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We evaluated associations between serum 25-hydroxyvitamin D [25(OH)D] level and severity of new coronavirus infection (COVID-19) in hospitalized patients. We assessed serum 25(OH)D level in 133 patients aged 21–93 years. Twenty-five (19%) patients had severe disease, 108 patients (81%) had moderate disease, and 18 (14%) patients died. 25(OH)D level ranged from 3.0 to 97.0 ng/mL (median, 13.5 [25%, 75%, 9.6, 23.3] ng/mL). Vitamin D deficiency was diagnosed in 90 patients, including 37 with severe deficiency. In patients with severe course of disease, 25(OH)D level was lower (median, 9.7 [25%, 75%, 6.0, 14.9] ng/mL), and vitamin D deficiency was more common than in patients with moderate course (median, 14.6 [25%, 75%, 10.6, 24.4] ng/mL, p = 0.003). In patients who died, 25(OH)D was 9.6 [25%, 11.5] ng/mL, compared with 14.8 [25%, 75%, 10.1, 24.3] ng/mL in discharged patients (p = 0.001). Severe vitamin D deficiency was associated with increased risk of COVID-19 severity and fatal outcome. The threshold for 25(OH)D level associated with increased risk of severe course was 11.7 ng/mL. Approximately the same 25(OH)D level, 10.9 ng/mL, was associated with increased risk of mortality. Thus, most COVID-19 patients have vitamin D deficiency, severe vitamin D deficiency is associated with increased risk of COVID-19 severity and fatal outcome.