Emergency Visits for Firearm Injuries Rose During the COVID-19 Pandemic

In March 2020, as the COVID-19 national emergency was declared and total visits to emergency departments (EDs) fell steeply, one kind of visit went up: firearm injuries. Then, in late May, they jumped sharply, and stayed high for the rest of the year. Compared with 2019, the average number of weekly ED visits for firearm injuries was 37% higher in 2020, 36% higher in 2021 and 20% higher in 2022.

Weekly ED visits for firearm injury, 2019–2022; the vertical scales differ between panels. Credit: CDC, Morbidity and Mortality Weekly Report*.*

The context

The U.S. firearm homicide rate rose by nearly 35% during the pandemic, and the firearm suicide rate stayed high during 2019–2020. Provisional data show both kept rising in 2021, to their highest levels since 1993 and 1990 respectively. EDs are where firearm injuries are first treated, and visits for them had been creeping up during 2018–2019 — but how they changed during the pandemic was not known.

CDC used near real-time health record data from the National Syndromic Surveillance Program (NSSP), which receives data from about 75% of the nation's EDs, to count first visits for firearm injuries of every intent — unintentional, self-inflicted, assault, undetermined, legal intervention and terrorism — from January 2019 through December 2022, including only facilities that reported consistently.

Two turning points

• Week of March 13, 2020: the national emergency was declared and community mitigation measures began. Total ED visits fell steeply, but weekly firearm injury visits began to climb.
• Week of May 24, 2020: a sharp increase that stayed elevated through 2020. It coincided with social unrest over strained relations between law enforcement and communities and over longstanding systemic inequities, structural racism and trauma experienced by racial and ethnic minority groups; with changes in COVID-19 prevention rules and in people following them; and with reported increases in some types of crime. The report did not examine causes.

Who was affected

Percentages are changes from 2019.

Firearm injuries also made up a larger share of all ED visits in 2020, 2021 and 2022 than in 2019, for both sexes and most age groups. The youngest group, ages 0–14, saw the biggest increase in that share: in 2020, firearm injuries were 2.81 times as large a share of girls' ED visits as in 2019, and 2.31 times for boys. The one clear exception was men 65 and older, whose share in 2022 was lower than in 2019.

Children's lives were upended in the pandemic in ways that might have raised their risk: disrupted routines and schooling, with isolation and more time at home — potentially with more access to guns kept there; reduced access to health care, including mental health services; and less security, from housing and financial insecurity to more exposure to violence and uncertainty about the future. Earlier studies have also pointed to rising gun purchases and limited parental supervision.

What helps

The authors call for a comprehensive approach that also addresses the social and economic inequities behind the risk of violence:

• Community and street outreach programs, in which trusted community members de-escalate violent conflicts and connect people most in need with support.
• Hospital-based programs that intervene with victims of violence.
• Better physical environments, such as cleaning up and greening vacant lots.
• Secure firearm storage, to reduce access for people at risk of harming themselves or others.
• Stronger social and economic supports for individuals and families.

Near real-time ED data can help health departments, clinicians and researchers spot trends quickly and tailor prevention to their communities.

Limits

NSSP is a convenience sample: fewer than half of facilities in California, Hawaii, Minnesota and Oklahoma take part, and results do not describe injuries treated elsewhere. Coding practices vary, the data do not distinguish intent, and they cannot show cause and effect. The study counted visits rather than rates, because pandemic swings in ED use made rates hard to interpret, and some demographic and facility details were incomplete.

Sources

Based on Marissa L. Zwald, Miriam E. Van Dyke, May S. Chen, et al., "Emergency Department Visits for Firearm Injuries Before and During the COVID-19 Pandemic — United States, January 2019–December 2022," Morbidity and Mortality Weekly Report, volume 72, Centers for Disease Control and Prevention; a work of the United States government in the public domain.