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Crises illuminate variations in government policy innovation, responsiveness, and capacity. In the face of a public health crisis, subnational governments are particularly important in addressing local challenges and can act quickly to respond while the central government faces more logistical and political constraints. Still, provincial governments in China vary widely in their choices of policy, communication strategy, and ability to respond. In the context of the COVID-19 crisis, what explains the variation in provincial policy content and timing? We argue that the local context is critical for understanding variation in policy adoptions. To test why some province were more proactive and adopted policies earlier than others, we collected data on the adoption of eighteen policies used to contain COVID-19 in all 33 provinces in China from December 30th, 2019 to March 18th, 2020. We use event history analyses to predict the probability of adopting each policy. Our results demonstrate that policies adopted during public health crises are often the result of local characteristics and local politics rather than top-down leadership. More specifically, we find that the severity of the regional outbreak and the leadership experience of top provincial officials are the most reliable predictors of policy adoption. The findings help explain variation in government responsiveness to health crises and highlight the critical role of local officials in crisis response, even in a largely top-down system.