This study of tertiary students in Hong Kong compared the association between spiritual health and psychological health, and the prevalence of severe symptoms of psychological distress, before and during the COVID-19 pandemic. Cross-sectional data were collected in two samples of students aged 17-24 in 2018 (N = 500) and 2020 (N = 568). The participants were asked to complete the Spiritual Health and Life-Orientation Measure (SHALOM) to evaluate their spiritual health and the short form of the Depression, Anxiety and Stress Scale-21 (DASS-21) to assess their emotional distress. Structural equation modelling showed that the statistically significant negative relationship between spiritual health and psychological distress in 2018 was still significant but weaker in the 2020 sample. In addition, whereas 0% of students suffered from extremely severe symptoms of depression, anxiety, and stress in 2018, the rates were 14.1%, 25.4%, and 8.8% respectively in 2020. The weakened role of spirituality in protecting psychological health under COVID-19, and the significantly higher rate of psychological health problems, are caused for concern, with implications for government, education systems, and students.