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Different Responses to COVID-19 in Four US States: Washington, New York, Missouri, and Alabama.

In the United States, public health is largely the responsibility of state governments' implementing authority specified in their constitutions or reserved to states under the 10th Amendment to the US Constitution. The public health-related powers granted to the federal government are substantially less and derive primarily from the Commerce Clause (Article 1, Section 8) of the US Constitution. In public health emergencies over the past several decades, however, the Centers for Disease Control and Prevention (CDC) has played a major role in providing guidance, resources, and other support to state and local public health departments, for example, in large foodborne disease outbreaks, in response to major natural disasters, and especially in response to large-scale infectious disease threats (e.g., West Nile virus, severe acute respiratory syndrome, and H1N1 influenza).1 (Am J Public Health. Published online ahead of print January 28, 2021: e1-e5. https://doi.org/10.2105/AJPH.2020.306111).