Massive pericardial effusion resulting in cardiac tamponade is a medical emergency requiring rapid treatment. Long-term outlook depends on how quickly diagnosis can be made and the underlying cause. However, in this Covid-19 pandemic, fear of hospital visit, shortage of PCR capacity and diagnostic modality in isolation settings prolonged diagnosis and treatment. A 60-year-old female came with worsening dyspnea, cough, and history of fever. Laboratory findings showed elevated white blood cell count and renal insufficiency. Chest x-ray showed bilateral pleural effusion and pneumonia. PCR test limitation in the peak of pandemic led to longer test result. Urgent pericardiocentesis was done as condition worsen to cardiac tamponade, dispensing total of massive 2500 ml reddish pericardial fluid, cytopathologically malignant (adenocarcinoma). Pericardial effusion in some malignancy cases could progress rapidly to cardiac tamponade. Urgent diagnosis and comprehensive treatment in pandemic era should be done in malignant pericardial tamponade.