• Michael R Fraser, Chrissie Juliano, and Gabrielle Nichols.
• Association of State and Territorial Health Officials, Arlington, Virginia (Dr Fraser); and Big Cities Health Coalition, Bethesda, Maryland (Mss Juliano and Nichols).
• J Public Health Manag Pract. 2021 Jan 1; 27 Suppl 1, COVID-19 and Public Health: Looking Back, Moving Forward: S29-S38.

AbstractUS states and big cities acted to protect the residents of their jurisdictions from the threat of SARS-CoV-2 infection and reduce COVID-19 transmission. As there were no known pharmacologic interventions to prevent COVID-19 at the outset of the pandemic, public health and elected leaders implemented a host of nonpharmaceutical interventions (NPIs) to slow the spread of the virus. This article discusses variation among states and cities in their implementation of 3 NPIs: stay-at-home/shelter-in-place orders, gathering restrictions, and mask mandates. We illustrate how frequently each was used by states and big cities, discuss state and local authorities to implement such interventions, and consider how these NPIs and accompanying public adherence to public health orders may vary considerably in different regions of the country and by local and state laws specific to state preemption of public health authority.

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