Experiences of COVID-19 infection in North Carolina: A qualitative analysis.


Background and aim

It has been demonstrated that marginalized populations across the U.S. have suffered a disproportionate burden of the coronavirus disease 2019 (COVID-19) pandemic, illustrating the role that social determinants of health play in health outcomes. To better understand how these vulnerable and high-risk populations have experienced the pandemic, we conducted a qualitative study to better understand their experiences from diagnosis through recovery.


We conducted a qualitative study of patients in a North Carolina healthcare system's registry who tested positive for COVID-19 from March 2020 through February 2021, identified from population-dense outbreaks of COVID-19 (hotspots). We conducted semi-structured phone interviews in English or Spanish, based on patient preference, with trained bilingual study personnel. Each interview was evaluated using a combination of deductive and inductive content analysis to determine prevalent themes related to COVID-19 knowledge, diagnosis, disease experience, and long-term impacts.


The 10 patients interviewed from our COVID-19 hotspot clusters were of equal distribution by sex, predominantly Black (70%), aged 22-70 years (IQR 45-62 years), and more frequently publicly insured (50% Medicaid/Medicare, vs 30% uninsured, vs 20% private insurance). Major themes identified included prior knowledge of COVID-19 and patient perceptions of their personal risk, the testing process in numerous settings, the process of quarantining at home after a positive diagnosis, the experience of receiving medical care during their illness, and difficulties with long-term recovery.


Our findings suggest areas for targeted interventions to reduce COVID-19 transmission in these high-risk communities, as well as improve the patient experience throughout the COVID-19 illness course.





Published Version (Please cite this version)


Publication Info

Seidenfeld, Justine, Anna Tupetz, Cassandra Fiorino, Alexander Limkakeng, Lincoln Silva, Catherine Staton, Joao RN Vissoci, John Purakal, et al. (2022). Experiences of COVID-19 infection in North Carolina: A qualitative analysis. PloS one, 17(6). p. e0269338. 10.1371/journal.pone.0269338 Retrieved from https://hdl.handle.net/10161/25538.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.



Anna Tupetz

Assistant Professor in Emergency Medicine

Alexander Tan Limkakeng

Professor of Emergency Medicine

Dr. Alexander T. Limkakeng, Jr., MD, MHSc, FACEP is a Professor of Emergency Medicine, Vice Chair of Clinical Research, Director of the Acute Care Research Team, and Director of the Resident Research Fellowship for the Department of Emergency Medicine in the Duke University School of Medicine in Durham, North Carolina.

Dr. Limkakeng has served as chair of the American College of Emergency Physicians (ACEP) Research Committee, and been the Course Director of the ACEP Research Forum from 2016-2018, the largest emergency medical research platform in the nation. He is also the Assistant Director of ACEP’s Emergency Medicine Basic Research Skills course. He was elected to the Nominating Committee of the Society of Academic Emergency Medicine.

As a researcher, Dr. Limkakeng has led multiple clinical trials and interdepartmental sponsored projects and is author on over 100 peer-reviewed manuscripts. These include studies in emergency conditions such as COVID-19, traumatic brain injury, hypertension, heart failure, thrombosis, stroke, envenomations, and septic shock. His research has been funded by grants and contracts totaling over $9 million dollars. He has lectured internationally on acute coronary syndrome, responsible conduct of research, design of clinical trials, and precision medicine in emergency care. He has led Duke’s involvement in NIH-funded research networks and in industry-funded work that led to FDA approval for multiple high-sensitivity cardiac troponin assays and point-of-care COVID-19 diagnostic tests. He has servesd as Co-PI for the Duke U24 Hub in the NIH Early Phase Pain Investigation Clinical Network (EPPIC-Net) (1U24NS114416) and now serves as a co-PI on the Duke U24 Hub award (1U24NS129498) in the NIH Strategies to Innovate Emergency Care Clinical Trials (SIREN) Network and in the NIH NINDS Strokenet network (1U24NS135250)

His personal research interest is finding new ways to diagnose acute coronary syndrome. In particular, he is interested in novel biomarkers and precision medicine approaches to this problem. The common element throughout this work is a focus on time-sensitive health conditions.

Catherine Ann Staton

Associate Professor of Emergency Medicine

Catherine Staton MD MSc

Dr. Staton is an Associate Professor in Emergency Medicine (EM), Neurosurgery & Global Health with tenure at Duke University. She is the Director of the GEMINI (Global EM Innovation & Implementation) Research Center and the EM Vice Chair of Research Strategy & Faculty Development. Her research integrates innovative implementation methods into health systems globally to improve access to acute care. In 2012, with an injury registry at Kilimanjaro Christian Medical Center, Tanzania Dr. Staton demonstrated 30% of injury patients had at risk alcohol use, providing preliminary data for a K01/Career Development Award. Her K01 award adapted a brief alcohol intervention to the KCMC ED and Swahili and is now being trialed in an NIAAA funded R01 pragmatic adaptive clinical trial. Dr. Staton and her mentor and collaborator Dr. Mmbaga are co-PD of the “The TReCK Program: Trauma Research Capacity Building in Kilimanjaro” to train 12 masters and doctoral learners to conduct innovative implementation and data science projects to improve care for injury patients. Currently, Dr. Staton and GEMINI partners with over a dozen faculty from over 6 low- and middle-income countries to conduct research, has mentored over 150 learners from undergraduate to post-doctoral levels from high, middle and low- income settings and has over 130 manuscripts.


John David Purakal

Assistant Professor of Emergency Medicine

John David Purakal, MD, MS, is an Assistant Professor in the Department of Emergency Medicine at Duke University School of Medicine. He holds appointments with the Duke-Margolis Center on Health Policy and Samuel Dubois Cook Center for Social Equity. Dr. Purakal's educational roles include serving as the Emergency Medicine Clerkship Director for the Duke University School of Medicine Outpatient Integrated Longitudinal Experience (PIONEER), and Core Faculty within the Department of Emergency Medicine Residency Program. Dr. Purakal has been an invited speaker locally, nationally, and internationally on topics related to health equity, racial disparities in care, and cardiovascular disease. His medical career started as a student at the Wayne State University School of Medicine, where he created a public health education initiative to provide multidisciplinary health education to at-risk populations around the city of Detroit. This work led to his receipt of the Arthur Johnson Leadership Award, Ralph Wadley, MD Scholarship, and the Crain's Detroit Business "Twenty in their 20's" Award. Dr. Purakal completed his emergency medicine residency at The University of Illinois - Chicago, and served as chief resident in his final year. He then started his academic career at The University of Chicago as an Assistant Professor in the Section of Emergency Medicine. 

Since joining Duke University School of Medicine, Dr. Purakal has worked to address unmet social needs in the emergency department patient population through development of a social needs screening program utilizing student volunteers and cross-sectoral collaborations with platforms such as NCCare360. He created the Health Equity Curriculum for the Emergency Medicine Residency Program, and serves multiple teaching roles within the School of Medicine. Additionally, he advises multiple Duke University student organizations that address health inequities in the Durham community. He has been awarded multiple departmental awards for this teaching and leadership, and was the recipient of the 2022 American College of Emergency Physicians (ACEP) National Junior Faculty Teaching Award, the 2023 Duke University Presidential Award, the 2023 Triangle Business Journal "40 in their 40's" Leadership Award, and was invited to the White House to discuss his work with other leaders in health equity from around the country.

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