Patient was a suspected COVID case with multiple underlying co-morbidities. Patient was initially admitted in Seti Zonal Hospital with severe resporatory distress and was under oxygen via high flow mask. The patient was intubated on our behest as he would have likely not survived the 2 and a half hour trip back to Kathmandu. On our first contact with the patient, we found that the patient was in an unstable state with poor oxygenation, extreme tachycardia and extreme hypertension. To add to the ails of lack of appropriate care at the primary facility, no ambulances in the city were willing to carry the patient from the hospital to the helicopter. After over an hour of struggle and involvement of the mayor of the city, the patient was finally stabilized enough for transfer and an ambulance was brought in. The trip back was full of ups and downs and resuscitation continued in the cramped setting of the helicopter. Thankfully, patient was brought to the receiving facility in a relatively stable state and the transfer team could breathe a sigh of relief after the day-long ordeal. He was later found to have Severe COVID illness in ARDS, and has been making slow but steady recovery.