Lung Irradiation for COVID-19 Pneumonia

Inclusion criteria * Diagnosis of SARS-CoV-2 infection by RT-PCR or another approved laboratory test ≤ 3 days before enrollment or ≤ 14 days before enrollment with progressive disease suggestive of ongoing SARS-CoV-2 infection; retesting allowed * Current hospitalization for ≤ 14 days with SARS-CoV-2 infection at the time of enrollment * Use of supplemental oxygen or oxygen saturation ≤ 94% on room air * Age ≥ 40 * May receive antiviral medication (e.g., remdesivir, lopinavir/ritonavir, oseltamivir, favipiravir), antibiotics (e.g., azithromycin), chloroquine, hydroxychloroquine, corticosteroids, statins, anticoagulation, antiplatelet agents (e.g., aspirin) and/or convalescent plasma from recovered individuals off study and/or on study if permitted by the other protocol Exclusion criteria * Prior or planned treatment with interleukin inhibitors (e.g., tocilizumab, canakinumab, sarilumab) or TNF-α inhibitors within 14 days of enrollment * Prior lobectomy or pneumonectomy * Prior thoracic radiotherapy with cumulative lung V20 \> 15% to either lung within 1 year of enrollment, or any radiotherapy resulting in a maximum lung dose of 100 cGy or higher within 14 days of enrollment * Prior chemotherapy or other systemic therapy with potential for pulmonary toxicity or radiosensitization within 14 days or 5 half-lives, whichever is greater, of enrollment, e.g., bleomycin or gemcitabine * Prior cancer immunotherapy with an immune checkpoint inhibitor within 60 days of enrollment * Severe pre-existing heart disease, e.g., New York Heart Association (NYHA) functional class ≥ 3 congestive heart failure * History of bone marrow or solid organ transplantation * Known history of autoimmune collagen vascular disease, e.g., scleroderma * Known hereditary syndrome with increased sensitivity to ionizing radiation, e.g., ataxia-telangiectasia or Fanconi anemia * Pregnancy * Inability to be positioned supine and flat for radiation planning and delivery * Inability to provide informed consent or lack of an authorized representative who can provide informed consent