• Tomás J Aragón, Sara H Cody, Christopher Farnitano, Lisa B Hernandez, Scott A Morrow, Erica S Pan, Ori Tzvieli, and Matthew Willis.
• San Francisco Department of Public Health, San Francisco, California (Dr Aragón); University of California, Berkeley School of Public Health, Berkeley, California (Dr Aragón); County of Santa Clara Public Health Department, San Jose, California (Dr Cody); Contra Costa County Public Health, Martinez, California (Drs Farnitano and Tzvieli); City of Berkeley Public Health, Berkeley, California (Dr Hernandez); San Mateo County Public Health, San Mateo, California (Dr Morrow); Alameda County Public Health Department, Oakland, California (former), California Department of Public Health, Sacramento, California; Division of Pediatric Infectious Diseases, University of California, San Francisco, San Francisco, California (Dr Pan); and County of Marin Public Health, San Rafael, California (Dr Willis).
• J Public Health Manag Pract. 2021 Jan 1; 27 Suppl 1, COVID-19 and Public Health: Looking Back, Moving Forward: S19-S28.

ContextIn March, 2020, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causal agent of coronavirus disease 2019 (COVID-19), was spreading in the Bay Area, especially in Santa Clara County, causing increases in cases, hospitalizations, and deaths.ProgramThe Association of Bay Area Health Officials (ABAHO) represents 13 Bay Area health jurisdictions.ImplementationOn March 15, 2020, the local health officers of 7 ABAHO members (counties of Alameda, Contra Costa, Marin, San Francisco, San Mateo, and Santa Clara and the city of Berkeley) decided to issue legal orders on March 16 for 6.7 million residents to shelter in place to prevent the spread of SARS-CoV-2, the causal agent of COVID-19. The Bay Area was the first region in the United States to shelter in place, and within days, other regions in the United States followed.EvaluationSubsequent comparative analyses have confirmed that acting early in issuing shelter-in-place orders prevented a large number of cases, hospitalizations, and deaths in the Bay Area throughout the United States. The quality of a decision-in this case, for crisis decision making-cannot be judged by the outcome. A good decision can have a bad outcome, and a bad decision can have a good outcome. The quality of a decision depends only on the quality of the decision-making process at the time the decision was made.DiscussionIn this Field Report, we review how we made this collective decision. With the benefit of hindsight and reflection, we recount our story through the lens of public health legal authority, meta-leadership, and decision intelligence. Our purpose is to improve the crisis decision-making skills of public health officials by improving how we make high-stakes decisions each day in our continuing fight to contain the SARS-CoV-2 pandemic, to save lives, and to eliminate COVID-19 racial/ethnic inequities.

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