Objective. To compare the patient population, common complaints, and physician recommendations in direct-to-consumer chat-based consults, before and during the COVID-19 outbreak. Data sources. Data on patient characteristics, patient complaints, and physician recommendations from 36,864 chat-based telemedicine consults with physicians in an online-clinic by patients from across the United States between April 2019 and April 2020. Study Design. We perform a retrospective analysis comparing patient characteristics, visit characteristics, and physician recommendation before and after the COVID-19 outbreak. We examine patient age TRANS
and gender TRANS
, visit time, patient chief complains, and physician medical recommendation (including prescription drugs, reassurance, and referrals). Principal Findings. Before March 2020, most patients were female TRANS
(75 percent) and 18-44 years old (89 percent). Common complaints such as abdominal pain HP abdominal pain MESHD
, dysuria HP dysuria MESHD
, or sore throat suggested minor acute conditions. Most cases (67 percent) were resolved remotely, mainly via prescriptions; a minority were referred. Since March 2020, the COVID-19 emergency has led to a sharp (fourfold) increase in case volume, including more males TRANS
(from 25 to 29 percent), patients aged TRANS
45 and older (from 11 to 17 percent), and more cases involving mental health complaints and complaints related to COVID-19. Across all symptoms, significantly more cases (78 percent) have been resolved remotely. Conclusions. The COVID-19 outbreak in the United States has been associated with a sharp increase in the use of chat-based telemedicine services, including by new patient demographics, an increase in both COVID-19 and mental health complains, and an increase in remote case resolutions.