A confluence of crises: a pandemic, an epidemic, and the need for a comprehensive public health response

AFFIRM Research

Author: Isabelle Sharon

Though the COVID-19 pandemic has captured public health awareness and resources, other epidemics have not receded. Firearm injury continues to be one of the United States’ most devastating public health crises, and the pandemic—hitting the same populations at the same time—is likely to influence it. The convergence of these issues is new and complex, and it should continue to be studied and analyzed. At the moment, however, it seems that the COVID-19 pandemic is having a significant impact on the firearm injury epidemic. Most notably, the pandemic has triggered a recent surge in firearm sales: from March to July 2020, sales were more than 70% higher than reported sales in the same months of 2019 (1). The highest increase, in June, was 145% (1). These numbers are staggering, though not necessarily surprising; in times of uncertainty and unrest, firearm sales tend to go up (2). There is growing evidence that this jump in sales, coupled with pandemic circumstances, is affecting rates of interpersonal, unintentional, and self-inflicted firearm injury, underscoring the critical need for a comprehensive public health response.

A preliminary report from the UC Davis Violence Prevention Program shows a significant correlation between state-level increases in firearm purchases and increased rates of intentional interpersonal firearm violence between March and May 2020 (3). Intimate partner violence may be contributing to this increase. Victims of domestic violence are five times more likely to be killed by their partner if there is a firearm at home, a risk that is undoubtedly worsened by stay-at-home orders that put the victim and perpetrator in continual close quarters (4).

The presence of a firearm at home can pose a significant risk to children. Seventy-seven percent of unintentional pediatric firearm injuries occur in the home (5). In March and April, unintentional pediatric firearm injuries rose by 7% (compared to a 2017-2019 average), while fatalities from such injuries rose by 43% (6). Though this analysis covers only a short period, it is likely we will continue to see increased rates of unintentional pediatric shootings over the full course of the pandemic. According to the Children’s Hospital of Philadelphia, 89% of unintentional pediatric firearm injuries occur in the home—most often when children, outside parental supervision, discover a loaded firearm and start playing with it (7). First-time firearm owners, who account for much of the recent increase in purchases, may be less aware of best practices for safe storage, or of the risks an unsafely-stored firearm poses to their children (8). Moreover, with children now staying home from school, their exposure to firearms will likely increase, thereby increasing their risk of unintentional firearm injury and fatality.

The increase in firearm sales could also increase firearm suicide. As many as half of recent firearm sales have been to first-time owners, and according to a recent study by Drs. Studdert, Zhang, Swanson, et al. at Stanford Medicine, suicide risk among first-time firearm owners is significantly higher than among non-gun owners and peaks during the period immediately after purchase (8, 9). The COVID-19 pandemic has also, for many Americans, exacerbated suicide risk factors such as social isolation, economic stress, and lack of access to mental health care. Some experts worry that the compound impact of these widely experienced risk factors, coupled with increased access to a firearm, has the potential to cause a spike in suicides (10).

However, these risks are not inevitable, and there are steps that firearm owners can take to keep themselves and their families safe. First and foremost is firearm education, and many resources have been created to help. Organizations like the National Shooting Sports Foundation provide firearm owners with free suicide prevention toolkits, the American Association for Pediatrics highlights how to keep children safe, and the National Crime Prevention Council advises on safe storage (11-13). If both new and experienced firearm owners use these resources and others to implement safe storage, practice safe usage, and form a contingency plan in the event of a family member’s suicidal ideation, we can reduce the amount of firearm injury and death we see in the next few months.

Additionally, the data observed to date should not determine our final understanding. A myriad of factors influence both the COVID-19 pandemic and the firearm injury epidemic, and a myriad more influence their convergence. In the same way that we should not disregard the potential compounding of firearm injury risk factors, we also should not jump to the conclusion that COVID-19 has undoubtedly caused any and all fluctuations in firearm injury rates.

To solidify our understanding of this interplay, we need sustained, well-funded public health research. We need to identify risk and protective factors, we need to understand the social determinants of health that have put Black Americans at disproportionate risk for both COVID-19 and firearm injury, and we need insight into the most effective interventions. The COVID-19 pandemic has provided a window of heightened awareness of the importance of public health. If it is used to guide research-driven policy and build a more robust public health infrastructure, we can facilitate procedures and best practices that promote better, more equitable health outcomes and help prevent similar crises in the future.


  1.         SAAF Press Releases. Small Arms Analytics & Forecasting. https://smallarmsanalytics.com/saaf-press-releases/. Published 2020. Accessed August 11, 2020.
  2.         Levine PB MR. Three million more guns: The Spring 2020 spike in firearm sales. Brookings. https://www.brookings.edu/blog/up-front/2020/07/13/three-million-more-guns-the-spring-2020-spike-in-firearm-sales/. Published 2020. Accessed August 11, 2020.
  3.         Schleimer JP, McCort CD, Pear VA, al. e. Firearm Purchasing and Firearm Violence in the First Months of the Coronavirus Pandemic in the United States. medrxiv. 2020.
  4.         Hatchimonji JS, Swendiman RA, Seamon MJ, Nance ML. Trauma Does not Quarantine: Violence During the COVID-19 Pandemic. Ann Surg. 2020;272(2):e53-e54.
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  6.         Unintentional Shootings by Children Have Increased in March and April, New Analysis Shows [press release]. Everytown For Gun Safety2020.
  7.         Gun Violence: Facts and Statistics. Children’s Hospital of Philadelphia Research Institute. https://injury.research.chop.edu/violence-prevention-initiative/types-violence-involving-youth/gun-violence/gun-violence-facts-and#.X1eQry-z1QJ. Published 2020. Accessed August 11, 2020.
  8.         Arnold C. Pandemic And Protests Spark Record Gun Sales. National Public Radio. https://www.npr.org/2020/07/16/891608244/protests-and-pandemic-spark-record-gun-sales. Published 2020. Accessed August 11, 2020.
  9.         Studdert DM, Zhang Y, Swanson SA, et al. Handgun Ownership and Suicide in California. N Engl J Med. 2020;382(23):2220-2229.
  10.       Mannix R, Lee LK, Fleegler EW. Coronavirus Disease 2019 (COVID-19) and Firearms in the United States: Will an Epidemic of Suicide Follow? Ann Intern Med. 2020;173(3):228-229.
  11.       Suicide Prevention Toolkit Items. National Shooting Sports Foundation. https://www.nssf.org/safety/suicide-prevention/suicide-prevention-toolkit/. Published 2020. Accessed August 11, 2020.
  12.       Schaechter J. Guns in the Home. American Academy of Pediatrics. https://www.healthychildren.org/English/safety-prevention/at-home/Pages/Handguns-in-the-Home.aspx. Published 2018. Updated 6/12/2020. Accessed August 11, 2020.
  13.       Safe Firearms Storage. National Crime Prevention Council. https://www.safefirearmsstorage.org. Published 2015. Accessed August 11, 2020.

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