Background <p>Coronavirus disease 2019, is an infectious disease caused by the severe acute respiratory syndrome corona virus type-2 virus. Children affected are usually asymptomatic and those that have symptoms tend to be milder and infants are most at risk for severe disease. We describe the first two cases of coronavirus disease 2019 deaths among infants with complication of severe acute malnutrition in Sierra Leone. In the first half of June 2020, Kenema district reported first two coronavirus disease 2019 deaths of infants in Sierra Leone. We conducted a death review to understand the underlying medical conditions and predisposing factors of the deaths given the rarity of death among children with coronavirus disease 2019 disease. We describe the clinical presentation of the cases and their possible underlying medical conditions.</p> Case presentation <p>The two infant decedents were 8-month-old male and 6-month-old female Sierra Leoneans who presented with fever, vomiting, and flu-like symptoms and had complications of severe acute malnutrition and were coinfected with coronavirus disease 2019. Both patients developed severe respiratory distress which were not resolved with antibiotics and oxygen therapy. In addition, the diagnosis of coronavirus disease 2019 infection in both cases were also delayed due to low index of suspicion, and lack of treatment for coronavirus disease 2019 exacerbated their likelihood of death.</p> Conclusion <p>The severe acute malnutrition made the infants prone to severe coronavirus disease 2019 disease and thus led to their death. We recommend community sensitization on good nutrition for infants to increase the chance of survival of children with coronavirus disease 2019 infection.</p>