Low-dose Tocilizumab Versus Standard of Care in Hospitalized Patients With COVID-19

Inclusion Criteria: * Adults ≥ 18 years of age * Approval from the patient's primary inpatient service * Hospitalized * Fever, documented in electronic medical record and defined as: T ≥ 38 degrees C by any conventional clinical method (forehead, tympanic, oral, axillary, rectal) * Positive test for active SARS-CoV-2 infection * Radiographic evidence of infiltrates on chest radiograph (CXR) or computed tomography (CT) * Ability to provide written informed consent on the part of the subject or, in the absence of decisional capacity of the subject, an appropriate surrogate (e.g. a legally authorized representative). Exclusion Criteria: * Concurrent use of invasive mechanical ventilation * Concurrent use of vasopressor or inotropic medications * Previous receipt of tocilizumab or another anti-IL6R or IL-6 inhibitor in the year prior. * Known history of hypersensitivity to tocilizumab. * Diagnosis of end-stage liver disease or listed for liver transplant. * Elevation of AST or ALT in excess of 10 times the upper limit of normal. * Neutropenia (Absolute neutrophil count \< 500/uL). * Thrombocytopenia (Platelets \< 50,000/uL). * On active therapy with a Bruton's tyrosine kinase-targeted agent, which include the following: * Acalabrutinib * Ibrutinib * Zanubrutinib * On active therapy with a JAK2-targeted agent, which include the following: * Tofacitinib * Baricitinib * Upadacitinib * Ruxolitinib * Any of the following biologic immunosuppressive agent (and any biosimilar versions thereof) administered in the past 6 months or less:: * Abatacept * Adalimumab * Alemtuzumab * Atezolizumab * Belimumab * Blinatumomab * Brentuximab * Certolizumab * Daratumumab * Durvalumab * Eculizumab * Elotuzumab * Etanercept * Gemtuzumab * Golimumab * Ibritumomab * Infliximab * Inotuzumab * Ipilimumab * Ixekizumab * Moxetumomab * Nivolumab * Obinutuzumab * Ocrelizumab * Ofatumumab * Pembrolizumab * Polatuzumab * Rituximab * Rituximab * Sarilumab * Secukinumab * Tocilizumab * Tositumumab * Tremelimumab * Urelumab * Ustekinumab * History of bone marrow transplantation (including chimeric antigen receptor T-cell) or solid organ transplant * Known history of Hepatitis B or Hepatitis C (patients who have completed curative-intent anti-HCV treatments are not excluded from trial) * Positive result on hepatitis B or C screening * Known history of mycobacterium tuberculosis infection at risk for reactivation * Known history of gastrointestinal perforation * Active diverticulitis * Multi-organ failure as determined by primary treating physicians * Any other documented serious, active infection besides COVID-19 - including but not limited to: lobar pneumonia consistent with bacterial infection, bacteremia, culture-negative endocarditis, or current mycobacterial infection - at the discretion of primary treating physicians * Pregnant patients or nursing mothers * Patients who are unable to discontinue scheduled antipyretic medications, either as monotherapy (e.g., acetaminophen or ibuprofen \[aspirin is acceptable\]) or as part of combination therapy (e.g., hydrocodone/acetaminophen, aspirin/acetaminophen/caffeine \[Excedrin®\]) * CRP \< 40 mg/L