Interpersonal violence has plagued our large cities for decades (1,2). As our region
and medical system prepared to manage the anticipated influx of critically ill Coronavirus
Disease 2019 (COVID-19) patients, we sincerely hoped social distancing measures would
interrupt this cycle of interpersonal violence.
However, in many large metropolitan centers across the country—including Chicago,
Dallas, Houston, and Philadelphia—this epidemic of violence, fueled by irresponsible
and often criminal use of handguns, has intensified in recent weeks (3). Our center's
experience has mirrored this trend. Although blunt injuries have decreased with less
vehicular and pedestrian traffic, in the 6 weeks since the World Health Organization
declared a global pandemic, our highest-level activations and penetrating injuries
have risen sharply in comparison with the same period in 2019 (Figure 1
).
Figure 1
Trauma center activity during the current COVID-19 pandemic (March 9, 2020 to April
19, 2020) as compared with the same time period in 2019. Although overall trauma contacts
decreased by 16.7% (264 in 2019 vs. 220 in 2020), the proportion of critically injured
patients requiring the highest-level activation (ALERTS) increased significantly (41%
vs. 55%, p = 0.003), along with the rate of penetrating trauma (23% vs. 33%, p = 0.009).
Error bars denote 95% confidence interval. Data obtained from the University of Pennsylvania
Trauma Registry.
This observation prompts two questions. First, how do we balance the simultaneous
demand for additional high-acuity trauma care while meeting the unprecedented pandemic-fueled
demand for those same critical resources? Like most others across the country, our
center has cancelled all elective procedures and rapidly re-configured and expanded
our inpatient space to meet the pandemic surge. Even with such aggressive measures,
at least one metropolitan area with a high concentration of COVID-19 activity significantly
curtailed trauma services due to lack of bed availability, creating limited regional
access to trauma care, thereby potentially increasing preventable deaths (4). To avoid
such a quandary and remain fully open to trauma, we diligently attend to patient throughput
in our trauma bay, designate a minimum of two open “crash” trauma critical care beds
at all times, and actively arbitrate critical care beds assignments with multidisciplinary
input.
Second, how can we remedy this epidemic of violence? In the short term, community
interventions and social services focused on acute urban societal stresses must be
deployed into violence hot spots. Longer term, funding for gun violence research through
private philanthropy and federal agencies including the Centers for Disease Control
and Prevention and the National Institutes of Health must significantly increase to
match the burden of disease caused by this epidemic (5,6). Medical journals must commit
to disseminate timely and actionable findings from these research activities on gun
violence (7). Civic interventions should include training nonviolent conflict resolution
focused especially on our youth in schools, religious organizations, and community
centers. We must also train, equip, and empower individuals to stop critical bleeding
with tourniquets and hemostatic dressings when injuries do occur. Finally, legislation
must promote safe, responsible, and legal gun ownership (2). Just as public health
interventions are flattening the curve of the COVID-19 pandemic, the long-term benefit
to our health system and our society equally justifies an intense, concerted effort
to change behavior and end our nation's epidemic of violence.