This case study explores the progression of COVID-19 from initial flu-like symptoms to acute respiratory distress syndrome (ARDS) due to infection with the SARS-CoV-2 virus. It details the story of a 32-year-old emergency department nurse who begins to show signs of a respiratory illness. The case follows the development of his respiratory distress based on arterial blood gas values and chest radiograph results. A series of directed questions guide students through exploring respiratory physiology and acid-base balance, focusing on the unique consequences of ARDS in COVID-19 patients. The questions fall into three categories: (1) acid-base disturbance due to respiratory insufficiency, (2) decreased diffusion capacity due to diffuse alveolar damage and fluid accumulation as the cause of respiratory insufficiency, and (3) mechanical ventilation as a treatment to improve gas exchange by increasing the fraction of inspired oxygen and positive end-expiratory pressure, both of which improve gas exchange and therefore oxygen delivery to the bloodstream. The case was designed for upper-level undergraduate or graduate-level physiology/biology students but would also be relevant for students in nursing/medicine/physician assistant programs, pathophysiology courses, and respiratory therapy programs.