A Milwaukee Syndemic? Penetrative Injury and COVID-19

This study sought to evaluate injury frequency of penetrative trauma before and after stay-at-home orders were implemented due to COVID-19 in Wisconsin.

Patients who presented to a level I trauma center from January 2018 through December 2021 with a mechanism of injury of firearm or stab wound were included. The study was split into pre-COVID (January 2018-February 2020) and COVID (March 2020-December 2021) periods. Statistical analysis included chi-square tests and interrupted time series analysis.

A total of 1702 patients met inclusion criteria. The COVID group had a statistically significantly higher proportion of firearm injuries (83.2%) and a significantly lower proportion of stab injuries (16.8%) compared to the pre-COVID period group (70% and 30%, respectively, P  < 0.001). There was no change from pre-COVID to COVID periods in in-hospital mortality or length of hospital stays. There was an increase in firearm incidents in the COVID period in 72% of Milwaukee County ZIP codes and a decrease in stab incidents in 48% of ZIP codes. Interrupted time series analysis indicated a significant increase from the pre-COVID to COVID periods in monthly firearm and stab injuries. Firearm injury significantly increased from pre-COVID to COVID for Black or African American patients but no other racial group.

These findings are consistent with other state and national trends suggesting increasing penetrative injury during the COVID-19 pandemic. The intersection of the COVID-19 pandemic and violence pandemic may yield a "syndemic," imposing a significant burden on trauma systems. Evidenced-based public health interventions are needed to mitigate the surge of firearm injuries.