This is a first observational study of four patients on steroid pulse therapy for secondary organizing pneumonia with respiratory failure due to the Coronavirus Disease 2019 (COVID-19) in our hospital. All patients needed invasive mechanical ventilation and had bimodal worseness of their respiratory status with organizing pneumonia after intubation. All cases could successfully discontinue oxygen therapy without any severe adverse events after this pulse therapy. Although few previous reports showed the efficacy and safety of this therapy, this therapy is believed to be effective on some optimal patients. Hence, further studies to explore this efficacy and safety were needed.