The Violence Epidemic: Firearm Injuries Increased 51% During the COVID-19 Pandemic

Elizabeth C Pino, PhD

Rates of violence soared during the first year of the COVID-19 pandemic as public health measures implemented to contain the virus disrupted the structure of daily life, according to a new study.

A team of investigators, led by Elizabeth Pino, PhD, of the Boston Violence Advocacy Program (VIAP), and Department of Emergency Medicine at Boston Medical Center, examined the trends in violent penetrating injuries throughout the first year of the pandemic and comapred them with previous years.

"Our data show that pandemic firearm injuries were disproportionately among Black men, and that Hispanic men compromised a larger share of patients presenting with gunshot wounds than they had prepandemic," investigators wrote.

Observing the 5 years prior to the COVID-19 pandemic, they discovered an association between the strategies implemented to inhibit the spread of the virus and an increase in gun violence.

The First Year of COVID-19

In March 2020, when the severity of SARS-CoV-2 outbreaks became apparent in the US, unprecedented public health measures were put into action in response to the transmissibility of the virus.

Remote learning and virtual meetings took the place of in person attendance in schools and many workplaces, with some nonessential industries pausing operations indefinitely.

Some states, like Massachusetts, issued stay-at-hime advisories that halted all nonessential business and urged individuals to go out only for essential activities. While this helped curb the spread of COVID-19, investigators believed it may have contributed to an increase in violence.

Violent intentional injuries that resulted in trauma admissions began occurring at extremely high rates. According to police department data, serious violence significantly increased since the onset of the pandemic.

However, the exact explanation for the rise in violence wasn't clear. Aside from the stay-at-home orders, there were other aspects, such as the role of firearms, and the social unrest that was instigated by the murder of George Floyd by the Minneapolis police, that have to be factored in for a comprehensive examination, Pino and colleagues wrote.

Investigators emphasized the necessity of understanding the nature of the violence during COVID-19 in order to respond effectively and adapt preventative methods to the possible shifting trends of violent injury.

Examining All The Factors

This study examined changes in presentation for violent penetrating injuries at the emergency department (ED) of an urban, level 1 trauma center and safety-net hospital in Boston, Massachusetts, throughout the first year of the COVID-19 pandemic.

The objectives included the assessment of the following factors:

1. The magnitude of the increase in firearm injuries, compared with previous years and compared with changes in other violent penetrating injuries
2. The timing of the increase in firearm violence and it's association with daily activity patterns, given the stay-at-home orders and racial protests
3. The demographic and socioeconomic characteristics of patients presenting with firearm injury during the pandemic.

It's clear that the burden of additional violence disproportionately affected communities of color, such as Black and Hispanic communities, investigators noted. What's unclear, though, is how these disparities were associated with racial and economic marginalization, changes to daily activities, and other factors.

Existing literature mainly focused on patterns of violence only in the initial months of the pandemic and disproportionately documented patterns from the city of Philadelphia.

Therefore, investigators performed a retrospective cross-sectional study using electronic health record data from a cohort of patients presenting to the Boston Medical Center (BMC) emergency department for violent penetrating injury, in hopes of gaining a more comprehensive understanding of the nature of the violence.

The dataset consisted of all penetrating injuries severe enough to be treated in the emergency department from 2015-2021. This differs from police department data that only captured critical injuries requiring a response from law enforcement.

Assessing the Escalation in Violence

Of the 2383 patients who presented with a violent penetrating injury, 85.4% were men and 14.6% were women with a median age of 29.5 years. In terms of racial representation, 65.7% of patients were Black, 18.8% were Hispanic, and 8.8% were White.

In the first year of the pandemic (March 2020-February 2021), there were 441 patients with penetrating injuries. This displayed an increase when compared with the mean of the previous 5 years, which was 388 patients per year.

The increase was due to a rise in gunshot wounds during the pandemic and showed no change regarding the frequency of stab wounds.

The pandemic year saw a 32% increase in firearm injuries from the previous 5 years. When looking at the difference from the year beginning in March of 2019, firearm injuries increased 51%.

The time of day that the incidence of injury occurred aligned with pre-pandemic patterns—though there was an increase during weekdays. Pandemic patients that presented with these injuries were less likely to have presented with them before as oppposed to patients prepandemic, and they were more likely to be unemployed at the time of injury.

"The increase in violence began at the peak of the first wave of COVID-19 hospitalizations and before the state’s stay-at-home advisory was lifted but well before large-scale protests for racial justice in the aftermath of the George Floyd killing," investigators wrote. "We also found that violence during the pandemic was more likely to involve firearms than prepandemic violence."