An existing study evaluating multiple treatments for severe pneumonia ("REMAP-CAP") is currently active in over 70 ICUs worldwide, including 10 sites in NZ. Severe pneumonia is the most common cause of death from COVID-19, but there are currently no known effective treatments for COVID-19. In conjunction with our international collaborators, we will add the assessment of some drugs with potential antiviral activity (lopinavir/ritonavir and hydroxychloroquine) and treatments that modulate the body’s immune response (anakinra and interferon beta 1a), which in severe cases is thought to further damage the lungs. This study has a special adaptive design which allows the results from around the world to be analysed as frequently as every week, which are then used to immediately increase the proportion of participants who are allocated the treatments more likely to be effective. Assessment of other potential treatments can also be added quickly in the future.