The COVID-19 pandemic and its impacts on mass shootings in six major US cities.

BACKGROUND: The COVID-19 pandemic has significant impacts on the US socioeconomic structure. Gun violence is a major public health issue and the effects on this area have not been well-elucidated. The objective of this study was to determine the impacts of the pandemic on mass shootings in six major United States cities with historically high rates of gun violence. METHODS: Mass shooting data were extracted from an open-source database, Gun Violence Archive. Mass shooting was defined as four or more people shot at a single event. Data from six cities with the highest incidence of mass shootings were analyzed in 2019 versus 2020 (Baltimore, Chicago, Detroit, New Orleans, Philadelphia, and St. Louis). Geographic data were examined to assess changes in each city's mass shooting geographic distribution over time. Quantitative changes were assessed using the Area Deprivation Index (ADI), and qualitative data were assessed using ArcGIS. RESULTS: In 2020, the overall percentage of mass shootings increased by 46.7% though there was no change in the distribution of these events when assessed quantitatively (no change in average ADI) nor qualitatively (using ArcGIS). In the six cities analyzed, the total proportion of mass shooting events was unchanged during the pandemic (21.8% vs 20.6%, p = 0.64). Chicago, the US city with the highest incidence of mass shootings, did not experience a significant change in 2020 (n = 34/91, 37.3% vs. n = 53/126, 42.1%, p = 0.57). Baltimore had a significant decrease in mass shooting events (n = 18/91, 19.8% vs. 10/126, 7.9%, p = 0.01). The other four cities had no significant change in the number of mass shootings (p>0.05). CONCLUSION: This study is the first to use ArcGIS technology to describe the patterns of mass shooting in six major US cities during the COVID-19 pandemic. The number of mass shootings in six US cities remained largely unchanged which suggests that changes in mass shootings is likely occurring in smaller cities. Future studies should focus on the changing patterns of homicides in at-risk communities and other possible social influences.

Firearm injury-a preventable public health issue.

Firearm-related injury is a leading cause of death disproportionately affecting adolescents and young adults across the world, especially in the Americas. Little progress has been made over the past four decades, as inaction and the adoption of ineffective or unevidenced interventions have become commonplace. The COVID-19 pandemic reconfigured health systems towards prevention and harm reduction, sharpened public attention to the burden of preventable deaths, and inspired a fresh ambition of eliminating avertable deaths. In this Viewpoint, we argue that preventing firearm injury should garner bolder action in post-pandemic public health and we present a case for reducing the global burden of firearm injury supported by evidence and international examples. Crucially, we aim to guide policy making in directions that end the cycle of grief, anger, activism, deflection, and inaction and create more peaceful and fairer societies.

Emergency Department Visits for Firearm Injuries Before and During the COVID-19 Pandemic - United States, January 2019-December 2022.

During the COVID-19 pandemic, the U.S. firearm homicide rate increased by nearly 35%, and the firearm suicide rate remained high during 2019-2020 (1). Provisional mortality data from the National Vital Statistics System indicate that rates continued to increase in 2021: the rates of firearm homicide and firearm suicide in 2021 were the highest recorded since 1993 and 1990, respectively (2). Firearm injuries treated in emergency departments (EDs), the primary setting for the immediate medical treatment of such injuries, gradually increased during 2018-2019 (3); however, more recent patterns of ED visits for firearm injuries, particularly during the COVID-19 pandemic, are unknown. Using data from the National Syndromic Surveillance Program (NSSP),* CDC examined changes in ED visits for initial firearm injury encounters during January 2019-December 2022, by year, patient sex, and age group. Increases in the overall weekly number of firearm injury ED visits were detected at certain periods during the COVID-19 pandemic. One such period during which there was a gradual increase was March 2020, which coincided with both the declaration of COVID-19 as a national emergency† and a pronounced decrease in the total number of ED visits. Another increase in firearm injury ED visits occurred in late May 2020, concurrent with a period marked by public outcry related to social injustice and structural racism (4), changes in state-level COVID-19-specific prevention strategies,§ decreased engagement in COVID-19 mitigation behaviors (5), and reported increases in some types of crime (4). Compared with 2019, the average number of weekly ED visits for firearm injury was 37% higher in 2020, 36% higher in 2021, and 20% higher in 2022. A comprehensive approach is needed to prevent and respond to firearm injuries in communities, including strategies that engage community and street outreach programs, implement hospital-based violence prevention programs, improve community physical environments, enhance secure storage of firearms, and strengthen social and economic supports.

Analyzing Child Firearm Assault Injuries by Race and Ethnicity During the COVID-19 Pandemic in 4 Major US Cities.

This cross-sectional study examines changes in rates and disparities of fatal and nonfatal firearm assaults among children in New York, Los Angeles, Chicago, and Philadelphia before and during the COVID-19 pandemic.

Trends in assault-related hospitalizations during the SARS-CoV-2 pandemic.

INTRODUCTION: Violence remains a priority issue in the United States (US) requiring public health input to discern the magnitude and impact of violence on the health system. Concerns over violence and the injuries resulting from violence have increased following the SARS-CoV-2 pandemic which exacerbated an array of individual and economic stressors related to violence including increased unemployment, alcohol intake, social isolation, anxiety and panic and decreased access to health services. The aim of this study was to analyze the trends in violence-related injuries in the state of Illinois during the SARS-CoV-2 lockdown periods and post-lockdown in order to inform future public health policy. MATERIAL AND METHODS: Outpatient and inpatient assault related injuries treated in Illinois hospitals from 2016 through March 2022 were analyzed. Segmented regression models evaluating change in time trends were adjusted for seasonality, serial correlation, overall trend and economic variables. RESULTS: The annual rate of assault related hospitalizations per one million Illinois residents decreased from 3857.8 pre-pandemic to 3458.7 pandemic period. However, during the pandemic there was an increase in deaths and in the proportion of injuries involving open wounds, internal injuries, and fractures, while there was a reduction in less serious injuries. Segmented regression time series models demonstrated significant increase in firearm violence in all four pandemic periods examined. Firearm violence increased particularly in subgroups including African-American victims, 15-34-year-olds, and Chicago residents. CONCLUSION: During SARS-CoV-2, we saw an overall reduction in assault related hospitalization, however, findings demonstrated an increase in serious injuries which may be associated with social and economic stressors of the pandemic, increased gun-violence while decrease in less serious injuries may be linked to hospital avoidance for non-lethal injuries during the peak waves of the pandemic. Our findings have implications for ongoing surveillance, service planning and management of the increased gunshot and penetrating assault cases and further demonstrate the need for public health input into the violence epidemic in the US.

Surge in Pediatric Firearm Injuries Presenting to US Children's Hospitals During the COVID-19 Pandemic.

This cohort study uses administrative health data to evaluate trends in pediatric firearm injuries before and during the COVID-19 pandemic.

Interpersonal Firearm Injury and Death in Portland, Oregon: 2018 Through 2021.

The annual number of firearm injuries in Portland, Oregon has been higher in the years since 2020 than in any prior year in the city's history. This descriptive study analyzed data from Gun Violence Archives (GVA) from January 1, 2018, to December 31, 2021. All incidents in GVA of interpersonal firearm injury that occurred in Portland during this period were analyzed for location, number of people injured or killed, and demographic information for those injured or killed. Comparisons in firearm injury rates were made with Seattle and San Francisco. Interpersonal firearm injuries began to rise after the first COVID-19 case in Oregon; July 2020 had the most injuries in the four-year period. Black men suffered the highest rate of interpersonal fatalities, with more than 11-fold higher rate per 100,000 than White men in every year studied. Portland had a higher rate of total interpersonal firearm injuries and a higher rate of firearm fatalities from 2018 through 2021 compared to Seattle and San Francisco. Neighborhoods near Downtown and those on the Eastside of the city had the highest rates of interpersonal injuries and deaths from firearms, whereas those in the Southwest had the lowest. Defining the burden of disease from interpersonal firearm injuries is a fundamental step in designing future public health research and implementing interventions to curb the trauma brought by interpersonal firearm injury.

Firearm Violence Surrounding the COVID-19 Pandemic: A Reopening Phenomenon.

INTRODUCTION: Past research has demonstrated a "reopening phenomenon" of increased firearm violence associated with the initial lifting of coronavirus disease 2019 (COVID-19) pandemic-related restrictions after the first wave. Now, with widespread societal reemergence from stay-at-home measures, we hypothesize another spike in firearm violence in the United States (US). Thus, the purpose of this study was to evaluate the trends in firearm violence before and after extensive community reopenings during the COVID-19 pandemic. METHODS: The Gun Violence Archive was utilized to collect data on daily firearm violence incidents, injuries, and deaths as well as on types of firearm violence. Mann-Whitney U-tests were performed for trends and types of firearm violence "before" (12/14/20-4/9/21) versus "after" (4/10/21-7/31/21) widespread societal reopening in the US. Additional analyses also sought to compare the after reopening time-period to historical data (2017-2020) of similar calendar dates, to better control for possible annual/seasonal variation. RESULTS: Median daily firearm violence incidents (153 versus 176, P < 0.001), injuries (89 versus 121, P < 0.001) and deaths (54 versus 58, P < 0.001) increased from before versus after reopening. Compared to all historical years, in the after reopening time-period there were consistent increases in total as well as mass shooting incidents/injuries/deaths (all P < 0.05). CONCLUSIONS: Firearm violence incidents, injuries, and deaths increased after societal reemergence from the COVID-19 pandemic. In addition, there has been an increase in mass shootings despite a relative lull initially brought on by the pandemic. This suggests the "reopening phenomenon" has worsened an already substantial national firearm epidemic.

A Parallel Pandemic: Increased Firearm Injuries at Five Northern California Trauma Centers During the COVID-19 Pandemic: An Interrupted Time-series Analysis.

OBJECTIVE: This study aimed to characterize changes in firearm injuries at 5 level 1 trauma centers in Northern California in the 12 months following the start of the COVID-19 pandemic compared with the preceding 4 years, accounting for regional variations and seasonal trends. SUMMARY AND BACKGROUND DATA: Increased firearm injuries have been reported during the early peaks of the COVID-19 pandemic despite shelter-in-place restrictions. However, these data are overwhelmingly from singlecenter studies, during the initial phase of the pandemic prior to lifting of shelter-in-place restrictions, or do not account for seasonal trends. METHODS: An interrupted time-series analysis (ITSA) of all firearm injuries presenting to 5 adult level 1 trauma centers in Northern California was performed (January 2016to February 2021). ITSA modeled the association of the onset of the COVID-19 pandemic (March 2020) with monthly firearm injuries using the ordinary least-squares method, included month indicators to adjust for seasonality, and specified lags of up to 12 months to account for autocorrelation. RESULTS: Prior to the start of COVID-19, firearm injuries averaged (±SD) of 86 (±16) and were decreasing by 0.5/month (P < 0.01). The start of COVID- 19 (March 2020) was associated with an alarming increase of 39 firearm injuries/month (P < 0.01) followed by an ongoing rise of 3.5/mo (P < 0.01). This resulted in an average of 130 (±26) firearm injuries/month during the COVID-19 period and included 8 of the 10 highest monthly firearm injury rates in the past 5 years. CONCLUSIONS: These data highlight an alarming escalation in firearm injuries in the 12 months following the onset of the COVID-19 pandemic in Northern California. Additional studies and resources are needed to better understand and address this parallel public health crisis.

National evaluation of the association between stay-at-home orders on mechanism of injury and trauma admission volume.

BACKGROUND: The COVID-19 pandemic had numerous negative effects on the US healthcare system. Many states implemented stay-at-home (SAH) orders to slow COVID-19 virus transmission. We measured the association between SAH orders on the injury mechanism type and volume of trauma center admissions during the first wave of the COVID-19 pandemic. METHODS: All trauma patients aged 16 years and older who were treated at the American College of Surgeons Trauma Quality Improvement Program participating centers from January 2018-September 2020. Weekly trauma patient volume, patient demographics, and injury characteristics were compared across the corresponding SAH time periods from each year. Patient volume was modeled using harmonic regression with a random hospital effect. RESULTS: There were 166,773 patients admitted in 2020 after a SAH order and an average of 160,962 patients were treated over the corresponding periods in 2018-2019 in 474 centers. Patients presenting with a pre-existing condition of alcohol misuse increased (13,611 (8.3%) vs. 10,440 (6.6%), p <0.001). Assault injuries increased (19,056 (11.4%) vs. 15,605 (9.8%)) and firearm-related injuries (14,246 (8.5%) vs. 10,316 (6.4%)), p<0.001. Firearm-specific assault injuries increased (10,748 (75.5%) vs. 7,600 (74.0%)) as did firearm-specific unintentional injuries (1,318 (9.3%) vs. 830 (8.1%), p<0.001. In the month preceding the SAH orders, trauma center admissions decreased. Within a week of SAH implementation, hospital admissions increased (p<0.001) until a plateau occurred 10 weeks later above predicted levels. On regional sub-analysis, admission volume remained significantly elevated for the Midwest during weeks 11-25 after SAH order implementation, (p<0.001).

Assessing the effect of COVID-19 stay-at -home orders on firearm injury in Maryland.

This study sought to characterize frequency and demographic characteristics of firearm injury and penetrating trauma in Maryland over the first year of the pandemic, by comparing these characteristics to those of the three years prior to stay-at-home order issuance. Patients were identified in the Maryland Health Services Cost Review Commission database using ICD-10 codes for firearm injury by all intents and assaults by penetrating trauma. Cases from July 1, 2017 to March 31, 2020 ("pre-stay-at-home") were compared to those from April 1, 2020 to March 31, 2021 ("post-stay-at-home") using descriptive statistics. There was no significant change overall in frequency or demographics of firearm injury or penetrating trauma in the year after stay-at-home orders were issued. Youth between ages 15 and 24, overwhelmingly male, comprise a disproportionately high percentage of firearm injuries and assaults, and most penetrating trauma occurs in urban environments where Black non-Hispanic youth and children of low socioeconomic status are at high risk. Our study also found unintentional firearm injury among adults was significantly increased during the pandemic. While increased unintentional firearm injury among adults was the major significant change found in our study, the persistence of firearm injury, particularly in youth, racial and ethnic minority groups, and those in urban environments, should be deeply concerning. Stay-at-home policies did not keep youth safer from firearm injury. With continued high rates of firearm injury and the national debate over how to prevent these incidents, increased education and comprehensive strategies for prevention are needed.

A Closer Look at the Rising Epidemic of Mass Shootings in the United States and Its Association With Gun Legislation, Laws, and Sales.

INTRODUCTION: Mass shootings pose a considerable threat to public safety and significantly cost the United States in terms of lives and expenses. The following are the specific aims of this study: (1) to assess US mass shootings, firearm-related sales, laws, and regional differences from 2015 to 2021 and (2) to investigate changes in mass shootings and firearm sales before and during the Coronavirus Disease 2019 pandemic. METHODS: A retrospective review was conducted of mass shootings, gun sales, and laws regarding the minimum age required to purchase a firearm within the United States from 2015 to 2021. The 10 states/regions with the greatest mean mass shootings/capita from 2015 to 2021 were selected for further analysis. RESULTS: Mass shootings correlated significantly with firearm sales from 2015 to 2021 nationwide (P < 0.02 for all). The growth in mass shootings, the number killed/injured, and gun sales were greater in 2020 and 2021 compared to the years prior. The 10 states with the highest mean mass shooting/capita over the study period were Alabama, Arkansas, the District of Columbia, Illinois, Louisiana, Maryland, Mississippi, Missouri, South Carolina, and Tennessee. No significant correlation was found between the number of mass shootings/capita and the minimum age to purchase a firearm. CONCLUSIONS: Firearm sales correlated significantly with mass shootings from 2015 to 2021. Mass shootings and gun sales increased at greater rates during the Coronavirus Disease 2019 pandemic compared to the years before the pandemic. Mass shootings exhibited inconsistent trends with state gun laws regarding the minimum age to purchase a firearm. Future studies may consider investigating the methods by which firearms used in mass shootings are obtained to further identify targets for prevention.

A new pandemic and an old epidemic: The impact of COVID-19 and gun violence as measured by years of potential life lost in a US city.

BACKGROUND: The COVID-19 pandemic has altered daily life on a global scale and has resulted in significant mortality with >985,000 lives lost in the United States alone. Superimposed on the COVID-19 pandemic has been a concurrent worsening of longstanding urban gun violence. We sought to evaluate the impact attributable to these 2 major public health issues on the greater Louisville region as determined by years of potential life lost. METHODS: Using the Collaborative Jefferson County Firearm Injury Database, all firearm injuries from January 1, 2011 to December 31, 2021 were examined. The COVID-19 data was compiled from the Louisville Metro Department of Public Health and Wellness. Pre-COVID (March 1, 2019-February 29, 2020) and COVID (March 1, 2020-February 28, 2021) time intervals were examined. The demographics, outcomes data, and years of potential life lost were determined for the groups, and injury locations were geocoded. RESULTS: From 2011 to 2021, there were 6,043 firearm injuries in Jefferson County, Kentucky. During the COVID time interval, there were 4,574 years of potential life lost due to the SARS-CoV-2 virus and 9,722 years of potential life lost due to all-cause gun violence. In the pre-COVID time interval, there were 5,723 years of potential life lost due to all-cause gun violence. CONCLUSION: In Louisville, greater years of potential life lost were attributable to firearm fatalities than the SARS-CoV-2 virus. Given the impact of COVID-19, the robust response has been proportionate and appropriate. The lack of response to firearm injury and fatality is striking in comparison. Additional resources to combat the sequelae of gun violence are needed.

The Effects of the COVID-19 Pandemic on Penetrating Neurotrauma at a Level 1 Trauma Center.

BACKGROUND/OBJECTIVE: The COVID-19 pandemic has had a profound impact on the global delivery of health care. Recent data suggest a possible impact of the pandemic on patterns of neurotrauma. The aim was to assess the impact of the pandemic on the incidence of neurotrauma, with a focus on cranial gunshot wounds (cGSWs) at a large Midwestern level 1 trauma center. METHODS: We conducted a retrospective review of our trauma registry from March through September 2020 and compared it to the same months in 2019. Odds ratios were utilized to assess for differences in patient demographics, injury characteristics, rates of neurotrauma, and rates of cGSWs. RESULTS: A total of 1188 patients presented with neurotrauma, 558 in 2019 and 630 in 2020. The majority of patients were male (71.33% in 2019; 68.57% in 2020) and Caucasian (78.67% in 2019; 75.4% in 2020). Patients presented with cGSWs more frequently in 2020 (n = 49, 7.78%) than in 2019 (n = 25, 4.48%). The odds of suffering a cGSW in 2020 was 73.6% higher than those in 2019 (95% confidence interval = [1.0871, 2.7722]; P = 0.0209). The etiology of such injury was most commonly assault (n = 16, 21.62% in 2019; n = 34, 45.95% in 2020), followed by self-inflicted injury (n = 4, 5.41% in 2019; 12, 16.22% in 2020). CONCLUSIONS: Despite the government-mandated shutdown, we observed an increase in the number of neurotrauma cases in 2020. There was a significant increase in the incidence cGSWs in 2020, with an increase in assaults and self-inflicted injuries. Further investigation into socioeconomic factors for the observed increase in cGSWs is warranted.

Trends in Geriatric Trauma Emergency Department Admissions During COVID-19.

BACKGROUND: The impact of coronavirus disease-2019 (COVID-19) on geriatric trauma presenting to the emergency department is unknown. OBJECTIVE: To examine geriatric trauma emergency department admission trends during the COVID-19 pandemic. METHODS: This retrospective, observational, comparison study was conducted in an academic emergency department in Turkey. Trauma patients 65 years and older who presented to the emergency department within 1 year of March 12, 2020, were included. Patients admitted in the same date range in the previous year were included as the control group. The characteristics of the patients, injured area, and injury mechanisms were compared. RESULTS: Geriatric trauma admissions decreased (relative risk = 0.71, odds ratio [OR] = 0.69 [95% confidence interval, CI: 0.62, 0.77], p < .001). According to the type of injury, there was no significant difference in admissions to the emergency department (p = .318). During the pandemic, there was an increase in falls and a decrease in stab wounds and gunshot wounds (p = .001). Multiple trauma (OR = 5.56 [95% CI: 3.75, 8.23], p < .001), fall (OR = 2.41 [95% CI: 1.6, 3.73], p < .001), and-assault related injuries (OR = 4.43 [95% CI: 2.06, 9.56], p < .001) were determined as factors that increased the admissions to the emergency department compared with the prepandemic. CONCLUSION: Although geriatric trauma emergency department admissions decreased during the pandemic, those due to falls and assaults increased. Although curfews and social isolation resulted in a decrease in penetrating injuries, assault-related trauma has increased.