In the early stages of COVID-19 prevention and control, due to insufficient understanding of the disease, severe patients were difficult to treat and had a high mortality rate, which posed challenges to ICU physicians. One patient with severe COVID-19 was admitted to our hospital in the early stage of the outbreak. With experiences from the previous management of acute respiratory distress syndrome, the patient was treated with early waking prone position combined with high-flow nasal cannula (HFNC) oxygen therapy. Without endotracheal intubation and mechanical ventilation the patient recovered and was discharged. In this paper, we elaborate the prone position combined with HFNC oxygen therapy together with the comprehensive treatment process of this case. With literature review, we outline the evidence-based basis, notices and timing of invasive mechanical ventilation for awake prone position combined with HFNC in the treatment of severe COVID-19, and summarize the concept of “forward prone position”, which might help making a critical medical decision for the treatment of severe COVID-19 patients.