Recent studies have drawn attention to high rates of COVID-19 associated pulmonary aspergillosis (CAPA). This is a retrospective study that utilized the COVID-19 Precision Medicine Analytics Platform (PMAP) Registry (JH-CROWN), which includes data from all COVID-19 patients cared for at five hospitals in JHM, whose admission date was between March and August 2020. A total of 396 patients were included in this cohort: 20 probable CAPA, 19 possible CAPA, and 357 patients without CAPA. The incidence of recognized CAPA ranged from 5 to 10%. People with CAPA had different underlying diseases, especially with regards to BMI, pulmonary, liver, and oncologic diseases prior to COVID-19, compared with those who did not develop CAPA. People with CAPA had uniformly worse outcomes compared to those without, especially with regards to severity of illness, ventilatory and hemodynamic support, and duration of hospitalization. People with CAPA had similar severity of illness compared to controls, at admission. However, people with CAPA improved slower during hospitalization when compared to their counterpart control groups, having increased durations of mechanical and hemodynamic support. Although there was no difference in overall mortality, it is likely that this study lacked the power to detect small differences amongst mechanically ventilated patients with COVID-19. It is notable that the underlying risks for CAPA do not mimic those that are typically associated with severe COVID-19. Given difficulties in invasive sampling, improved non-invasive diagnostics that enable screening, and/or prophylactic antifungal therapy may be warranted in high-risk patients to improve COVID-19 outcomes.