Assessing an Innovative Community-based Response to COVID-19 in Rural North Carolina (2020-2021)


In Pamlico County, residents are particularly vulnerable to COVID-19. In addition to the frequent exposure to environmental disasters, approximately 30% of the 12,000 residents are 65 years old or older, almost 15% live in poverty and a high proportion of residents currently live with chronic illnesses, including diabetes mellitus, obesity, heart disease and mental health conditions.

Prior to the onset of the COVID-19 pandemic, Duke faculty investigated community-based approaches to hurricane relief, chronic diseases and mental health in Pamlico County. The ensuing COVID-19 crisis required a redirection to focus on pandemic response. In April 2020, the COVID-19 Community Task Force was launched to assist the Health Department and to engage the community in mitigating the spread of COVID-19.

Project Description

This project team will seek to improve health outcomes in an underserved rural community by integrating reverse innovation and public-private community partnerships to develop a community-based response network and health engagement system. Team members aim to strengthen and empower individuals and a network of community organizations to become accountable for their personal and collective health and to catalyze partnerships to effectively respond to disasters.

The COVID-19 Community Task Force (CCTF) is a multisectoral model for a community-wide gathering of providers, partners and community members to address priority health issues related to the pandemic. 

The CCTF involves four main streams of work:

  1. The Community Response Network (CRN) of over 120 community organizations
  2. “Masketeers” tasked with creating and distributing masks to vulnerable residents
  3. A medical surge capacity team tasked to develop a reserve medical corps to assist the County Health Department with contact tracing, educating community organizations about virus transmission and minimizing the risk of infection
  4. A communications and editorial team to disseminate evidence-based pandemic health information

Team members will address three main goals:

  1. Internal evaluation of the CCTF: The team will create survey tools, interview primary stakeholders and capture implementation metrics to understand current perceptions of the model.
  2. Refine the CCTF model: Team members will address the sustainable elements of CCTF and consider how the Community Response Network platform can be adapted for an integrated disaster response beyond the pandemic.
  3. Create a community-based service and engagement model: The team will incorporate digital and reverse innovation to focus on chronic conditions. The final event of the project will be a community discussion about the CCTF model, potential partners, sources of funding and a potential operational plan.

To advance the design and adaptation of the integrated model, team members will conduct a literature review to determine how reverse innovation can be introduced and used in the next iteration of the CCTF model. They will interview innovators from Duke’s Global Health Innovation Center, especially those involved in frugal or reverse innovation during the pandemic. Students will also interview an array of organizations to develop a transition plan, so that appropriate organization(s) can assume responsibility for key elements of the platform.

Analysis of the model will be used to adapt or merge the COVID-19 and hurricane platforms and to operationalize a more integrated and sustainable approach. After the hurricane season is over, the project team will investigate the experience of the merged or integrated response and, using all information gathered to date, hold a county meeting with key stakeholders to agree upon a longer-term sustainability plan.

Anticipated Outputs

Participant reports of COVID-19 Community Task Force and Community Response Network; formal assessment of platforms; publication; presentation; participant blog


Fall 2020 – Summer 2021

  • Fall 2020: Begin team meetings; complete training on historical context and population health; learn the CCTF model; conduct literature review; develop final assessment plan; start implementation; analyze CCTF and CRN platforms; draft plan to merge platforms; develop sustainability platform
  • Spring 2021: Convene county meeting with key stakeholders; draft community engagement model; draft application model of platforms in Pamlico County
  • Summer 2021 (optional): Convene second county meeting; submit manuscript

This Team in the News

Two Graduate Students Honored for Their Outstanding Mentorship


Image: Pamlico County Line, by J. Stephen Conn, licensed under CC BY-NC 2.0

Pamlico County Line sign.

Team Leaders

  • Sumedha Ariely, Duke Global Health Institute
  • Diana Silimperi, Duke Global Health Institute

/graduate Team Members

  • Anna Bartz, Masters of Public Policy
  • Nathan Ellermeier, Global Health - MSc
  • Arianna Fischer, Masters of Public Policy
  • Lucas Stewart, Masters of Public Policy

/undergraduate Team Members

  • Maggie Chang
  • Sayle Evarts, Public Policy Studies (AB)
  • Nikhita Gopisetty
  • Advika Kumar
  • Ryan Sellers, Biology (BS)
  • Shawin Vitsupakorn

/yfaculty/staff Team Members

  • Krishnakumar Udayakumar, Duke Global Health Institute

/zcommunity Team Members

  • Yolanda Christiani , Hope Clinic
  • Scott Lenart, Pamlico County Health Department
  • Rachel Nugent, Center for Global Noncommunicable Diseases