Study never started due to need for additional preclinical work requested by FDA>

This is a phase II study to test adenosine efficacy for down-regulation of the overwhelming inflammation of COVID-19 in the lungs as reflected by clinical recovery of lung function; resolution of clinically relevant markers of lung function, and resolution of systemic markers of inflammation and coagulation.

Inclusion Criteria:

• Adult (≥ 18 years old) male and female patients with diagnosed COVID-19 respiratory infection, verified by culture/swab RNA. Impending ARDS respiratory collapse with progressive increasing oxygen requirements, and in line with sub-study as defined below.
• Patients intubated within the prior 24 hours.
• Hemodynamically stable (not requiring vasopressors or catecholamine agents to support systemic blood pressure; no existing shock defined as BP < 100 mmHg systolic).
• In-place continuous arterial line for blood sampling.

Exclusion Criteria:

• Younger than 18 years old.
• Prisoners
• Pregnant women.
• Unable to obtain next of kin consent.
• End-stage cardiac disease with COVID-19.
• Non COVID-related causes of ARDS/respiratory failure, septic shock, or post trauma shock, respiratory failure after blood transfusion or surgery.
• Unstable asthma or history of frequent/poorly controlled asthmatic attacks.
• Not expected to live more than 6 months due to underlying condition such as cancer.