Highlights What is the primary question addressed by this study? How have ECT practices changed to adapt to public health guidelines for treating older adults amidst the coronavirus 2019 (COVID-19) pandemic? What is the main finding of this study? Electroconvulsive therapy (ECT) continues to be an essential treatment for older adults with severe mental illness, and extensive infection control and public health measures are being taken to mitigate risk of transmission while sustaining operations. What is the meaning of the finding? Substantial changes to ECT practices are anticipated to be long-standing and will likely evolve further in response to availability of testing and treatment for COVID-19.