Inclusion Criteria:

1. Adults ≥ 18 years of age.

2. Suspected or confirmed COVID-19. Defined as: a positive PCR for SARS CoV-2 or pending
PCR results for patients that are suspected to have COVID-19.

3. Hypoxemia on room air (SPO2<90%), and oxygen requirement ≥ 0.4 FiO2 (i.e. ≥ 40%
oxygen).

4. Bilateral or unilateral chest infiltrates on x-ray as interpreted by the treating
team.

5. Admitted to the ICU or an acute care bed where hemodynamic and respiratory monitoring
is feasible.

Exclusion Criteria:

1. Immediate need for intubation as determined by the treating team.

2. Decreased level of consciousness (Glasgow Coma Scale score <10), or significant
cognitive impairment hat may interfere with compliance (delirium, dementia)

3. Contraindication to proning including, but not limited to any of the following:

Open chest or abdomen, abdominal surgery (i.e. laparotomy) within the 4 days, Unstable
spine, facial, cervical, femur, or pelvic fractures. Limited neck mobility or
inability to lie prone comfortably Skeletal deformities that interfere with proning.
Complete bowel obstruction. Active upper gastrointestinal bleeding. Patient is
unlikely/unable to prone, or to be compliant as indicated by the treating team.

4. Body mass index > 40 kg/m2

5. Pregnancy - third trimester.

6. Patient/substitute decision maker or caring physician's refusal to enroll in the
study.

7. Patients with hemodynamic instability and moderate to high dose of vasopressors
(norepinephrine dose ≥ 0.15 mcg/kg/min)

8. Intubation is not within patient's goals of care

9. Patient received awake proning session for > 1 day prior to randomization

10. Previous intubation within the same hospital admission