Objective To assess changes in presentations to EDs during the COVID‐19 pandemic lockdown in the Southern Region of New Zealand. Methods We conducted a retrospective audit of patients attending EDs in the Southern District Health Board (SDHB), from 1 March to 13 May 2020. We made comparisons with attendances during the same period in 2019. The 2020 study period included ‘pre‐lockdown’ (1 March–25 March), ‘level 4 (strict) lockdown’ (26 March–27 April) and ‘level 3 (eased) lockdown’ (28 April–13 May). Results Patient volumes reduced in all SDHB EDs during levels 4 and 3, mostly representing a loss of low acuity patients (Australasian Triage Scale 3, 4 and 5), although high‐acuity presentations also declined. Average patient age increased by 5 years; however, the proportions of sexes and ethnicities did not change. Presentations of cerebrovascular accidents and appendicitis did not change significantly. Trauma, mental health, acute coronary syndrome and infectious respiratory presentations decreased significantly during level 4, and infectious respiratory presentations decreased further in level 3. Conclusions Within the SDHB, patient volumes reduced during levels 4 and 3 of our lockdown, with reduced low‐acuity presentations. High‐acuity patient numbers also declined. Trauma, mental health, alcohol‐related, infectious respiratory and acute coronary syndrome presentations declined while cerebrovascular accident and appendicitis numbers showed little to no change.