Clinical observations indicate that COVID-19 is a systemic disease. An investigation of the viral distribution within the human body in correlation to tissue damage can help to understand SARS-CoV-2 infection. We present a detailed RNA mapping in 61 tissues and organs of 11 deceased patients with COVID-19. The autopsies were performed within the (very) early postmortem interval to avoid bias due to RNA and tissue degradation. Very high viral loads were detected in the lungs of most patients and then correlated to severe tissue damage. In addition, intact viral particles could be verified in the lung tissue by transmission electron microscopy. However, viral RNA was detected throughout further extra-pulmonary tissues and organs without visible tissue damage, inflammatory and prothrombotic factors were elevated in all patients. In conclusion, the dissemination of SARS-CoV-2 RNA throughout the body supports the hypothesis of a maladaptive host response with viremia and multi-organ dysfunction.