The Philippine national government’s largely ineffective response to the COVID-19 pandemic sets the context for a diversity of policy adaptations at the local level. This article focuses on the two largest metropolitan areas in the Visayan Islands, Cebu City and Iloilo City. The Cebu City government, with strong personal ties to President Rodrigo Duterte, acquiesced to the national government’s takeover with uniformed personnel deployed for enforcement. The Iloilo City government, lacking such ties, pushed back and pursued innovative strategies including frequent use of appeals against national government quarantine classifications. The cases depict constricted decision-making space for local governments to balance public health safety and economic reopening. This is especially problematic given the deficiencies in the central government’s pandemic response.