RepurpoSing Old Drugs TO SuppRess a Modern Threat: COVID-19 STORM

This study will randomize 20 patients with confirmed or highly suspected early stage severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to Doxycycline (100 mg BID) or Placebo and then assess the progression of their disease over the next three weeks with the primary endpoint being days alive and out of the hospital. The investigators will collect specimens for measurement of viral burden (nasopharyngeal luminex (SARS-CoV-2), SARS-CoV-2 serum quantitative viral load, SARS-CoV-2 IgM/IgG antibodies), markers of inflammation (WBC, ESR, TNFa, IL-1, IL-6, IL-1B), and cardiac dysfunction (CRP, pro-BNP, hsTnT). Eligibility will be based on history and physical examination findings - collated into a clinical suspicion score. The decision to enroll based on clinical suspicion score rather than confirmed SARS-CoV-2 disease is based on the variable and unacceptably high false negative rate of the nasopharyngeal PCR test for in early disease. Clinical Suspicion Score: Greater than or equal to 6/20 (at least 4 points of which must be clinical) will be eligible for enrollment. Clinical Criteria: Max 12 points * Fever (2 points) * Cough (2 points) * Dyspnea (2 points) * Chest pain (1 point) * Myalgias (1 point) * Fatigue (1 point) * GI symptoms (1 point) * Loss of Smell (1 point) * Loss of Taste (1 point) Exposure Criteria: Max 8 points * Contact with known COVID+ (2 points) * Healthcare worker -- frequent \<6 feet contact for 15 minutes (2 points) * High-risk work -- supermarket, deli, transportation (2 points) * Endemic community -- prison/jail/nursing home/LTAC/SNF/rehab/homeless/homeless shelter (2 points) Genetic variants may explain why patients who are infected with SARS-CoV-2 have either a relatively benign or an inappropriately aggressive response to an infectious insult. Medications may be more or less effective in that group of patients harboring genetic variants of a disease-related protein. To better understand this, whole genome sequencing and analysis will be performed on all study patients.