Background Acute cholecystitis is a common reason for emergency general surgery admission. The declaration of the COVID-19 pandemic may have resulted in treatment delays and corresponding increases in severity of disease. This study compared cholecystitis admissions and disease severity pre- and post-declaration of pandemic. Materials and Methods Retrospective review of adult acute cholecystitis admissions (1/1/20-5/31/20). Corresponding time periods in 2018 and 2019 comprised the historical control. Difference-in-differences analysis compared biweekly cholecystitis admissions pre- and post-declaration in 2020 to the historical control. Odds of increased severity of disease presentation were assessed using multivariable logistic regression. Results Cholecystitis admissions decreased 48.7% from 5.2 to 2.67 cases [RR 0.51(0.28,0.96), p=0.04] following pandemic declaration when comparing 2020 to historical control (p=0.02). After stratifying by severity, only Tokyo I admissions declined significantly post-declaration [RR 0.42(0.18,0.97)], when compared to historical control (p=0.02). There was no change in odds of presenting with severe disease after the pandemic declaration [aOR 1.00 (95% CI 0.30, 3.38) p<0.99] despite significantly longer lengths of symptoms reported in mild cases. Conclusion Post-pandemic declaration we experienced a significant decrease in cholecystitis admissions without corresponding increases in disease severity. The pandemic impacted healthcare-seeking behaviors, with fewer mild presentations. Given that the pandemic did not increase odds of presenting with increased severity of disease, our data suggests that not all mild cases of cholecystitis progress to worsening disease and some may resolve without medical or surgical intervention.