Rise in gun violence during pandemic adds pressure to overburdened hospitals
At the start of the pandemic, as hospitals filled to capacity and patients overflowed into the hallways, emergency rooms in particular were seeing fewer patients than usual.
Car crashes declined in 2020 as lockdown measures kept many home and off the road, and the threat of Covid-19 infection likely prevented many from seeking non-emergency care.
But gun violence has persisted despite the Covid-19 prevention measures in place, and the outbreak of violence has had a direct effect on the country’s health system.
While Covid-19 hospitalizations have recently fallen to the lowest point on record, the stress on hospitals remains – and some experts say tackling gun violence should be a top priority to help ease the strain.
Emergency rooms saw more victims of gun violence
Overall, ER visits fell 26%, but visits for firearm injuries jumped 34%, according to data shared with CNN by the US Department of Health and Human Services.
The HHS Agency for Healthcare Research and Quality analyzed preliminary data from 29 states between April and December 2020 and compared it to data from the same period a year earlier.
“The thing that I think could be addressed in a shorter term and would be extremely helpful is addressing violence in our communities as we are seeing more trauma entering our emergency rooms now in many places. across the country,” said Nancy Foster, vice president of quality and patient safety policy at the American Hospital Association.
There was uncertainty then, with questions about how to handle an unprecedented surge in patients and how the situation would affect trends in gun violence, said Kaufman, a trauma surgeon at the University of Pennsylvania in Philadelphia.
Preventable injuries drain healthcare resources
Two years on, much of the uncertainty is resolved: hospitals have a better understanding of how to deal with waves of Covid-19 patients, and it’s clear that gun violence has increased. But the general sentiment holds.
“Injuries in general are preventable. Essentially, every patient I treat should never have needed us,” Kaufman said. “But it never seemed more extreme than in this time when resources seemed scarce and even more valuable than usual.”
Gunshot wounds are far from the most common reason for a hospital visit. They accounted for about one in 800 ER visits in 2020, according to a CNN analysis of HHS data, nearly double the share from the previous year, as trends in overall ER visits and those specifically for gun violence have diverged.
Covid-19 patients, by comparison, accounted for 1 in 7 emergency room visits at the height of Omicron’s surge and still account for around 1 in 100 visits.
But people who present to emergency rooms with gunshot wounds are often in critical condition, requiring immediate attention and additional resources for their care.
Like people who have had a heart attack or stroke, victims of gun violence are usually “triaged to the highest priority so they can be seen immediately”, said Dr. Greg Martin, professor of Medicine at Emory University and past president of the Society of Critical Care Medicine.
“So they will often override the care of other patients. They skip the line of those other patients to try to do that.”
People taken to the emergency room with a gunshot wound are twice as likely to be admitted to hospital as the average, with around 1 in 4 requiring intensive care. People injured by firearms are also more likely to be readmitted within 90 days than those injured in a car accident.
“The intensity and immediacy of this [gunshot] The visit is different from other emergency visits and puts different kinds of pressure,” Kaufman said. This calls into question a system that has been sorely understaffed for years.
“All of a sudden you went from one nurse for a few patients to maybe three nurses to help care for that patient.”
Kaufman is careful to say that no patient should have to experience the trauma of gun violence, and no one should be in the spotlight more than another. But with the students, she often thinks of a recent patient who had six vital organs damaged after being hit by a stray bullet at her birthday party.
“She ended up having the most invasive potential surgery she could have. We had to open her abdomen, we had to open her chest and fix all these things. And we did, and she got away with it. came out well,” Kaufman said. “But that’s one of the completely unnecessary and completely extreme things. And if we hadn’t put all those things in place to care for a patient like that at all times, she wouldn’t be here with us.”
Tackling gun violence will relieve tension, but takes time
The solutions may seem obvious, but there is no immediate solution to gun violence, experts say.
“We think gun violence is something that could be solved relatively simply if we didn’t have guns, which is conceptually wonderful but obviously not that easy to achieve,” Martin said.
But violence is as much a social and behavioral issue as it is an access issue, he said.
“Unsurprisingly, these are the same fundamental issues that explain why people have heart attacks and strokes. Much of the healthcare needs around the world – but certainly in the developed world in the United States – are much more behavioral than anything else.”
But even one less person filling one less hospital bed could make all the difference.
“The capacity is very close to the margin most of the time. So even the places where we can make small improvements can really make a big difference overall,” Kaufman said.