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The Health Wrap: gun trauma, COVID complacency, saving lives – and good news for natural history buffs

In her latest column, Adjunct Associate Professor Lesley Russell investigates the trauma of gun violence in the United States, where it is easier to buy a gun than to adopt a dog in at least one state.

Health technology assessment, the ongoing COVID toll, an under-discussed complication of pregnancy, and treatment of drug overdoses are also covered. Watch for the eye-rolling.


Lesley Russell writes:

In the wake of last week’s shooting in Nashville, which killed three primary school student and three adults, the United States is yet again going through a period where gun opponents are angry and sad and demanding action, while gun proponents offer thoughts and prayers and indicate that nothing more can be done, because gun ownership is a constitutionally given right and part of American “freedom”.

President Joe Biden has described gun violence in the US as an epidemic and an international embarrassment. In April 2021 he announced some modest but significant efforts to address gun violence but partisan politics at both the federal and state levels is hindering progress on these.

An opinion piece in The New York Times summed up the situation:

We should judge a nation by a simple metric: the number of weeping parents it allows, the small coffins it tolerates. The debate around gun control is not new, of course, and each tragedy brings a fresh wave of calls for common-sense gun regulation.

The adversaries of reform will rebuke us for turning a tragedy, the deaths of six innocent people, into an occasion to debate politics. We will be urged to offer prayers for the victims and their families while we await the appropriate time to discuss the more difficult issues. But too often it seems that rather than waiting for the right time, politicians are simply trying to wait out the news cycle.”

So, inevitably in the face of inaction, mass shootings continue to rise across the nation. Data from the Gun Violence Archive show that in the first three months of 2023 there were 131 mass shootings and 10,325 gun-related deaths, of which 417 were children and teenagers.

Mass shootings are so common that survivors of one are now sometimes finding themselves impacted by another, offering a devastating portrait of compounding trauma.

American children and teens are more likely to die by guns than any other cause.

In Australia, motor vehicles are the primary cause of death for this age group, although it is somewhat disturbing to see firearms as the 11th cause of death.

An analysis published in 2018 showed that there were more privately-owned guns in the United States than people; 393 million guns which equates to 120 guns for every 100 people. Gun-owning households (42 percent of all households) had an average of eight guns each.

What makes the situation worse is that gun-buyers are increasingly purchasing AR-15 style weapons that inflict dreadful damage on the human body, especially that of a child. The doctors who treat the victims of mass shootings say they are haunted by their experiences confronting injuries so dire they struggle to find words to describe them.

New York Times journalist Nick Kristoff makes the point that it is far too easy for people seeking to do harm to others or themselves to purchase guns.

He compares the process for adopting a dog in Mississippi (a 64-question form; in-person meeting with entire family; approval from landlord if renting; property inspection; a trial sleep-over) with what is required to buy a gun (not obviously under-age or drunk; a brief background check – you can access the form here).

And he asks the obvious question: why is it easier to buy a gun than to adopt a dog?

Australia is often held up as an exemplar for national gun control, but my investigation of actual numbers of firearms makes me concerned: the country has 14.5 guns per 100 people. That means Australian civilians now own more than 3.5 million registered firearms, an average of four for each licensed gun owner. Most guns used in crimes are stolen and/or illegally purchased.

The good news is that the proportion of Australians who hold a gun licence has fallen by 48 percent since 1997 and the proportion of Australian households with a firearm has fallen by 75 percent. These data indicate that people who already own guns have bought more rather than an increase in new gun owners.


End of the COVID-19 pandemic – or not?

Like gun violence and Donald Trump, there is one other topic that shows no signs of disappearing – despite what some politicians would have us believe – and that is the impact of the COVID-19 pandemic.

As the most recent data on COVID-19 deaths makes plain, the pandemic is continuing to claim too many Australian lives (see tweets below from Professor Adrian Esterman and Professor Kathy Eagar).

See also these recent articles in Croakey Health Media:

In an article published recently in the BMJ, my Croakey colleague Alison Barrett reported that Health Minister Mark Butler says Australia needs to “learn the lessons” of the latest COVID-19 wave, which has lasted longer than expected (it began in late October 2022 and is now thought to be nearing its end).

“It is my intention to make sure that we learn the lessons of the past few months and constantly make sure that the response that all governments, including the Commonwealth, put in place to deal with what inevitably will be the next wave of COVID sometime over the course of 2023 is aligned with the best understanding and the best evidence,” he said.

I fear too many of us, driven to cynicism by experience, are rolling our eyes at that statement.

However, on 30 March the Commonwealth Chief Medical Officer, Professor Paul Kelly, released his report, Lessons from the Fourth Omicron COVID-19 wave.

This is a modest six-page document that strikes me as a fairly complacent take on where Australia currently finds itself and what the future might bring.

It does say this about what 2023 might bring:

The Australian community will continue to experience waves of COVID-19 infection, which may put pressure on health systems and result in deaths. The next wave may coincide with the winter season, and while COVID-19 is not a seasonable disease there is a risk that co-circulation with other seasonal respiratory viruses such as influenza and respiratory syncytial virus (RSV) might occur, as has been seen in the recent Northern Hemisphere winter.

This makes winter a much more dangerous time, especially for older Australians and people with complex health conditions. Preparations are underway ahead of the Australian winter to ensure our system is well prepared to manage such an eventuality, building on the substantial work from 2022.”

I think many public health experts wonder just what these “preparations” and “substantial work” encompass.

In the United States, the Biden Administration acted in January to renew the COVID-19 public health emergency because “there’s still a lot of COVID out there, and the public health emergency and his determination gives us tools to fight this.” This emergency declaration is expected to end on 11 May 2023.

However, several major relief measures are now decoupled from the public health emergency. This includes the requirement that prevents states from disenrolling Medicaid recipients as long as the public health emergency is in effect (in exchange for an enhanced federal match) and enhanced food stamp benefits. These changes are expected to cause confusion and hardship for many.

One of the areas where the United States is leading the way is in the analyses and critiques of pandemic management and in efforts to improve readiness for the nest pandemic – which many fear will be a strain of H5N1 bird flu.

A very substantial observational analysis