The global death rate from COVID-19 is 2.1%, while it is 3.2% in Indonesia. There were 81 deaths (32%) out of the 244 total COVID-19 cases at Muhammadiyah University General Hospital of Malang in July 2021. This study examined the immediate causes and conditions leading to these deaths in COVID-19 patients. We aimed to describe several causes of death defined in the death certificate compared with the autopsy findings based on previous literature. This was a retrospective and analytical observational study. There was a death rate of 40.7% in the emergency department, 22.0% in the intensive care unit and 37.0% outside of the intensive care unit. Respiratory failure was the main immediate cause of death with 77 cases (95.06%). Covid-19 pneumonia was the main condition leading to death with 61 cases (75.31%). These data are expected to encourage clinicians to better understand and perceive the circumstances under which a patient may progress from severe infection towards death and manage such cases more efficiently. Keywords: causes of death, COVID-19, immediate condition leading to causes of death, emergency room, non-ICU, ICU