Introduction
DISEASE, SYNDROME
The COVID-19 pandemic is an enormous burden on health care systems and economies around the globe. While effective vaccines directed against the SARS-CoV-2 spike protein are available, it will take much time and effort for worldwide immunization levels to be high enough to bring the COVID-19 pandemic to an end [A hyperinflammatory syndrome or cytokine storm contributes to severe disease [The development of new medicines and repurposing of existing drugs with potential value in COVID-19 has required large resources for the delivery of national and international trials. Complex networks have had to be set up, including the RECOVERY and PRINCIPLE platform trials in the UK and ACTIV in the USA, with additional international networks, such as the REMAP-CAP and the World Health Organisation (WHO) Solidarity Plus trial. This global effort has identified several effective treatments which feature in COVID-19 treatment guidelines [Doxycycline is an established, widely available and inexpensive oral drug with a good safety profile and pleiotropic therapeutic effects. It exerts broad-spectrum activity against both extra- and intracellular pathogens [To test this hypothesis, we conducted a randomized, open-label, multi-centre trial based in 6 hospitals in India with high quality ICU facilities. The need for ICU admission was chosen as the primary outcome, and the study was powered based on the assumption that, with standard of care treatments (SoC) at the time of protocol development for this trial, up to 25% of hospitalized COVID-19 patients require ICU admission [