Background. COVID-19, a new viral disease caused by Corona Virus (SARS-CoV-2) was reported first by Chinese. WHO declared it a pandemic in March 2020. We saw a huge number of this illness that caused a stress on health care systems and a high proportion of mortality. World Health Organization declared it as a pandemic in March 2020. We planned this study with the objective of knowing clinical presentation, hospital management and final outcome of COVID-19 in our population and compare it with other institution who studied the disease elsewhere. Materials and methods. A retrospective study on COVID-19 patients with severe to critical illness was conducted in King Saud Medical City Riyadh. Proper permission was issued by ethical committee of King Saud Medical City. Data was collected manually as well from electronic records. Data was analyzed using standard statistical methods. A total of 689 patients that were admitted to KSMC from 1st March 2020 to 30th of June 2020. Results. More than 50 % of our patients were from Indian subcontinent (India, Pakistan and Bangladesh). Our mean age was 50 years. Females comprised 17.3 % of our patients. Common presentation was breathlessness (79 %), cough (70 %) and fever (67 %). Mean oxygen saturation on presentation was 92 %. Around sixty one percent of our patients were critical and were treated in intensive care unit. Mortality was 35 % and multi-organ failure 25 %. Although diabetes mellitus (37.3 %) and hypertension (29.5 %) were common comorbidities but it did not increase the mortality in our patients. Our mortality seems to be related to late reporting to hospital and severe disease itself. Conclusions. A retrospective study conducted at King Saud Medical city on 689 patients of severe and critical COVID-19. A high proportion were admitted to intensive care unit (60.8 %), 41 % needed invasive ventilation and 29 % required vasopressors and 14 % needed hemodialysis. Mortality of 35 % was recorded in our study. People of Indian subcontinent (Pakistani, Bangladeshi and Indians) formed more than 50 % of patients.