Due to the increased number of COVID positive cases in the pandemic period, the rate of severe COVID pneumonia has been found to be increased in the past, necessitating increased ICU admission and the tracheostomy [2]. Later is considered as a vital surgical procedure for early weaning from the ventilator after the cessation of the insulting factors [6, 7]. Being an aerosol generating procedure, there is a high chance of spread of infection to the health care personals during the surgery [8]. Hence it is always a challenge for an otolaryngologist to perform the surgery, avoiding the risk of infection. Different treatment guidelines have been proposed in the past for better perioperative management of COVID 19 patients. The variation in the management protocol could be due to the availability of the infrastructure, expenses towards the health sector and to accommodate the massive caseload of COVID 19 patients in the ICU, especially in a developing country like India [2]. Being an aerosol generating procedure, tracheostomy is usually deferred and often advised to perform 2 weeks after the endotracheal intubation in patients with severe COVID pneumonia [3]. In contrast, in the present series, the average period of intubation was 4 days (range 3–7 days). The relatively early tracheostomy could be due to the limited capacity of ICU beds to accommodate the patient load and to hasten the period of weaning from the ventilator. When we compare the surgical approaches, no significant difference was noted between the percutaneous and surgical tracheostomy, although the latter is often preferred to the percutaneous tracheostomy because of less disruption of the airway [5]. In contrast, in the present series, all the tracheotomies were performed through surgical methods by a team of surgeons consisted of otolaryngologists. Based on the infrastructure of the hospital, the procedure can be successfully performed in the ICU or in the OT. The most important aspect of the location of surgery is the ventilation, i.e., the surgical procedure is advised to perform in a well-ventilated OT. The modular OT with the HEPA filter can fulfil the above purpose, reducing the virus load as demonstrated in our series. As documented in the literature, one air exchange in the operative room can decrease the viral load by 63% [9]. In the present case series, of the 12 patients, 6 patients were operated in the ICU and 6 patients were operated in the COVID operation theatre. In both settings, adequate attention was given for the PPE irrespective of the COVID status before the surgery as the sensitivity does not reach to 100% [10]. In the present case series, we did not find any health care personals including the operating surgeons were infected with the disease and there was no difference between these two settings. The tracheostomy of the COVID pneumonia patient was almost the same as that of conventional surgery. Some authors propose to create the tracheal flaps in spite of making a stoma for ease of changing the tube in the postoperative period. In the present case, we have followed the standard procedure and a tracheal stoma was created in each patient in the region of the second/third tracheal ring. The average duration of the surgery was found to be 31 min, and there was no significant difference detected between the two locations, i.e., in the ICU and the OT (p ≥ 0.05). Postoperative care was almost similar to standard tracheostomy, although special attention was paid towards the blockage of the tube/ requirement of change of the tracheostomy. Chest physiotherapy and systemic mucolytics were started early in the postoperative period to prevent tube blockage and for the improvement of the pulmonary reserve. The average duration of the tracheostomy tube change was documented to be 5 days, although in one case, it was done after 72 h of tracheostomy due to the displacement of the tube in a patient with a suicidal cut throat. In the present case series, the average time of weaning off the COVID pneumonia patients was 65 h (range 48 h–80 h) and no significant difference was noted between the two locations. Two patients had died in the postoperative period, which could be due to the associated comorbidities and elder age of presentation. Although there is no direct evidence of the severity of the COVID 19 disease with the pre-existing comorbidities [11,12,13], the mortality in our series has predominantly happened in these patients. None of the Health care personals, including the operating surgeons, were infected during the management of COVID 19 patients.