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Despite a range of federal and state interventions to slow the spread of COVID-19, the US has seen millions of infections and hundreds of thousands of deaths. Top-down mandates have been ineffective because the community spread of the pandemic has been influenced by complex local dynamics that have evolved over time. Systems thinking approaches, specifically causal loop diagrams, and leverage points, are important techniques for representing complexity at the local level and identifying responsive systems change opportunities. This commentary presents a causal loop diagram highlighting the progressive effects of prolonged state-level COVID-19 mandates at the community level. We also identify potential system leverage points that address these effects and present an imagined future state causal loop diagram in which these solutions are implemented. Our future system demonstrates the importance of collaborations to enable community-driven, bottom-up approaches to public health crises, such as the COVID-19 pandemic, that are adaptive and responsive to local needs.

Developing Complexity-Informed COVID-19 Responses to Optimize Community Well-Being: A Systems Thinking Approach