Objective <p>Our study investigates the efforts of local medical health officers during COVID-19 in Canada, with a focus on explicating enabling factors and barriers to effectively respond through local public health efforts.</p> Methods <p>We conducted 26 semi-structured interviews with local-level public health leadership from across Canada and analyzed the transcripts for salient facilitators and barriers to effective local public health practice using the Consolidated Framework for Implementation Research.</p> Results <p>Effective local-level public health practice was facilitated by efforts that potentiated synergistic efforts inside and outside of the public health sector, including trust, buy-in, and ample resources. Barriers to effective practice involved uncertainty associated with governance, human resources, and the complexity of the pandemic itself.</p> Conclusion <p>Sustained coordinated efforts across organizations together with clear governance mandates are required for robust local emergency management.</p>