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The COVID-19 pandemic, which has been expanding since the first cases in Asia in late 2019, may result in acute respiratory failure (ARF) with severe hypoxemia [1-3]. In prehospital settings, the paucity of clinical respiratory signs has made assessing the severity of some COVID-19 patients challenging. Indeed, even though hypoxic ARF generally leads to an increase in respiratory rate (RR) [4], in some COVID-19 patients, a persistent normal RR was inconsistent with the severity of hypoxia. Based on retrospective data, we aimed to describe the discrepancy between prehospital initial RR (RRi) and initial SpO2 (Spo2i; i.e., before oxygen supplementation, FiO2 = 21%) in COVID-19 patients suffering from ARF. We retrospectively examined consecutive COVID-19 patients suffering from ARF who were treated by the Paris Fire Brigade's basic life-support (BLS) teams in the prehospital setting. Data were provided from primary home care providers. Based on a previous study [5], we used the SpO2i/RRi ratio as an estimator of the discrepancy insofar as a low numerator is associated with hypoxia, whereas a high denominator is typically associated with respiratory failure. After having measured the SpO2i/RRi values in COVID-19 patients, we compared them to those of non-COVID-19 patients (i.e., patients with other causes of ARF treated by the BLS teams over the previous 3 years in the same period). Continuous data were described as median (interquartile range) and were compared by applying the Kruskal-Wallis test. The French Society of Anaesthesia and

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