Pakistan has reported a substantial number of COVID-19 cases since 2020. A multicenter observational study was conducted to identify the pattern of SARS-CoV-2 infection, transmission, and treatment in patients admitted to seven low to middle-income district hospitals in the Province of Punjab, Pakistan from March to June 2020. A total of 102 patients were recruited. 57 patients tested positive and 45 developed moderate-severe COVID-19 disease. About 67% of the patients in March-April and 93% in May-June have contracted the disease from the local transmission. The mean number of symptoms in SARS-CoV-2 positive patients was significantly higher than suspected patients (6.46 vs 5.04, p=0.003). The number of deaths was low (n=8) with 86% recovery rate. Mild COVID patients received acetaminophen (n=102), azithromycin (n=8), and hydroxychloroquine (n=4) in addition to standard medical care. The treatment provided to moderate-severe cases included acetaminophen (45/45), azithromycin (45/45), Ivermectin (14/45) and corticosteroids (13/45). The mean number of antimicrobials was significantly higher in moderate-severe patients than mild cases (1.80 vs 1.12, p=0.001). Low number of deaths with a high recovery rate was reported. Diabetes was the most common comorbid condition followed by hypertension. Many antimicrobials were prescribed in both mild and moderate-severe cases that require careful review.