Patients have reported delaying or forgoing routine, urgent, and emergent health care during the COVID-19 pandemic. This cohort study included patients admitted to one large US academic medical center to assess the incidence of hospital-acquired COVID-19 during the first weeks of the pandemic. Among hospitalized patients who tested positive for COVID-19 (n=697) and patients discharged after non-COVID-19-related hospitalizations (n=8,370), only two cases were deemed to be hospital-acquired. These findings suggest that hospital-acquired COVID-19 was rare during the height of the pandemic and may reassure patients who are delaying or forgoing health care due to concerns about transmission.