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The clinical application of lung ultrasound (LUS) in the assessment of coronavirus disease 2019 (COVID-19) pneumonia severity remains limited.Herein,we investigated the role of LUS imaging in COVID-19 pneumonia patients and the relationship between LUS findings and disease severity.This was a retro-spective,observational study at Tongji Hospital in Wuhan,on 48 recruited patients with COVID-19 pneu-monia,including 32 non-critically ill patients and 16 critically ill patients.LUS was performed and the respiratory rate oxygenation (ROX) index,disease severity,and confusion,blood urea nitrogen,respira-tory rate,blood pressure,and age (CURB-65) score were recorded on days 0-7,8-14,and 15-21 after symptom onset.Lung images were divided into 12 regions,and the LUS score (0-36 points) was calcu-lated.Chest computed tomography (CT) scores (0-20 points) were also recorded on days 0-7.Correlations between the LUS score,ROX index,and CURB-65 scores were examined.LUS detected COVID-19 pneumonia in 38 patients.LUS signs included B lines (34/38,89.5％),consolidations (6/38,15.8％),and pleural effusions (2/38,5.3％).Most cases showed more than one lesion (32/38,84.2％) and involved both lungs (28/38,73.7％).Compared with non-critically ill patients,the LUS scores of critically ill patients were higher (12 (10-18) vs 2 (0-5),p ＜ 0.001).The LUS score showed significant negative cor-relations with the ROX index on days 0-7 (r =0.85,p ＜ 0.001),days 8-14 (r =-0.71,p ＜ 0.001),and days 15-21 (r =-0.76,p ＜ 0.001) after symptom onset.However,the LUS score was positively correlated with the CT score (r =0.82,p ＜ 0.001).The number of patients with LUS-detected lesions decreased from 27 cases (81.8％) to 20 cases (46.5％),and the LUS scores significantly decreased from 4 (2-10) to 0 (0-5)(p ＜ 0.001) from days 0-7 to 17-21.We conclude that LUS can detect lung lesions in COVID-19 pneumo-nia patients in a portable,real-time,and safe manner.Thus,LUS is helpful in assessing COVID-19 pneu-monia severity in critically ill patients.