written informed consent prior to performing study procedures * Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)-2 infection confirmed by polymerase chain reaction (PCR) test ≤ 5 days before randomization OR Clinical presentation consistent with COVID-19 infection (fever or cough or shortness of breath) with positive IgM serology * Currently hospitalized or in an emergency department * Peripheral capillary oxygen saturation (SpO2) ≥ 93% on room air at screening Exclusion Criteria: * Participation in any other clinical trial of an experimental treatment for COVID-19 (use of hydroxycholoroquine or compassionate use of choloroquine or azithromycin is allowed) * Concurrent treatment with other agents with actual or possible direct acting antiviral activity against SARS-CoV-2 is prohibited \< 24 hours prior to study drug/placebo dosing * Requiring mechanical ventilation at screening * Requiring ICU care at admission * NSAID use within 12 hours of randomization or requiring continued NSAID use during this trial * Alanine Aminotransferase (ALT) or aspartate aminotransferase (AST) \> 5 X upper limit of normal (ULN) * Estimated GFR \< 40 mL/min * History of serum creatinine ≥ 2 mg/dl in the previous 28 days * Systolic BP \< 100 mm hg or diastolic BP \< 65 mm hg * Hypersensitivity to ACEI * History of angioedema * Outpatient use of ACE inhibitor or Angiotensin II receptor blocker in the last 7 days * History of renal artery stenosis * Serum potassium ≥ 5.1 mEq/L * Pregnancy or breastfeeding * Use of aliskiren, amifostine, lithium, sacubitril within 7 days