Early in the pandemic, as hospitals filled to capacity and patients overflowed into hallways, emergency rooms in particular were seeing fewer patients than usual.
Car crashes dropped off in 2020 as lockdown measures kept many at home and off the road, and the threat of Covid-19 infection probably kept many from seeking non-urgent care.
But gun violence persisted despite the Covid-19 prevention measures in place, and the spike in violence translated to a direct effect on the nation’s health care system.
While Covid-19 hospitalizations have recently dropped to the lowest point on record, stress on hospitals remains — and some experts say that addressing gun violence should be a top priority to help ease the strain.
Emergency rooms saw more gun violence victims
Overall emergency department visits dropped 26%, but visits for firearm injury 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 for 29 states between April and December 2020 and compared it to data from the same period a year earlier.
“The thing that I think might be addressed on a shorter-term basis and would be extraordinarily helpful is addressing the violence in our communities, because we’re seeing more trauma come into our emergency rooms now in many places across the country,” said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association.
There was uncertainty then, with questions about how to manage an unprecedented surge in patients and how the situation would affect trends in gun violence, said Kaufman, a trauma surgeon with the University of Pennsylvania in Philadelphia.
Preventable injuries drain health care resources
Two years later, much of the uncertainty is resolved: Hospitals better understand how to cope with the waves of Covid-19 patients, and it’s clear that gun violence increased. But the general sentiment holds.
“Injury in general is preventable. Essentially, every patient that I treat should never have needed us,” Kaufman said. “But it never seemed more extreme than at that time when resources seemed scarce and even more precious than usual.”
Gun injuries are far from the most common reason for a hospital visit. They represented about one in every 800 emergency room visits in 2020, according to a CNN analysis of HHS data, nearly twice the share from the year before as trends in overall emergency room visits and those specifically for gun violence diverged.
Covid-19 patients, by comparison, represented 1 in every 7 emergency department visits at the peak of the Omicron surge and still account for about 1 in every 100 visits.
But people who come into the emergency room with gun injuries are often in critical condition, requiring immediate attention and extra resources for their care.
Like people with a heart attack or stroke, gun violence victims are usually “triaged to the highest level of priority so that 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 trump the care of other patients. They jump the line of those other patients to try and do that.”
People taken to the emergency room with a gunshot injury are twice as likely to be admitted to the hospital than average, with about 1 in 4 requiring ICU care. People with a gunshot injury are also more likely to be readmitted within 90 days than those injured in a car crash.
“The intensity and immediacy of that [gunshot] visit is different from other emergency visits and puts different kinds of strain,” Kaufman said. It challenges a system that has been critically understaffed for years.
“All of a sudden, you went from needing one nurse for a few patients to maybe three nurses to help take care of that one patient.”
Kaufman is careful to say that no patient should have to experience the trauma of gun violence, and none should be more in the spotlight than another. But with students, she often reflects on one recent patient who had six vital organs damaged after being hit by a stray bullet at her birthday party.
“She ended up having sort of the most invasive potential surgery she could have. We had to open her abdomen; we had to open her chest and repair all these things. And we did, and she did fine,” Kaufman said. “But that is one of the things completely unnecessary and completely extreme. And if we didn’t have all of those things set up to care for a patient like that at a moment’s notice, she wouldn’t be here with us.”
Addressing gun violence will ease strain, but takes time
The solutions may seem obvious, but there’s no immediate fix to gun violence, experts say.
“We think of gun violence as being something that could be addressed relatively simply if we didn’t have guns, which conceptually is wonderful but obviously not so easy to achieve,” Martin said.
But violence is as much of a social and behavioral problem as it is an access problem, he said.
“Not surprisingly, those are the same core problems that exist for why people have heart attacks and strokes. So much of the health care needs in the world — but certainly in the developed world in the US — is much more behavioral than anything.”
But even one less person filling one less hospital bed could make all the difference.
“Capacity is very close to the margin most of the time. So even places where we can make small improvements can really make a big difference overall,” Kaufman said.