Response to Wyatt et al.'s comment on "Changes in traumatic mechanisms of injury in Southern California related to COVID-19: Penetrating trauma as a second pandemic".

To the Editor:

We appreciate the response, data, and insights provided by Wyatt et al. Their esteemed Level I trauma center in Texas noted an increase in penetrating trauma rates associated with COVID-19–related restrictions, similar to findings in our multicenter study in Southern California.[1] However, their center notably serves both urban and rural communities, allowing for a unique comparison of pandemic-related changes in trauma between these diverse geographic locations.

Their study found that the more urban region of Lubbock County suffered an increase in assaultive penetrating trauma compared with surrounding rural communities, postulating that urban communities may be more affected as a whole by factors unique to 2020. Although prior studies have shown significant increases in penetrating trauma in urban and rural areas separately, the current study describes an important difference in the magnitude of change between two different communities in close proximity.[2-4] Wyatt et al. go on to discuss that this finding may be related to a greater impact of social distancing regulations on urban communities or disparities in financial impacts. Regardless of the cause, we agree that this adds another layer to the discussion regarding the substantial impact this pandemic has had on the preexisting epidemic of penetrating trauma across the country.

We believe future studies should confirm differences in penetrating trauma burden between rural versus urban areas and search deeper to understand the exact underlying risk factors, including social determinants of health, substance abuse, socioeconomic status, and strictness of pandemic-related restrictions.[5] We believe that understanding these subtleties may prove useful to design interventions at the hospital and/or community level to combat the second pandemic of firearm violence.