Background: Covid19 infection became one of the most widespread respiratory tract infections worldwide. The pandemic lastly spreading in Egypt made a great challenge for the health workers of different specialties. Anesthetists had to solve difficult problems related to the infected patients requiring surgical interventions and to make the balance between patient safety and medical team protection during the procedure. Objective: Thisstudy aimed to check for clear guideline protocol for anesthetic management of Covid-19 cases undergoing cesarean section, here is a case presentation for a twins pregnant patient. Case presentation: Female patient 32 years old diagnosed as covid-19 positive prepared for cesarean section for delivery of preterm twins with CT finding corads 5, clinically presented by acute respiratory distress syndrome (ARDS). The patient received spinal anesthesia associated with tap block, oxygenation was done by closed circuit system of the anesthesia machine with partial closure of adjustable pressure limiting (APL) valve and hypotension was managed by noradrenaline infusion during the procedure. Conclusion: Combined spinal anesthesia with tap block was the most successful modality for anesthesia for cesarean section(CS) in severe cases of covid-19 infected patients.