At the end of January, the North Carolina Department of Health and Human Services released the COVID-19 Response Interim Review: January 2020 through December 2021. For this review, independent consultants interviewed over 65 state and local officials involved in North Carolina’s pandemic response, in order to “reflect on and encapsulate some of the emerging lessons learned from the first 20 months of the pandemic in North Carolina.” The goal is to help NCDHHS “learn, identify opportunities for improvement, and begin the forward-looking work of strengthening our state’s capacity to respond to future public health emergencies more swiftly and effectively.”

The interim review compiled lessons and experiences from stakeholders and identified strengths and challenges in response across the following areas: progress to date in the fight against COVID-19; meeting critical individual needs; maintaining health system capacity; vaccination and treatment; building trust during crisis and change; and collaboration in a decentralized model.

Interviewees discussed their experiences working with and within NCDHHS and identified several lessons from the COVID-19 response. Those lessons included:

• Communications in a time of crisis requires transparency and managing of expectations.
• That said, it is extremely challenging to build trust in government and public health during a

time of crisis. Trust must be earned through intentional relationships, consistency, resources,

and time.

• Centralized public health decision-making and authority is necessary and must come with

accountability.

• Always be in a learning mode. State agencies need to be flexible, willing to hear and accept

criticism, and pivot as the pandemic changes.

• Think about data first.
• Effective response to a pandemic requires simple, clear, easy to understand messaging that

influences behavior change.

• Advancing health equity requires consistent effort and prioritization.
• A modern governmental health and human services agency must evolve its core

competencies.

• Whole person care matters.
• NCDHHS agency coordination and collaboration to support long-term care facilities needs to

be strengthened.

• Politicization, misinformation, and social media will continue to play a large role in the public

discourse related to COVID-19 and future public health emergencies.

• Be prepared for a marathon.

With a similar eye toward learning from the pandemic response, the North Carolina Institute of Medicine, in partnership with the South Carolina Institute of Medicine and Public Health and with support from the Duke Endowment and NCDHHS, has been convening the Carolinas Pandemic Preparedness Task Force. Starting in July 2021, this two-state task force has been examining lessons from the first year of the COVID-19 pandemic for health care, education, and social and economic stability, with a specific lens on equity in the impact of and response to the pandemic. The task force will continue meeting through April 2022, with a final report to be published in June. The Carolinas Pandemic Preparedness Task Force has identified many similar emerging themes to those listed in the NCDHHS COVID-19 Response Interim Review. These themes include:

• the importance of robust and effective collaborations across sectors;
• the need for timely and accurate data to drive state and local decision-making and to inform the public;
• increased investment in workforce infrastructure, retention, and mental health supports;
• a focus on culturally competent communication that helps address mistrust and misinformation;
• and the importance of prioritizing equity in both response and in understanding the social and cultural context driving the pandemic’s impact.

The NCIOM Task Force on the Future of Local Public Health also aims to address infrastructure needs, funding supports, and lessons from the pandemic for North Carolina’s local public health departments. This task force aims to develop a vision for the future of local public health in the state focused on principles of health equity, leadership, connection between clinical services and population health, opportunities for targeted investments, public communication about the value of public health, and data integration to drive improvements in service delivery and outcomes. Convened in August 2021 in partnership with Kate B. Reynolds Charitable Trust, this task force will issue full recommendations in May 2022, themes of which include:

• maximizing and understanding the role(s) of local public health;
• addressing challenges within local public health workforce retention and development;
• identifying strategies for enhancing data development and data infrastructure;
• identifying sustainable funding strategies at the federal, state, and local levels, as well as philanthropic partners;
• enhancing local partnerships and trust within communities;
• improving communications capacity and identifying key partners for robust communications strategies