Background: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; named 2019 novel coronavirus or 2019-nCoV) disease in China at the end of 2019 has led to pandemic. A robust surveillance system is required for true estimation of burden of the disease. This study was conducted to identify the strengths and weaknesses of laboratory-based COVID-19 surveillance system in Pakistan and to propose some doable actions for improvement.