There has been increasing interest in the role of multilevel governance during the COVID-19 pandemic, and its impact on democracy and effective pandemic management. While the latter is hard to assess due to a variety of other factors, the former is discussed in this chapter. How did multilevel governance affect decision-making and implementation during the COVID-19 pandemic in a variety of European countries? What key issues affected the performance of different countries, and which lessons can be learned from this? The chapter addresses these questions in the framework of emergency constitutionalism, first assessing how national and regional actors used emergency provisions to address the pandemic, and subsequently implemented major mitigating measures. It concludes with a discussion of important insights from a variety of angles: the importance of intergovernmental relations, the recognized significance of trust in decision-making and decision-makers, and the need to revise and adjust both constitutional and pandemic frameworks for future health crises to come.