The Pandemic's Other Casualties

Unnatural deaths of Americans are surging, and not just because of COVID-19. Or at least not directly because of COVID-19.

The pandemic that has killed more than 550,000 Americans so far also unleashed massive societal upheaval. That shock has caused its own problems.

Today we’ll take a look at three of those areas, where state and local leaders struggled even before the pandemic to contain the fallout but now face even more heartbreaking surges in deaths: fatal shootings, opioid deaths and traffic fatalities.

That’s the story this week, as a fourth wave of the COVID-19 takes hold in the United States.

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The coronavirus, like any other major crisis, has exposed weaknesses that already existed in our society. Today, we look at three areas in which the toll has been especially remarkable. Policy makers have been working for years on these problems, only to see their work upended by the global health emergency.

Mass shootings in Atlanta and in Colorado in the last few weeks reawakened much of the American public to the looming threat of gun violence. Sadly, though, the gun violence never went away, not even during the darkest days of the pandemic. In fact, U.S. gun deaths in 2020 climbed to their highest point in decades.

“The number of people murdered in everyday violence last year surged in cities large and small,” notes The Guardian. “Early estimates suggest the U.S. may have seen at least 4,000 more murders last year than in 2019, and potentially as many as 5,000 more, according to projections based on FBI data, though complete official statistics will not be available until the fall.”

Much of that violence took place in predominantly Black neighborhoods. The Trace, a publication that focuses on gun-related violence, documented the spike at the end of last summer.

“Nearly 50 percent of the shootings analyzed by The Trace took place in majority-Black census tracts, though less than 10 percent of census tracts nationally have majority Black populations. The pattern held in almost every city that has had more than five mass shootings in 2020. In Chicago, for example, 31 out of 36 shootings with four or more victims happened in majority-Black census tracts,” the Trace reporters wrote in September. In Detroit and Milwaukee, they noted, all of the shootings took place in Black neighborhoods.

J. Brian Charles, one of the reporters on that team (a friend and a former Governing colleague of mine), told NPR recently that the pandemic had circumvented some of the activities that cities and community groups normally took to prevent violence. Police were leery of close contact with residents, because they were worried about both catching the coronavirus and spreading it.

Violence prevention groups – which can play a big role in cities’ violence prevention efforts – also had a more difficult time working with people because of the pandemic, Charles said. “They found it very hard to do their work, because they couldn’t go do things like go into a home and do a home visit,” he explained.

Other factors may be at play, too. Americans went on a gun-buying spree during the pandemic. The number of FBI background checks for firearms was 40 percent higher in 2020 than in 2019.

Many observers have raised the prospect that the widespread protests against police brutality following the police killing of George Floyd last May could also be a factor. Cops might feel they are under more scrutiny and, therefore, be more reluctant to intervene in dangerous situations.

Patrick Sharkey, a sociology professor at Princeton, told TIME magazine that the uptick in violent deaths started even before the protests. “All the sources of data tell us that, right from the start of 2020, it’s been a year with very high violence,” Sharkey said. “There has been a real increase since May, but there was change going on before that.”

But one report that looked at how criminal activity fluctuated over the year found that homicides were high in the early months of 2020. They dropped when the pandemic first hit the country, as lockdowns kept more people at home. They rose again in the summer, following the George Floyd protests.

“COVID-related restrictions may have had an initial suppressive effect on homicides, but the waning of those restrictions, coupled with the strain on at-risk individuals and key institutions – aggravated further by the lack of outreach to such individuals – have all likely contributed to elevated homicide rates in 2020,” researchers wrote in a report for Arnold Ventures and the National Commission on COVID-19 and Criminal Justice.

One caveat that they pointed out is that, while the numbers of murders may be the highest in decades, the numbers of murders per capita was still lower in 2020 than it had been in the early 1990s.

The number of Americans who died from a drug overdose surged in the year leading up to August 2020, compared to the year before. The CDC estimates the increase to be 27 percent. That would amount to nearly 19,000 more drug-related deaths than in the previous year.

“Opioid-related deaths drove these increases, specifically synthetic opioids such as fentanyl,” wrote health researchers for the Commonwealth Fund. “Opioids accounted for around 75 percent of all overdose deaths during the early months of the pandemic; around 80 percent of those included synthetic opioids.”

In fact, other researchers have found that opioids have taken a heavy toll during the pandemic, as well.

CDC researchers who looked at emergency room use during the pandemic found that visits for drug overdoses did not decrease like visits for other health problems had.

In 2020, many people avoided going to the emergency room or getting medical care, to avoid the risk of contracting COVID-19. But that didn’t happen for drug overdoses. The discrepancy was “especially compelling, suggesting an increase in [overdose burden] during the pandemic,” they wrote for the Journal of the American Medical Association (JAMA).

“Opioid ODs in particular exhibited the most consistent increases in counts,” they added. They only found small decreases in visits for opioid-related visits while the public largely kept away from the emergency rooms. And even with those drops, the number of overdose visits never fell below corresponding 2019 numbers.

“This finding might reflect changes in the illicit drug supply during the pandemic and that persons using opioids used them alone or in higher-risk ways, increasing the likelihood of OD, or that they lacked access to naloxone or other risk-reduction services—all potential effects of COVID-19 mitigation measures,” the researchers wrote.

In the Minneapolis area, Hennepin County saw a record of 285 opioid-related deaths last year, compared to 170 the year before, reported the Minneapolis Star Tribune. Almost all of the opioid-related deaths in 2020 involved at least some fentanyl.

“Health officials and street outreach workers across Minnesota said that the pandemic pushed residents struggling with addiction deeper into isolation. At the same time, county and law enforcement resources were redirected to tackle the spreading virus and away from programs to drive down opioid fatalities,” Star Tribune reporter David Chanen explained.

In the Chicago area, opioid overdoses surged during state-ordered stay-at-home orders last spring.

Cook County had seen an average of about 23 opioid-related deaths per week before COVID-19 emerged. Those deaths started to increase in December 2019, before the pandemic, but hit their highest levels of more than 43 deaths per week during the stay-at-home order. Once the order was lifted, opioid-related deaths declined to 31 a week.

“These findings should not necessarily be used to determine whether or not a stay-at-home order is issued, but rather what stopgap measures can be put in place if a stay-at-home order has to be made,” Maryann Mason, a Northwestern University professor who conducted the study with researchers from the Cook County Medical Examiner’s Office, told U.S. News and World Report.

Normally, when people drive less, fewer people die in traffic crashes. But that wasn’t the case in 2020.

Traffic deaths rose by 8 percent between 2019 and 2020, according to National Safety Council (NSC) estimates, even though the number of miles Americans drove last year fell by 13 percent.

Put the two together and it means that the average number of deaths per mile driven rose by 24 percent last year.

“The increase in the rate of death is the highest estimated year-over-year jump that NSC has calculated since 1924 – 96 years. It underscores the nation’s persistent failure to prioritize safety on the roads, which became emptier but far more deadly,” NSC warned.

In fact, the emptier roads added a new deadly element to American roads: speed.

“Drivers who remained on the roads engaged in more risky behavior, including speeding, failing to wear seat belts, and driving under the influence of drugs or alcohol,” the National Transportation Safety Board warned last fall.

Meanwhile, cops who might have normally been nabbing speeders had their hands full with other pandemic-related duties.

“You had the open roads and the lack of enforcement and drivers behaving badly and dangerously,” Jonathan Adkins, executive director of the Governors Highway Safety Association, a group that represents highway safety agencies, told The Washington Post. “We heard it everywhere across the country that many people took to the open roads thinking that they could speed, and speed significantly.”

Safety advocates have been raising the alarm about too-fast vehicles for years. NTSB, a federal agency, took up the cause in 2017 after years of limited action.

The problem has only grown, as the size of passenger vehicles in the United States has grown and states have raised their speed limits. Even small increases in vehicle speed can drastically increase the fatality rate in a crash. Force, after all, is mass times acceleration.

Speed is a factor in about a third of all fatal traffic crashes.

While it’s easy to blame individual motorists for irresponsible behavior, the U.S. road system also encourages people to drive as fast as they can, argues University of Connecticut law professor Sara Bronin in Bloomberg CityLab.

“You might think that these numbers were boosted by Americans’ heavy-footed driving habits, or that we have a distracted driver (and pedestrian) crisis,” she wrote.

“While both may be factors, they would not make us unusual — while our fatality rate is. Compare us with Germany, for example, where a love for speed and widespread cellphone use has not resulted in the death rates we see in the U.S. German traffic deaths fell 12% in 2020, which tracks the country’s 11% decrease in traffic volume,” Bronin pointed out.

Road design guidelines, fire codes and even national standards for how road signs and other traffic devices look all promote designs that encourage motorists to speed with too-wide lanes while all but ignoring pedestrians and other non-motorists who use the road, she said.

“To reverse these horrific trends, it’s not just popular culture, which romanticizes speed, that must change. It’s our regulatory culture. Design standards dictate how streets and vehicles look and function,” Bronin said.

The professor called on the federal government in particular to make changes that would result in road designs that discourage speeding.

It remains to be seen how the Biden administration will respond, but the infrastructure package that the president unveiled Wednesday would include $20 billion to “improve road safety for all users, including increases to existing safety programs … and other improvements to reduce crashes and fatalities, especially for cyclists and pedestrians.”

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