inclusion criteria: 1. individuals ≥ 40 years of age at time of enrolment. 2. laboratory-confirmed diagnosis of sars-cov-2 infection as determined by rt-pcr/ rapid antigen test/ any other test. 3. hospitalized within 2 days from screening and exhibiting tachypnea with i) a respiratory rate (rr) \> 30 breaths/min and ii) a spo2 readings \<90% on room air. 4. less than or equal to 8 days from covid-19 symptom onset prior to randomization. symptoms are defined as one or more of the following: cough, fever, shortness of breath, chest pain, abdominal pain, nausea/vomiting, diarrhea, body aches, weakness/fatigue, chills/sweating, headache, confusion, sore throat, runny nose/congestion, loss of taste or smell, or any other covid-19 symptoms as determined by the investigator. 5. requiring supplemental oxygen by i) mask or tongs, or ii) high-flow oxygen (who category 4 and 5). 6. currently on the standard of care (soc) for covid-19 infection as prescribed by the investigator/ treating physician. 7. the soc will include one or more of the following: * anticoagulants * antibiotics * corticosteroid * other treatment modalities (considered ethical by the investigator with the exception of protocol prohibited medications) 8. patients previously diagnosed with hypertension or currently having a systolic blood pressure ≥ 130mmhg and/or diastolic ≥ 85 mmhg 9. abdominal obesity with a waist circumference \> 88cm in women and \> 102 cm in men. 10. patients diagnosed with one or more conditions linked to metabolic syndrome, which includes: * hyperlipidemia (as defined by a valid report of triglyceride level ≥ 150mg/dl or currently on medication for hyperlipidemia). * a valid report of hdl \< 50mg/dl in women \& \< 40mg/dl in men. * hyperglycemia (as defined by a valid report of fasting glucose level ≥ 110 mg/dl or currently on anti-diabetic drugs) 11. patients with an mbds score ≥ 3. 12. available for, and agrees to attend, all scheduled trial visits and assessments at the research site, and able to complete all assessments and documents contained in the research trial. 13. naturally post-menopausal women with amenorrhea for 1 year will be eligible. 14. females of childbearing potential should be either sexually inactive (abstinent) for 60 days prior to the first dose of the study, throughout the study and for 30 days after completion of the study, or be using one of the following acceptable methods of birth control: * surgically sterile (bilateral tubal-ligation, hysterectomy, bilateral oophorectomy) for at least 90 days prior to the first dose of the study. * iud in place for at least 60 days prior to the first dose of the study, throughout the study and for 30 days after completion of the study. * hormonal contraceptives for at least 90 days prior to the first dose of the study, throughout the study, and for 30 days after study completion. * changes to the method of birth control while participating in the study will be judged by the pi for acceptability. 15. having given written informed consent by a legally acceptable representative to participate in the research trial. 16. patients ready to abstain from niacin and/or nicotinamide supplements.

inclusion criteria: 1. individuals ≥ 40 years of age at time of enrolment. 2. laboratory-confirmed diagnosis of sars-cov-2 infection as determined by rt-pcr/ rapid antigen test/ any other test. 3. hospitalized within 2 days from screening and exhibiting tachypnea with i) a respiratory rate (rr) \> 30 breaths/min and ii) a spo2 readings \<90% on room air. 4. less than or equal to 8 days from covid-19 symptom onset prior to randomization. symptoms are defined as one or more of the following: cough, fever, shortness of breath, chest pain, abdominal pain, nausea/vomiting, diarrhea, body aches, weakness/fatigue, chills/sweating, headache, confusion, sore throat, runny nose/congestion, loss of taste or smell, or any other covid-19 symptoms as determined by the investigator. 5. requiring supplemental oxygen by i) mask or tongs, or ii) high-flow oxygen (who category 4 and 5). 6. currently on the standard of care (soc) for covid-19 infection as prescribed by the investigator/ treating physician. 7. the soc will include one or more of the following: * anticoagulants * antibiotics * corticosteroid * other treatment modalities (considered ethical by the investigator with the exception of protocol prohibited medications) 8. patients previously diagnosed with hypertension or currently having a systolic blood pressure ≥ 130mmhg and/or diastolic ≥ 85 mmhg 9. abdominal obesity with a waist circumference \> 88cm in women and \> 102 cm in men. 10. patients diagnosed with one or more conditions linked to metabolic syndrome, which includes: * hyperlipidemia (as defined by a valid report of triglyceride level ≥ 150mg/dl or currently on medication for hyperlipidemia). * a valid report of hdl \< 50mg/dl in women \& \< 40mg/dl in men. * hyperglycemia (as defined by a valid report of fasting glucose level ≥ 110 mg/dl or currently on anti-diabetic drugs) 11. patients with an mbds score ≥ 3. 12. available for, and agrees to attend, all scheduled trial visits and assessments at the research site, and able to complete all assessments and documents contained in the research trial. 13. naturally post-menopausal women with amenorrhea for 1 year will be eligible. 14. females of childbearing potential should be either sexually inactive (abstinent) for 60 days prior to the first dose of the study, throughout the study and for 30 days after completion of the study, or be using one of the following acceptable methods of birth control: * surgically sterile (bilateral tubal-ligation, hysterectomy, bilateral oophorectomy) for at least 90 days prior to the first dose of the study. * iud in place for at least 60 days prior to the first dose of the study, throughout the study and for 30 days after completion of the study. * hormonal contraceptives for at least 90 days prior to the first dose of the study, throughout the study, and for 30 days after study completion. * changes to the method of birth control while participating in the study will be judged by the pi for acceptability. 15. having given written informed consent by a legally acceptable representative to participate in the research trial. 16. patients ready to abstain from niacin and/or nicotinamide supplements.

inclusion criteria: individuals ≥ 40 years of age at time of enrolment. laboratory-confirmed diagnosis of sars-cov-2 infection as determined by rt-pcr/ rapid antigen test/ any other test. hospitalized within 2 days from screening and exhibiting tachypnea with i) a respiratory rate (rr) > 30 breaths/min and ii) a spo2 readings <90% on room air. less than or equal to 8 days from covid-19 symptom onset prior to randomization. symptoms are defined as one or more of the following: cough, fever, shortness of breath, chest pain, abdominal pain, nausea/vomiting, diarrhea, body aches, weakness/fatigue, chills/sweating, headache, confusion, sore throat, runny nose/congestion, loss of taste or smell, or any other covid-19 symptoms as determined by the investigator. requiring supplemental oxygen by i) mask or tongs, or ii) high-flow oxygen (who category 4 and 5). currently on the standard of care (soc) for covid-19 infection as prescribed by the investigator/ treating physician. the soc will include one or more of the following: anticoagulants antibiotics corticosteroid other treatment modalities (considered ethical by the investigator with the exception of protocol prohibited medications) patients previously diagnosed with hypertension or currently having a systolic blood pressure ≥ 130mmhg and/or diastolic ≥ 85 mmhg abdominal obesity with a waist circumference > 88cm in women and > 102 cm in men. patients diagnosed with one or more conditions linked to metabolic syndrome, which includes: hyperlipidemia (as defined by a valid report of triglyceride level ≥ 150mg/dl or currently on medication for hyperlipidemia). a valid report of hdl < 50mg/dl in women & < 40mg/dl in men. hyperglycemia (as defined by a valid report of fasting glucose level ≥ 110 mg/dl or currently on anti-diabetic drugs) patients with an mbds score ≥ 3. available for, and agrees to attend, all scheduled trial visits and assessments at the research site, and able to complete all assessments and documents contained in the research trial. naturally post-menopausal women with amenorrhea for 1 year will be eligible. females of childbearing potential should be either sexually inactive (abstinent) for 60 days prior to the first dose of the study, throughout the study and for 30 days after completion of the study, or be using one of the following acceptable methods of birth control: surgically sterile (bilateral tubal-ligation, hysterectomy, bilateral oophorectomy) for at least 90 days prior to the first dose of the study. iud in place for at least 60 days prior to the first dose of the study, throughout the study and for 30 days after completion of the study. hormonal contraceptives for at least 90 days prior to the first dose of the study, throughout the study, and for 30 days after study completion. changes to the method of birth control while participating in the study will be judged by the pi for acceptability. having given written informed consent by a legally acceptable representative to participate in the research trial. patients ready to abstain from niacin and/or nicotinamide supplements.

inclusion criteria: individuals ≥ 40 years of age at time of enrolment. laboratory-confirmed diagnosis of sars-cov-2 infection as determined by rt-pcr/ rapid antigen test/ any other test. hospitalized within 2 days from screening and exhibiting tachypnea with i) a respiratory rate (rr) > 30 breaths/min and ii) a spo2 readings <90% on room air. less than or equal to 8 days from covid-19 symptom onset prior to randomization. symptoms are defined as one or more of the following: cough, fever, shortness of breath, chest pain, abdominal pain, nausea/vomiting, diarrhea, body aches, weakness/fatigue, chills/sweating, headache, confusion, sore throat, runny nose/congestion, loss of taste or smell, or any other covid-19 symptoms as determined by the investigator. requiring supplemental oxygen by i) mask or tongs, or ii) high-flow oxygen (who category 4 and 5). currently on the standard of care (soc) for covid-19 infection as prescribed by the investigator/ treating physician. the soc will include one or more of the following: anticoagulants antibiotics corticosteroid other treatment modalities (considered ethical by the investigator with the exception of protocol prohibited medications) patients previously diagnosed with hypertension or currently having a systolic blood pressure ≥ 130mmhg and/or diastolic ≥ 85 mmhg abdominal obesity with a waist circumference > 88cm in women and > 102 cm in men. patients diagnosed with one or more conditions linked to metabolic syndrome, which includes: hyperlipidemia (as defined by a valid report of triglyceride level ≥ 150mg/dl or currently on medication for hyperlipidemia). a valid report of hdl < 50mg/dl in women & < 40mg/dl in men. hyperglycemia (as defined by a valid report of fasting glucose level ≥ 110 mg/dl or currently on anti-diabetic drugs) patients with an mbds score ≥ 3. available for, and agrees to attend, all scheduled trial visits and assessments at the research site, and able to complete all assessments and documents contained in the research trial. naturally post-menopausal women with amenorrhea for 1 year will be eligible. females of childbearing potential should be either sexually inactive (abstinent) for 60 days prior to the first dose of the study, throughout the study and for 30 days after completion of the study, or be using one of the following acceptable methods of birth control: surgically sterile (bilateral tubal-ligation, hysterectomy, bilateral oophorectomy) for at least 90 days prior to the first dose of the study. iud in place for at least 60 days prior to the first dose of the study, throughout the study and for 30 days after completion of the study. hormonal contraceptives for at least 90 days prior to the first dose of the study, throughout the study, and for 30 days after study completion. changes to the method of birth control while participating in the study will be judged by the pi for acceptability. having given written informed consent by a legally acceptable representative to participate in the research trial. patients ready to abstain from niacin and/or nicotinamide supplements.

inclusion criteria: adult individuals diagnosed with sars-cov-2 and currently hospitalized and provided standard of care. patients previously diagnosed with hypertension or currently having a systolic blood pressure ≥ 130mmhg and/or diastolic ≥ 85 mmhg. abdominal obesity with a waist circumference > 88cm in women and > 102 cm in men. patients diagnosed with one or more conditions linked to metabolic syndrome, which includes: patients with an mbds score ≥ 3. available for, and agrees to attend, all scheduled trial visits and assessments at the research site, and able to complete all assessments and documents contained in the research trial. females of childbearing potential should be either sexually inactive (abstinent) for 60 days prior to the first dose of the study, throughout the study and for 30 days after completion of the study, or be using one of the following acceptable methods of birth control: surgically sterile (bilateral tubal-ligation, hysterectomy, bilateral oophorectomy) for at least 90 days prior to the first dose of the study. iud in place for at least 60 days prior to the first dose of the study, throughout the study and for 30 days after completion of the study. hormonal contraceptives for at least 90 days prior to the first dose of the study, throughout the study, and for 30 days after study completion. changes to the method of birth control while participating in the study will be judged by the pi for acceptability. having given written informed consent by a legally acceptable representative to participate in the research trial. patients ready to abstain from niacin and/or nicotinamide supplements.

inclusion criteria: adult individuals diagnosed with sars-cov-2 and currently hospitalized and provided standard of care. patients previously diagnosed with hypertension or currently having a systolic blood pressure ≥ 130mmhg and/or diastolic ≥ 85 mmhg. abdominal obesity with a waist circumference > 88cm in women and > 102 cm in men. patients diagnosed with one or more conditions linked to metabolic syndrome, which includes: patients with an mbds score ≥ 3. available for, and agrees to attend, all scheduled trial visits and assessments at the research site, and able to complete all assessments and documents contained in the research trial. females of childbearing potential should be either sexually inactive (abstinent) for 60 days prior to the first dose of the study, throughout the study and for 30 days after completion of the study, or be using one of the following acceptable methods of birth control: surgically sterile (bilateral tubal-ligation, hysterectomy, bilateral oophorectomy) for at least 90 days prior to the first dose of the study. iud in place for at least 60 days prior to the first dose of the study, throughout the study and for 30 days after completion of the study. hormonal contraceptives for at least 90 days prior to the first dose of the study, throughout the study, and for 30 days after study completion. changes to the method of birth control while participating in the study will be judged by the pi for acceptability. having given written informed consent by a legally acceptable representative to participate in the research trial. patients ready to abstain from niacin and/or nicotinamide supplements.