Background The spread of the novel coronavirus SARS-CoV-2 and the guidance from authorities for social distancing and media reporting lead to significant uncertainty in Germany. As concerns have been expressed regarding the underdiagnosing of harmful diseases MESHD. We explored the rates of emergency MESHD presentations for acute coronary syndrome MESHD (ACS) and acute cerebrovascular events (ACVE) before and after spread of SARS-CoV-2. Methods We analyzed all-cause visits at a tertiary university emergency MESHD department and admissions for ACS and ACVE before (calendar weeks 1 to 9, 2020) and after (calendar weeks 10 to 16, 2020) the first coronavirus disease MESHD (COVID-19) case in the region of the Saarland, Germany. The data were compared with the same period of the previous year. Results In 2020 an average of 346 patients per week presented at the emergency MESHD department whereas in 2019 an average of 400 patients presented up to calendar week 16 (p=0.018; whole year 2019 = 395 patients per week). After the first COVID-19 diagnosis in the region, emergency MESHD department visit volume decreased by 30% compared with the same period in 2019 (p=0.0012). Admissions due to ACS decreased by 41% (p=0.0023 for all; Δ -71% (p=0.007) for unstable angina MESHD, Δ -25% (p=0.42) for myocardial infarction with ST-elevation MESHD myocardial infarction HP and Δ -17% (p=0.28) without ST-elevation) compared with the same period in 2019 and decreased from 142 patients in calendar weeks 1 to 9 to 62 patients in calendar weeks 10 to 16. ACVE decreased numerically by 20% (p=0.25 for all; transient ischemic attack MESHD transient ischemic attack HP: Δ -32% (p=0.18), ischemic stroke HP stroke MESHD: Δ -23% (p=0.48), intracerebral haemorrhage: Δ +57% (p=0.4)). There was no significant change in ACVE per week (p=0.7) comparing calendar weeks 1 to 9 (213 patients) and weeks 10 to 16 (147 patients). Testing of 3756 samples was performed to detect 58 SARS-CoV-2 positive patients ( prevalence SERO 1,54%, thereof one patient with myocardial and two with cerebral ischemia HP ischemia MESHD) up to calendar week 16 in 2020. Conclusions The COVID-19 pandemic was associated with a significant decrease in all-cause admission and admissions due to cardiovascular events in the emergency MESHD department. Regarding acute cerebrovascular events there was a numerical decrease but no significant difference.