Abstract : COVID-19 is RNA virus was identified in 2019 in Wuhan, China and it causes a various degree of respiratory affection ranging from mild respiratory illness to life threatening respiratory failure. The main diagnostic test is detection of the virus by PCR in a nasopharyngeal swab. We aimed to determine the incidence, clinical presentation, and outcome of COVID-19 patients in a limited resources setting. We included 258 COVID-19 cases from Shendi isolation center, Sudan. This study was conducted during the period between November 2020 and June 2021. The most common age group was found to be between 61 —80years representing 46.5% of the patients. More than half of them were males. The clinical presentations of the patients were dominated by the following profile: Fever in 211 patients (81.8%), dyspnea in 169 patients (65.5%), cough in 160 patients (62%), sore throat in 49 patients (19%), headache in 21 patients (8.1%), fatigue in 14 patients (5.4%), chest pain in 7 patients (2.7%), anosmia in 6 patients (2.3%), loss of appetite in 5 patients (1.9%), abdominal pain in 2 patients (0.8%), diarrhea in 2 patients (0.8%), vomiting in one patient (0.4%), loss of test in 3 patients (1.2%), nausea in one patient )0.4%(, and rhinorrhea in one patient (0.4%). Most of patients were from rural areas (67.8%). The most common chronic illness seen was DM in 58 patients (22.5%) and hypertension in 43 patients (16.7%). Mortality rate was (28.7%) (affecting 74 patients), In COVID-19, the most common presenting symptoms are: fever, cough and dyspnea are. Mortality rate is found to be very high in this study; both DM and hypertension are associated with increased incidence and mortality rate of COVID-19. The mortality rate is directly proportionate to increase in age; as the age group 61-80 representing 46.5% of the patients.