Background: More than 356 million people have been infected with the new coronavirus (SARS-CoV-2) that causes COVID-19.Objective: to assess outcomes and survival of COVID-19 patients admitted at Zigzag University Hospitals. Patients and methods: Retrospective cohort study was conducted at COVID isolation Sednawy Hospital, Zagazig University during the period from Jan 2021 to Dec 2021 including 900 cases as a comprehensive sample, were selected as severe to critical COVID patients according to the criteria of Egyptian protocol for management of COVID-19 patients. All patients had real-time polymerase chain reaction (RT-PCR) in respiratory tract materials. Results: There was significant relation between severity and overall survival, which was significantly higher in those with severe disease. There was significant relation between comorbidity and overall survival, which was significantly higher in those without comorbidity and overall survival, death was 40.9% of all cases; 84.9% of critical and 12% of severe (P 0.001). Survival was highest in 3^rd group 72.8%, while lowest in 1^st group 42.3% (P 0.001). Remdesivir was used in 58.4% of critical and 45% in severe cases, while non-used antiviral was in 29% of critical and 27% of severe cases. CRP, IL6, Albumin/IL6 ratio, neutrophil/lymphocytes ratio were all statistically different between critical and severe cases, while PCT and CRP were insignificantly different. Conclusion: Outcome improving over different groups with time, this means improvement in medical care, different comorbidities, change in the level of acute phase reactant and anti-inflammatory drugs may affect the survival of severe and critically ill COVID 19 patients.