217 CXRs of 133 patients (99 men, mean age 43.9±15.7 years;133 initial CXRs of 132 symptomatic patients; 84 follow-up radiographs of 33 patients) revealed 96(96/133;72.2%) normal initial CXRs. 12 patients with normal initial CXRs(12/96;12.5%) underwent follow up CXR but none was abnormal. Majority (21/37;56.75%) with abnormal CXR had mild (severity score 1-2) lung involvement. A severity score of 1 or more was associated with comorbidities (OR=3.14), male sex (OR=5.93) and increasing age (OR=1.06). ConclusionMajority of CXR in COVID-19 patients were normal during first wave in Sri Lanka. Majority with abnormal CXR had mild lung involvement.