The COVID-19 pandemic represents an exceptional global crisis that raises many questions among the international medical community. Its psychiatric consequences are still being explored. Given the lethal potential and the unpredictability of COVID-19, a high risk of posttraumatic stress disorder (PTSD) was identified in the beginning of the crisis [
1]. It is estimated that 5% of patients severely affected by COVID-19 were admitted to an intensive care unit (ICU) [
2], and more than 80% of them developed delirium in one study [
3]. Adult ICU survivors are at high risk of developing neuropsychiatric complications, such as post intensive care syndrome (PICS) at 19–22% [
4]. PICS constitutes new or worsening cognitive and/or psychiatric and/or physical functions, usually identified in the period immediate following critical illness. Psychiatric manifestations of PICS include anxiety, depression, and posttraumatic stress disorder (PTSD) [
5]. PTSD can occur as a consequence of acute stress disorder (ASD). The latter is characterized by acute stress reactions that may occur in the initial month after a person is exposed to a traumatic event. The disorder includes symptoms of intrusion, dissociation, negative mood, avoidance, and arousal. Early identification and treatment of severe acute stress responses can have the additional benefit of limiting subsequent PTSD, which is diagnosed after 4 weeks of symptoms following exposure to trauma. The experience of the disease itself can be a traumatic event and lead to PTSD, and several risk factors of developing PTSD after a trauma event are known [
6]. Before the trauma event, peritrauma factors are history of disease, previous psychiatric disorders, and childhood traumas. During the trauma event, peritrauma factors include peritraumatic dissociation. After the trauma event, posttrauma factors are acute stress disorder, acute stress symptoms, anxiety, avoidance, and depression [
6]. The risk of developing PTSD seems to be high for adults surviving COVID-19, with a rate of 28% reported in a recent study [
7]. In this case report, we illustrate the direct and indirect effects of stress from COVID-19 on the mental health of a 67-year-old Swiss patient who was hospitalized in the ICU for COVID-19 and how this complex clinical situation with a high risk of developing PTSD was managed. This paper describes a complex case of acute COVID-19 in intensive care unit associated with psychiatric issues and its clinical follow-up at 3 months during the first wave. This case is rare because it shows how direct and indirect effects of SARS-CoV-2 on the brain can interplay with the traumatic load related to the COVID-19 experience and how to manage the treatment with a 3-month follow-up. To the best of the authors’ knowledge, there are no case reports to date describing acute stress disorder in a COVID-19 survivor.