The ‘Science’: A Communal Understanding of Gun Violence Requires Treating Bullets a Pathogens

The 5.56 NATO bullet has been used in some of the country’s most horrific public mass shootings — including the ones so deadly that we refer to them by shorthand. Sandy Hook. Parkland. Aurora. Uvalde.

It’s hard to predict when these kinds of tragedies will take place, or the catastrophe’s magnitude. In mass shootings in particular, it can also be hard to anticipate the severity of the wounds victims may suffer. But according to a group of physicians and firearm researchers, there are ways to calculate this type of harm. They’re working to create a common metric to measure the lethality of different guns and bullets — an effort that could help policymakers better decide how to respond to varying levels of harm.

“The framework that ‘a gun is a gun and it doesn’t matter what the gun is’ is just not accurate,” said Dr. Eric Fleegler, a pediatric emergency medicine physician at Massachusetts General Hospital. “The gun is the instrument that shoots the bullet, and it is the bullet that is ultimately the agent that causes the damage to the human body.”

In medicine, experts have long understood a disease’s lethality by a measure known as case fatality rate (CFR), or the proportion of people who die from a specific disease among all the people diagnosed with it over a given period. The case fatality rate for untreated HIV is 90 percent, for example; the rate for rabies is 99 percent, and it’s 30 percent for smallpox. This percentage is key for developing treatments and understanding the severity of specific diseases. 

Fleegler and other researchers are working to apply that same methodology to bullets, when paired with specific firearms. In a 2019 study published by Annals of Internal Medicine, researchers found a 90 percent case fatality rate for firearm suicide — meaning that 90 percent of people who attempt suicide with a firearm die — and compared that to intentional overdose attempts, for which the CFR is only 2 to 3 percent. 

It is more difficult to parse out the rate of firearm homicides because there are more factors contributing to lethality. Previous research has found that the CFR range for firearm homicide could be up to 25 percent — but also that being shot with a large-caliber bullet increases the likelihood of death four-fold. 

But bullets are just a part of the equation. In an article published recently in the Journal of the American Medical Association, Fleegler and his co-authors reckoned with another factor: age. When they looked at the Sandy Hook, Uvalde, and Parkland mass shootings — in which the same kinds of bullets and firearms were used — they found that case fatality rates lowered as victims’ ages increased. The CFR was highest, at 100 percent, among the 20 first-graders who were killed in the Sandy Hook shooting; in the Parkland shooting, in which the victims were 15- and 16-year-olds, the CFR was 50 percent. …

“When we think about people being hit by a bullet, most of us envision something we’ve seen in the movies, so it’s very hard to understand what’s actually happening to the human body,” Fleegler told me. “These visuals are here to give a very vivid, although not overly graphic, example of what’s going on.” 

The JAMA article laid out a few different suggestions focused on reducing harm from bullets, including a tax rate comparable to other harmful products like cigarettes, or limiting the number of bullets purchased in one sale and requiring background checks for bullet sales.

“In our work, we talk about bullets as pathogens, and the guns as sort of vectors, similar to a mosquito carrying malaria. … It was important for us to highlight firearm violence in the same way,” said Dr. Laura Vargas, a psychiatry professor at the University of Colorado and a co-author of the article in JAMA. “The policies that we highlight are not anything new either, they have been proposed before.”

Vargas said it’s important to look at the financial, emotional, and communal damage of U.S. gun policy both within our borders and abroad to really grasp the importance of these policy recommendations. This type of communal understanding of firearm violence is also proposed in the article’s solutions, with ideas like licensing requirements for ammunition dealers and further research focused on understanding bullets’ damage on different groups. 

—  Fairriona Magee in What If Medical Experts Tracked the Lethality of Bullets Like Smallpox, Influenza, or HIV?