But after surgery, Bates said, she couldn’t get out of bed or walk to the bathroom without help. She complained of intense pain radiating down her left leg, weakness in her knee, and a numbing sensation below it, according to hospital records. Bates, who worked as an Uber Eats driver, didn’t have the strength to drive a car.

Still, Bates said, the hospital told her it was time to go.

“They didn’t do any further X-rays or CTs or MRIs to figure out why my knee was numb,” she said. “And they were just like, you know, ‘It’ll go away.’”

Doctors said she was medically stable, Bates said, and because she had no health insurance, they could not send her to a rehabilitation hospital or a skilled nursing facility, which can charge thousands of dollars a day for such care.

“They were just like, We need the bed for somebody who has insurance,” she said. “That’s of course, you know, what they say without saying it.”

At least one firearm injury is treated in an American emergency room every . Tens of thousands die from their injuries every year. Many more, like Bates, are left to face long recoveries, steep medical debt, and enduring trauma.

How insurance affects the care of gunshot wound victims has remained shrouded in mystery — until now, due to a new analysis by The Trace and Ñî¹óåú´«Ã½Ò•îl Health News of data that Florida hospitals compile to collect payments from insurance companies and file with the state.

When uninsured patients arrive at hospitals in Florida with gunshot wounds, on average they spend significantly fewer days in the hospital — in some cases half the time — than those with health insurance, according to the data analysis.

Among the most severely injured patients, the uninsured stayed three fewer days in the hospital on average than their counterparts with insurance.

The data was obtained exclusively for this reporting on gun violence hospitalizations in the state, aided by Florida state law.

The newsrooms spent more than a year analyzing the records, which did not identify patients. The data contained patients’ insurance status, their residential ZIP code, their race, and other demographic info. Reporters reviewed academic studies and government documents and interviewed health policy experts, doctors, activists, and victims of gun violence or their relatives.

The results are a first-of-its-kind look at what happens to the insured and the uninsured who are shot and admitted to the hospital for treatment.

Across Florida, the analysis of hospital billing data from 2018 to 2024 obtained from the Florida Agency for Health Care Administration shows:

• Uninsured patients make up a quarter of the more than 20,000 gunshot wound hospitalizations identified, making them the largest single group treated for firearm injuries.
• Uninsured gunshot victims had hospital stays of about six days on average, only three-quarters of the time spent by patients with private insurance and less than half the average stay for patients on traditional Medicaid, the public health insurance program for poor and disabled people.
• The gap in hospital care persisted regardless of hospital size, location, or ownership type, including at facilities that receive taxpayer money with a mandate to treat all patients regardless of their ability to pay.
• Of the gunshot wound patients, nearly half were Black, making the group highly overrepresented. About a quarter of nonwhite patients were uninsured, versus fewer than a fifth of white patients.

The inequality echoes a in U.S. healthcare against Black and Latino patients, groups that and a .

The U.S. has deaths than other wealthy nations, and no group suffers more than Black Americans like Bates. Black people are far to become victims of a firearm homicide than white people, according to the Johns Hopkins Bloomberg School of Public Health.

Patient outreach workers say hospital personnel might perceive gunshot victims as gang members or troublemakers who deserve blame for getting shot. rehab centers refuse to admit gunshot victims more often than other patients, and some medical records from hospitals were littered with racist or insensitive descriptions of patients and their behavior.

The damage can be lasting: Patients who after a traumatic injury have a higher risk of serious complications, including infection, hemorrhage, nerve damage, and death, especially if wounds — and mental health concerns — are left untreated.

, a University of Florida professor and vice chair for research in community health and family medicine, said there’s evidence that financial incentives drive care — for patients and for hospitals.

Regardless of how often the care team is told to follow quality protocols, Mainous said, “ultimately there’s a business aspect to it, whether the physician is thinking about it or not, whether the nurses think about it or not. But somebody is.”

The Florida data findings come at a time when Republican Gov. Ron DeSantis and state lawmakers have pushed to make guns cheaper and more widely available, despite a in the state from 2014 to 2023, and when President Donald Trump’s administration has rolled back legislation from the Joe Biden presidency to curb gun violence and .

allows eligible residents to carry a concealed firearm and to openly carry a firearm without a state-issued license. State law also prevents cities and counties from enacting stricter gun control measures.

In early June, Florida Attorney General James Uthmeier to strike down the state’s three-day waiting period for receiving a purchased gun, arguing it is unconstitutional. Uthmeier’s request is part of a proposed settlement of a lawsuit brought by the National Rifle Association.

Ñî¹óåú´«Ã½Ò•îl Health News and The Trace requested to speak with administrators at nine of Florida’s large hospital systems to ask why the disparities exist. None agreed to an interview.

Sarah Cannon, communications director at Tallahassee Memorial HealthCare, would not agree to an interview or address Bates’ account of her care for gunshot injuries.

“Clinical decisions, including acute medical intervention, readiness for discharge, and post-acute care needs, are guided by the patient’s condition and response to treatment,” she said in an email.

Cannon said the hospital offers support to patients after discharge, including from social workers who coordinate care and access to services including post-acute care placement, home healthcare, and primary care or specialty follow-up.

Bates said she had to coordinate her own care after being released from the hospital. She said nobody called to schedule a follow-up test of her leg’s muscle function, and her medical records show she did not receive one.

“If I had had insurance,” she said, “they would have definitely kept me there for at least another week to work with me on my standing and walking.”

‘It’s a Business’

Some of Florida’s largest hospitals showed huge differences in length of stay for gun injuries, the Ñî¹óåú´«Ã½Ò•îl Health News-Trace analysis showed. In Miami at Jackson Memorial, the average number of days in the hospital for uninsured patients was 6.6; for those with private insurance, it was 10.7; and for those on traditional Medicaid, it was 15.4. Jackson Memorial did not respond to requests for comment.

Tampa General Hospital reported 4.9 days for uninsured patients, 8 days for those with private insurance, and 13.6 days for Medicaid patients. “To suggest that care decisions for trauma-related patients, and in this case, gun shot victims, are influenced by insurance status is not only absurd, it’s inaccurate,” Amanda Bevis, a hospital spokesperson, said in a written statement. “At Tampa General, every patient is treated equally, based on clinical need and urgency, not insurance coverage.”

And at UF Health Jacksonville, it was 7.2 days for the uninsured, 8.5 days for the privately insured, and 13.8 days for patients on traditional Medicaid. UF Health declined to comment.

Broward Health in Fort Lauderdale reported 7.5 days for uninsured patients, 10.5 days for privately insured patients, and 12.2 days for those on traditional Medicaid. “Insurance status does not impact treatment plans for patients,” Jennifer Smith, a Broward Health spokesperson, said in an email. “Our physicians always proceed in the best interest of the patient regardless of reimbursement or what length of stay may be required.”

Memorial Regional Hospital in Hollywood reported 6.7 days for uninsured patients, 8.8 days for privately insured patients, and 9.5 days for those on traditional Medicaid. Tania Ordaz, a hospital spokesperson, said in an email that she disagreed with the findings: “Treatment decisions are based on the patient’s clinical condition and what is necessary to ensure a safe and appropriate transition of care, not on the patient’s insurance status.”

Trauma surgeons and academics said the Florida data aligns with research nationwide on where gun violence occurs and who’s most affected. Some said they fear the differences contribute to long-standing disparities in America’s healthcare system along the lines of race and class.

The Florida hospital data showed gunshot injuries are concentrated in a handful of ZIP codes marked by poverty, disinvestment, redlining, and other injustices stemming from racial discrimination.

“Why would people without insurance be discharged earlier?” Mainous said. “Because they’re in better health? I think we’ve got a lot of data that would suggest that’s not true.”

Once they leave the hospital, people with commercial insurance or traditional Medicaid are more than twice as likely to receive follow-up care from another provider — such as a rehab center or home health service — as uninsured patients.

Those patients are staying longer, in part, because hospital case managers coordinate their transfers to other facilities, which can be time-consuming and take days.

“You have to go through insurance authorization and approval,” said , a trauma surgeon formerly at Jackson Memorial in Miami who now practices in Oregon. He said patients with private insurance might have access to rehab, preventive care, and training for both the patient and their caregiver to “help them transition to a completely new phase of life.”

For patients without insurance, he said, “sometimes our hands are a little bit tied.”

“The hospital is telling us that this patient has to leave the hospital because they’re medically ready,” he said, “and so I guess we’re discharging them to their car or to their tent, and it doesn’t feel right, but I think that would probably explain some of the differences” in length of stay.

, a trauma surgeon at Jackson Memorial, said hospital staff work to ensure that uninsured patients with long recoveries learn to care for wounds and to enlist family help at home.

Valenzuela said the county-owned hospital does not send uninsured patients home to fend for themselves. She goes into neighborhoods and follows up with patients as part of a Miami-Dade County violence intervention program, whose social workers help them access food, employment, and more to heal and feel safe.

“We know that full recovery is beyond just the hospital and even the rehab centers, even the best ones,” Valenzuela said, pointing to housing and navigating the healthcare system as factors.

runs the Miami-Dade program, which connects victims of gun violence with social workers who visit bedside at the hospital and an intensive care unit-trained nurse who visits at home to provide wound care and other services.

Rawlins said young, Black gunshot patients without health insurance are often at a loss when they leave the hospital about how to schedule a follow-up appointment or manage their mental health.

“After they have been shot and they’re getting out of the hospital and they’re still in crisis,” he said, “their concern is more: How am I going to now pay the rent? How am I going to live? Who’s going to take care of me?”

Often, he said, his uninsured clients leave the hospital before they are ready.

“That’s the reality of it: It’s a business,” he said. “It’s like a hotel. You know, checkout time: You got to go. We got to make room for someone, for a next customer.”

How Long Is Long Enough?

Alea Bates said the hospital discharged her with crutches and one prescription: a seven-day supply of the painkiller Percocet.

A family member drove Bates home. She wore a leg brace, with bandages on her back, stomach, hand, forearm, and feet. When she tried to get out of the car, Bates said, her knee gave and she fell.

Surgeons, health policy experts, and researchers say physicians follow evidence-based best practices for treating gunshot wounds and that a shorter hospital stay does not necessarily reflect a lower-level of care.

, an assistant professor of surgery at the University of Pennsylvania who conducts research on violence reduction, offered one explanation.

In published in The Journal of Trauma and Acute Care Surgery, Kaufman and colleagues found that patients who were admitted while uninsured but then enrolled in Medicaid during their hospitalization — and who needed ongoing rehabilitative care after discharge — spent more time in the hospital and had higher costs.

“I have personally been in situations where I felt like I did the best I could for a patient, but they would say, ‘You’re kicking me out,’” she said. “Sometimes, what the doctor is telling you doesn’t match what you are feeling in your body.”

But Kaufman said: “I’m not going to tell you hospitals never discriminate. That would not be realistic. I would say it is more indirect.”

Kaufman said she couldn’t judge whether Bates stayed in the hospital long enough because she was not her doctor. Still, she said, Bates “didn’t get what she needed from our healthcare system.”

Unlike many states, Florida excludes most single adults without children, like Bates, from Medicaid eligibility, making it exceedingly uncommon for a Medicaid patient to have been admitted as an uninsured adult.

Gunshot survivors endure bleeding and oozing flesh wounds and pain, and they experience . “These experiences are common, but they are not talked about,” Kaufman said. “Mental health is part of the recovery process.”

Recovering the ability to walk or use an arm or a leg after a gunshot wound requires rehab and physical therapy that can be out of financial reach for uninsured patients, said , a pediatric surgeon and an associate professor at the University of Maryland who that uninsured patients hospitalized for traumatic injuries have shorter stays than insured patients.

A shorter stay, he said, “suggests that these patients are not getting the same level of care, and that’s going to put them at risk for functional deficits down the road.”

He said it is impossible to arrive at a set number of days that any patient should remain in a hospital. Factors include the severity of their injury, their age, and any other illnesses they have.

“We’re looking for that Goldilocks length of stay,” Englum said, “and unfortunately, it is not perfectly defined for any specific admission, and it’s not perfectly defined for any specific patient.”

‘Oh, Shit. He Shot Me.’

Bates had delivered her last order for the night when she was shot. It was December 2019: As she was walking back to her car, she heard two loud bangs. Just kids playing pranks, she thought to herself. Then she turned toward the sound and saw a gun pointed at her.

“In that split second it registered in my mind, like, ‘Oh, shit. He shot me,’” Bates said. “I had some brief, like, burning, but it wasn’t registering in my brain right away what it was.”

Within seconds, Bates said, the stranger emptied the clip of his handgun into her body, even after she fell to the ground. He shot her seven times — twice in the back and once each in the pelvis, stomach, left forearm, right thumb, and right foot.

Bates screamed. She reached for her cellphone to call 911. She said residents came out of their apartments. Someone took her phone to tell the emergency dispatcher the address. Another person pressed towels on her wounds to slow the bleeding. An ambulance rushed her to Tallahassee Memorial.

Bates said she did not believe race was a factor in the care she received. But she believed that the circumstances surrounding her shooting — that it happened while she was working, and that she did not know the shooter — affected the way doctors and nurses viewed her.

Language in medical records can sometimes signal a bias in clinicians and perpetuate differences in care that patients receive, said , an associate professor at the Boston University School of Public Health who conducts research on exposure to gun violence.

Jay said bias based on patients’ race, income, or insurance status can deny some people necessary treatment once they leave the hospital.

He said his research suggests the healthcare system treats gunshot survivors and motor vehicle accident victims differently based on perceptions of “whether the victim was in no way at fault. They made assumptions when a person was violently shot.”

“The results are consistent with what we hear so much from hospital outreach workers for gunshot victims,” he said. “They say there is substantial bias. There is an assumption that they contributed to their condition with risky behavior.”

The preoperative notes in Bates’ medical records describe her as “a pleasant 39-year-old female who sustained multiple gunshot wounds to her abdomen, pelvis and extremities last night after performing Uber Eats delivery.”

Bates said it mattered to her caregivers what she was doing when she was shot.

“The nurses and doctors, they all talk about that stuff,” she said. “They were like, ‘Oh, my God, you were ambushed. That’s so scary.’

“I was working. Like, I don’t know these people. And the fact that they were teenagers, I think that that is what maybe changed the narrative,” she said. “Because I feel a lot of times people blame you for what happened.

“But when I was asked and I told them what happened and my story and how I got there,” she said, “I think just the shock in people’s eyes of like, ‘Oh, my God. So you really were, like, you know, minding your business.’”

She added: “And it also wasn’t in a sketchy part of town, if I can just say that. I was in a predominantly white complex. So I think that’s what saved me.”

‘Less Than a Human Being’

Bates had received care at the hospital before as an insured patient.

She had lost her job in the legal department of a state agency — along with her insurance — two months before she was shot.

As an uninsured patient, Bates said, “they kind of just dismiss you. It makes you feel like less than a human being.”

She said she felt ignored when she told doctors she didn’t feel safe going home after four days. She said the physical therapist working with her at the hospital had persuaded the facility to let her stay an extra day.

“We would like, as a medical community, I think as a society, to see everybody get the same care,” said Englum, the University of Maryland trauma surgeon. “Regardless of what color their skin is, what insurance status they have — we want them to get appropriate care.”

The reason for racial or ethnic differences in care is hard to tease out, Englum said. Is it that there’s mistrust of the medical system in some Black and Latino communities, leading people to avoid going to rehab because they don’t want to be there? Is it an income issue? Is it that medical providers see some patients and, due to implicit or explicit bias, think, “That’s as good as they’re going to get?”

“Getting that care is what you need to get your full functional outcome back. And if you’re not getting it,” he said, “patients are suffering that didn’t have to.”

At home, Bates said, she depended on family members to help her out of bed, drive her places, even help her feel safe out in public.

“I really didn’t know how to stand or move or walk around,” she said. “I had to figure it out.”

She still fears loud noises, which remind her of being shot. Bates said she and her dog stay indoors on July Fourth and New Year’s Eve.

“The fireworks were going off, and I was paralyzed,” Bates said of her first New Year’s Eve after being shot. “I was literally sitting there crying. My cousin actually came outside and put my noise-canceling headphones on and turned the music on so that I couldn’t hear anymore. That’s the only way that I could move from outside to inside.”

Bates said her follow-up care included getting her stitches removed at an orthopedic clinic that has physicians who work at the hospital and had performed the initial surgery.

During the visit, Bates said, the orthopedic clinic’s staff reminded her of the unpaid balance from her surgery, which was about $1,200 for physician services. She still owed the hospital $52,000 for treatment, according to her medical bills, and an additional $5,300 for the anesthesiologist. Bates was not working at the time.

Bates said a community outpatient clinic provided physical therapy at a reduced cost and that the victim advocate unit at the Tallahassee Police Department helped find her mental health counseling and get her financial aid from Florida’s .

By 2021, Bates developed a cyst on the gunshot wound to her right thumb, which required surgery. But, she said, the clinic would not perform the surgery until she paid her $1,200 balance. She said friends paid the bill so she could have the surgery.

Bates’ knee bothered her. “Even with going through physical therapy,” she said, “it was still like I couldn’t feel it.”

Bates said she now has private health insurance that pays for her mental health therapy. She pays for physical therapy out-of-pocket.

“It’s crazy that in this country somebody else can hurt you,” Bates said, and “you have to pay for what they did to you.”

“So it’s like you’re triple-paying: You’re paying every day mentally, you’re paying with the bills, and you’re paying by them saying, We know that this is not your fault, but we still have to make our money.”

Methodology

The Trace and Ñî¹óåú´«Ã½Ò•îl Health News examined more than 20 million inpatient hospitalizations in Florida from 2018 to 2024, using data obtained from the Florida Agency for Health Care Administration. We identified 20,255 gunshot wound-related visits using the Centers for Disease Control and Prevention’s injury surveillance case definition, which relies on diagnosis codes. We limited the analysis to initial encounters and excluded patients who died in the hospital or left against medical advice. We excluded cases in the top 1% for hospital length of stay (68 days or more) to prevent these outliers from disproportionately influencing results.

Our primary finding compares the average length of stay of uninsured patients with that of privately insured patients. We chose privately insured patients as the reference group because many researchers believe their care on average is long enough to be effective but not longer than medically necessary. Overall, uninsured patients had hospital stays that were about 25% shorter on average than privately insured patients’ and 50% shorter than those of patients on traditional Medicaid. In most cases we also found that, within the same hospital, uninsured patients had shorter stays than privately insured ones.

To assess whether age or injury severity explained the shorter lengths of stay for uninsured patients, we calculated and fit regression models for Florida’s highest-volume gunshot wound hospitals. We found that, in nearly all cases, the gap narrowed slightly but did not disappear.

Ñî¹óåú´«Ã½Ò•îl Health News data editor Holly K. Hacker contributed to this report.

This article was produced in partnership with The Trace, a nonprofit newsroom covering gun violence in America. .

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

When she graduated from high school, she enrolled at Brown University, the scene of another shooting in December 2025, while she was studying for finals in her dorm room.

As messages flooded in about an active shooter on campus, she felt pain where she had been shot in the stomach. The college junior experienced a phenomenon she called “phantom bullet syndrome,” similar to phantom limb syndrome, in which someone senses something is there that is not. It occurs whenever she feels extremely stressed, she said.

“It’s crazy to say that the first time, I was the lucky one because though I got shot, I didn’t get killed,” said Tretta, now an anti-gun violence advocate who is studying public affairs and education. “And the second time, I was the lucky one because I was a few blocks away.”

Tretta represents a cohort of young people who have lived through more than one shooting. She also embodies the findings of a recent study that links gun violence exposure to chronic pain.

The study, in January, found that both direct and indirect exposure to gun violence are linked to higher rates of among American adults.

Rutgers University researchers studied six types of gun violence exposure: being shot, being threatened with a gun, hearing gunshots, witnessing a shooting, knowing a friend or family member who was shot, and knowing someone who died by firearm suicide. Using a nationally representative survey of 8,009 people, they found that 23.9% had pain most days or every day, while 18.8% said they had a lot of pain.

Daniel Semenza, the study’s lead author, told The Trace that whether someone has lost a person to gun violence or they’ve been shot themselves, their mental and physical health are inextricably linked.

“Your body, through the experience of post-traumatic stress, is going to feel as if it’s happening over and over and over again,” said Semenza, the director of research at the New Jersey Gun Violence Research Center and an associate professor at Rutgers University.

Tretta to remove the bullet, she said, and later received a nerve block to address ongoing pain from her injuries. But the bullet fragments remain in her body years later, she said.

She was also diagnosed with psoriatic arthritis — a chronic disease causing swelling, pain, and stiffness in the joints.

“I have dealt with chronic pain, immunodeficiencies, and bodily differences ever since the shooting happened,” Tretta said. “Every time I get a fever, it’s a completely different thing than anyone else I know, or even pre-shooting for me. I shake uncontrollably, and it hurts to even touch my arm.”

The is one of the first to focus on outcomes like chronic pain as part of an emerging body of work on the physical health toll of gun violence exposure.

“It highlights the fact that, for the thousands of people who are killed every year, there are lots of people who knew those folks,” Semenza said. “The toll of gun violence is much broader than we originally anticipated.”

Efrat Eichenbaum, an inpatient psychologist who has treated gun violence survivors and their families at a Level 1 trauma center in north Minneapolis, said the study accurately reflects what she has seen in her clinical work.

“You can plainly see the trauma that follows an event like that,” she said. “Not just for the survivors, but for their families. It does not even limit itself to family members. This is an issue that touches entire communities.”

David Patterson, an emeritus professor at the University of Washington whose work focuses on pain, says the study shows, in particular, just how far the impact of gun violence fans out and how costly a problem it is for society.

“Chronic pain is a major health problem in itself, and it because it’s very hard to manage,” he said. “You can’t cure it; it has to be managed.”

Back in her dorm room at Brown, Tretta explained that medical care does not end when someone leaves the hospital after a trauma like hers. It goes on for years.

“Your body will never be the same as it was before,” she said. “There’s no time that you can’t feel the 7 or 8 inches of scar tissue running through the middle of your stomach. It’s just a constant physical reminder, because you can’t leave your body.”

This article was reported by The Trace, a nonprofit newsroom covering gun violence in America. .

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

The effort, part of Baltimore’s more than $100 million gun violence prevention plan, relies on staffers like Fitzgerald to build trust with people at risk of such violence and offer them resources like housing or food. Researchers believe these programs reduce gun deaths.

Yet one morning in 2019, Fitzgerald said, his oldest son, Deshawn McCoy, then 26, was shot just outside of the neighborhood he patrolled at the time. Fitzgerald said McCoy was a “really beautiful soul,” who fixed dirt bikes at a local garage. McCoy became the city’s , one of 348 that year, among the city’s deadliest. He left behind three daughters.

“This is our zone,” said Fitzgerald, pointing toward McElderry Park. “My son got cooked over here.”

For years, violence intervention was the work of loosely organized, underfunded groups. Then gun violence spiked during the covid pandemic and the Biden administration and Congress poured in money to better integrate such programs within cities. It appeared to help: In Baltimore and beyond, gun violence has plummeted.

The number of homicides in the city dropped 41%, from more than 300 a year in 2021 to 201 in 2024, according to the U.S. attorney’s office in Maryland.

“Gun violence is a sticky, hard problem to solve,” said Daniel Webster, a researcher at the Johns Hopkins Center for Gun Violence Solutions in Baltimore. “We’re getting it right finally.”

Now President Donald Trump’s administration has gutted funding for that work.

Webster said it could take years to untangle what led to the city’s gun violence drop. Among the factors, he said: the pandemic’s end, investments in violence intervention, improvements that have given police more legitimacy in neighborhoods, targeted prosecutions, and an aggressive effort to remove untraceable ghost guns.

“You need all of these systems working well to have systemic reductions in gun violence,” he said.

The Trump administration has slashed funding for gun violence prevention and research, cutting about $500 million in grants to organizations that support public safety.

At the same time, Trump has loosened gun laws the Bureau of Alcohol, Tobacco, Firearms and Explosives, which oversees gun dealers. He has also sent federal troops into the Democratic-led cities of Chicago; Los Angeles; Memphis, Tennessee; Portland, Oregon; and Washington, D.C.

Webster said cities are still benefiting from pandemic-era efforts to address gun deaths. But given the Trump policy changes, if violence escalates, city leaders could have a hard time keeping it from spiraling out of control.

Trying Something Different

Safe Streets is among the promising violence prevention programs that could lose funding. Staffers in the city’s most violent neighborhoods operate like community health workers.

During the pandemic, the Biden administration provided billions of dollars to local governments through the American Rescue Plan Act. Biden urged them to deploy money to community violence intervention programs, which have been shown to by as much as 60%. His administration allowed states to spend Medicaid dollars on such programs. The goal: Stop gun deaths.

Few cities seized the opportunity.

Analyzing federal data, professors Philip Rocco of Marquette University and Amanda Kass of DePaul University found local governments used the ARPA money for 132,451 projects. Yet only 231, less than 0.2%, involved community violence intervention, they said.

In Baltimore, then-newly elected mayor Brandon Scott was ready for the federal influx.

Baltimore’s homicide rate had been high since 2015, when a 25-year-old Black man named Freddie Gray died in police custody. Protests erupted and fractures between residents and police deepened. Baltimore ended the year with 342 homicides, the first time since 1999 that more than 300 were recorded in the city.

“We got really good at our jobs” in the years after Gray’s death, said James Gannon, trauma program manager at Sinai Hospital of Baltimore.

Gun deaths tracked what public health researcher Lawrence T. Brown called the : racially segregated areas that fanned out across Baltimore’s eastern and western neighborhoods around a wealthy central strip. People who faced years of forced displacement and disinvestment became prone to violence, which fueled the cycle.

Every year from 2015 to 2022, the city recorded at least 300 homicides.

“We had to try something different,” said Stefanie Mavronis, director of the Mayor’s Office of Neighborhood Safety and Engagement. Scott created the agency weeks after he was sworn into office in 2020, later with $50 million in ARPA money and $20 million annually from the city’s budget.

Containing an Outbreak

The office’s budget — $22 million in fiscal year 2026 — is a fraction of the city’s .

Still, the money allowed Baltimore’s leaders to scale up a new approach: addressing gun violence the way public health officials might handle an infectious disease outbreak, Mavronis said.

City staffers identified the small subset of people most at risk of being shot or becoming the next shooter through crime data and referrals from social service workers, hospitals, and violence intervention staff, she said. Mavronis said that gangs, friends willing to engage in violence for each other, and retaliation had been driving gun deaths in the city.

“This never-ending cycle of violence and loss and trauma,” Mavronis said, “comes from that.”

The city convened hospital presidents to connect gunshot victims and their friends and family to counseling, crisis support, and city services.

It offered people help finding therapy, a job, or emergency relocation — and threatened arrest and prosecution if they retaliated.

“We decided that we were no longer going to subscribe to the belief that one thing, one agency, one part of government, one program was going to help cure Baltimore of this disease of gun violence that has had a stranglehold on this city for the entirety of my life,” Scott said.

The Coming Cliff

Baltimore is on pace this year to post its fewest gun deaths since Richard Nixon was president.

“Some of it is the national zeitgeist of the moment,” said Adam Rosenberg, executive director of Center for Hope at LifeBridge Health, which operates Safe Streets sites and the Violence Response Team at Sinai Hospital. He credits mainly the infusion of funding that allowed more resources and hands-on engagement with high-risk communities.

“We typically talk about how poverty affects homicides, but it works in reverse too,” Webster said. “People don’t invest in homes and businesses or, frankly, in people, where people get shot regularly.”

Fitzgerald, who grew up in East Baltimore, said he started working for Safe Streets in 2010 for the paycheck.

He’s been on both sides of gun violence, he said, as someone hit more than a dozen times in shootings — first when he was 12. At 13, Fitzgerald said, he shot a cousin in the leg. Over years, he was in and out of the criminal justice system, including for charges of attempted murder, which helped him understand the people he now works with every day, he said.

No college “can certify you in my experiences in violence,” he said. “That’s what allows me to identify and detect potentially violent situations.”

Today, Fitzgerald, 49, believes that teaching kids trauma coping mechanisms can drive culture change and stop shootings.

“Our kids see more death than soldiers,” he said.

But federal funding is drying up. Anthony Smith, executive director of , which supports local leaders on gun violence reduction, estimates that about 65 groups have lost funding this year. And Trump’s signature legislation slashes nearly $1 trillion in anticipated federal Medicaid spending over the next decade.

Center for Hope lost $1.2 million from federal cuts.

“It’s like a car racing along, and you see the cliff coming,” Rosenberg said. “I don’t know if the resources are there anymore, but the need certainly is.”

Rosenberg said that, because of their experiences, staffers such as Fitzgerald are “incredible messengers” for people involved in gun violence, and he noted that they are thoroughly vetted.

Fitzgerald put it this way: “I’m trying to save my kids, the community. The people we’re trying to save is our friends and our family, and ourselves.”

Ñî¹óåú´«Ã½Ò•îl Health News senior correspondent Fred Clasen-Kelly contributed to this report.

If you or someone you know have experienced the pain of a gunshot wound, and are willing to talk about the medical experience, please fill out our form here.

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

“When you get shot,” he said, “you stop thinking about the future.”

He is anchored by his wife and child and faith. He once wanted to work as a forklift driver but has built a stable career in information technology. He finds camaraderie with other gunshot survivors and in advocacy.

Still, trauma remains lodged in his daily life. As gun violence surged in the shadows of the covid pandemic, it shook Harris’ fragile sense of security. He moved his family out of Philadelphia to a leafy suburb in Delaware. But a nagging fear of crime persists.

Now he is thinking about buying a gun.

Harris is one of tens of thousands of Americans killed or injured each year by gun violence, a public health crisis that escalated in the pandemic and churns a into a hospital emergency room every half hour.

Over the past two decades, the firearm industry has and stepped up sales campaigns through social media influencers, conference presentations, . An industry trade group acknowledged that its traditional customer was “” and in recent years began targeting and who are disproportionately victimized by gun violence.

The Trump administration has moved to reduce federal oversight of gun businesses, announced by the Bureau of Alcohol, Tobacco, Firearms and Explosives as “marked by transparency, accountability, and partnership with the firearms industry.”

The pain of gun violence crosses political, cultural, and geographic divides — but no group has suffered as much as Black people, such as Harris. They were nearly 14 times as likely to die by gun homicide than white people in 2021, , citing federal data. Black men and boys are 6% of the population but of homicide victims.

Washington has offered little relief: Guns remain one of few consumer products the federal government for health and safety.

“The politics of guns in the U.S. are so out of whack with proper priorities that should focus on health and safety and most fundamental rights to live,” said attorney Jon Lowy, founder of , who helped represent Mexico in an unsuccessful lawsuit against Smith & Wesson and other gunmakers that reached the Supreme Court. “The U.S. allows and enables gun industry practices that would be totally unacceptable anywhere else in the world.”

Ñî¹óåú´«Ã½Ò•îl Health News undertook an examination of gun violence during the pandemic, a period when firearm deaths reached an all-time high. Reporters reviewed academic research, congressional reports, and hospital data and interviewed dozens of gun violence and public health experts, gun owners, and victims or their relatives.

The examination found that while public officials imposed restrictions intended to prevent covid’s spread, politicians and regulators helped fuel gun sales — and another public health crisis.

As state and local governments schools, advised residents to stay home, and closed gyms, theaters, malls, and other businesses to stop covid’s spread, President Donald Trump kept gun stores open, critical to the functioning of society.

White House spokesperson Kush Desai did not respond to interview requests or answer questions about the Trump administration’s efforts to reduce regulation of the firearm industry.

During the pandemic, the federal government gave firearm businesses and groups more than $150 million in financial assistance through the Paycheck Protection Program, even as some businesses reported brisk sales, according to from Everytown for Gun Safety, an advocacy group.

Federal officials said the program would keep people employed, but millions of dollars went to firearm companies that did not say whether it would save any jobs, the report said.

About bought a gun during the first two years of the pandemic, including millions of first-time buyers, according to survey data from NORC at the University of Chicago.

Harris is keenly aware of what drives the demand.

“Guns aren’t going away unless we get to the root of people’s fears,” he said.

most Americans who own a gun feel it makes them safer. But public health data suggests that owning a gun of homicide and triples chances of suicide in a home.

“There’s no evidence that guns provide an increase in protection,” said Kelly Drane, research director for the . “We have been told a fundamental lie.”

Record Deaths

Less than a year into the pandemic, 20-year-old Jacquez Anlage was shot dead in a Jacksonville, Florida, apartment. Five years later, the killing remains unsolved.

His mother, Crystal Anlage, said she fell to her knees and wailed in grief on her lawn when police delivered the news.

She said Jacquez overcame years in the foster care system — living in 36 homes — before she and her husband, Matt, adopted him at age 16.

Jacquez Anlage had just moved into his own apartment when he was shot. He loved animals and wanted to become a veterinary technician. He was kind and loving, Crystal Anlage said, with the 6-foot-4, 215-pound physique of the football and basketball player he’d been.

“He was just getting to a point in life where he felt safe,” Crystal Anlage said.

Gun violence researchers say parents like Crystal Anlage carry trauma that destroys their sense of security.

Anlage said she endures post-traumatic stress disorder and anxiety. She is terrified of guns and fireworks.

But she has made something meaningful of her son’s killing: She co-founded the Jacksonville Survivors Foundation, which works to raise awareness about the impact of homicide and to support grieving parents.

“Jacquez’s death can’t be in vain,” she said. “I want his legacy to be love.”

His legacy and that of other young men killed by guns is muted by firearm manufacturers’ powerful message of fear.

During the pandemic, gun marketers told Americans they needed firearms to defend themselves against criminals, protesters, unreliable cops, and , filed by gun control advocacy groups with the Federal Trade Commission.

In a since-deleted June 18, 2020, from Lone Wolf Arms, an Idaho-based manufacturer, a protester is depicted being confronted by police officers in riot gear between the words “Defund Police? Defend Yourself,” the petition shows. The caption says, “10% to 25% off demo guns and complete pistols.”

Impact Arms, an online gun seller, on Instagram on Aug. 3, 2020, showing a person putting a rifle in a backpack, the document says. “The world is pretty crazy right now,” the caption reads. “Not a bad idea to pack something more efficient than a handgun.”

The National Rifle Association in 2020 posted on YouTube a of a Black woman holding a rifle and telling viewers they need a gun in the pandemic. “You might be stockpiling up on food right now to get through this current crisis,” she said, “but if you aren’t preparing to defend your property when everything goes wrong, you’re really just stockpiling for somebody else.”

The messaging worked. Background checks for firearm sales soared 60% from , the year the federal government declared a public health emergency.

The same year, more than , the highest number up till then. In 2021, was broken again.

Weapons sold at the beginning of the pandemic were more likely to wind up at crime scenes within a year than in any previous period, according to by Democrats on Congress’ Joint Economic Committee, citing ATF data.

Gun manufacturers “used disturbing sales tactics” following mass shootings in Buffalo, New York, and Uvalde, Texas, “while failing to take even basic steps to monitor the violence and destruction their products have unleashed,” according to a released by congressional Democrats in July 2022 following a House Oversight and Reform Committee investigation of industry practices and profits.

The firearm industry has marketed “to white supremacist and extremist organizations for years, playing on fears of government repression against gun owners and fomenting racial tensions,” the House investigation said. “The increase in racially motivated violence has also led to rising rates of gun ownership among Black Americans, allowing the industry to profit from both white supremacists and their targets.”

In 2024, then-President Joe Biden’s Department of the Interior provided a to the National Shooting Sports Foundation, a leading , to help companies market guns to Black Americans.

The Federal Trade Commission is responsible for protecting consumers from deceptive and unfair business practices and has the power to take enforcement action. It issued warnings to companies that made unsubstantiated claims their products could prevent or treat covid, for instance.

But when families of gun violence victims, lawmakers, and advocacy groups in 2022, during Biden’s term, how firearms were marketed to children, people of color, and groups that espouse white supremacy, officials did not announce any public action.

This summer, the National Shooting Sports Foundation pressed its and derided “a coordinated ‘lawfare’ campaign” that it said gun control groups have waged against “constitutionally-protected firearm advertising.”

FTC spokesperson Mitchell Katz declined to comment, saying in an email that the agency does not acknowledge or deny the existence of investigations.

Serena Viswanathan, who retired as an FTC associate director in June, told Ñî¹óåú´«Ã½Ò•îl Health News that the agency lost at least a quarter of the staff in its advertising practices division after Trump came into office in January.

Gun companies Smith & Wesson, Lone Wolf Arms, and Impact Arms did not respond to requests for comment. Neither did the National Shooting Sports Foundation or the NRA.

In an August 2022 , Smith & Wesson President and CEO Mark Smith said gun manufacturers were being wrongly blamed by some politicians for the pandemic surge in violence, saying cities experiencing violent crime had “promoted irresponsible, soft-on-crime policies that often treat criminals as victims and victims as criminals.”

He added, “Some now seek to prohibit firearm manufacturers and supporters of the 2nd Amendment from advertising products in a manner designed to remind law-abiding citizens that they have a Constitutional right to bear arms in defense of themselves and their families.”

Guns and Race

In 2015, the National Shooting Sports Foundation gathered supporters at a conference in Savannah, Georgia, and urged the firearm industry to diversify its customer base, according to a and reports from and the .

Competitive shooter Chris Cheng gave a presentation called “Diversity: The Next Big Opportunity.” Screenshots from the conference include slides purporting to show “demographics,” “psychographics,” and “technographics” of Black and Hispanic shooters.

The slides described Black shooters as “expressive and confident socially, in a crowd” and “less likely to be married and to be a college grad.” They said Hispanic shooters were “much more trusting of advertising and celebrities.”

Nick Suplina, senior vice president for law and policy at Everytown for Gun Safety, said industry marketing shifted in the latter half of the 20th century as the popularity of hunting declined. The new sales pitch: guns for personal safety.

“They said, ‘We need to break into new markets,’” Suplina said. “They identified women and people of color. They didn’t have a lot of success until the pandemic, the Black Lives Matter movement, and the death of George Floyd. The marketing says, ‘You deserve the Second Amendment too.’ They are selling the product as an antidote to fear and anxiety.”

Gun manufacturers were harshly criticized in the Oversight Committee’s 2022 investigation for marketing products to people of color, as gun violence remains a leading cause of death for young Black and Latino men.

At the same time, some companies also promoted assault rifles to white supremacist groups who believe a race war is imminent, the investigation found. One company sold an AK-47-style rifle called the “Big Igloo Aloha,” a reference to an anti-government movement, it said.

Still, Philip Smith wants more Black people to get guns for protection.

Smith said he was working as a human resources consultant a decade ago when he got the idea to form the , which helped the National Shooting Sports Foundation compile its report on communicating with Black consumers.

Smith encourages Black people to buy firearms for self-defense and get proper training on how to use them.

After 10 years, Smith said, his group has about 45,000 members nationwide. Single members pay $39 a year and couples $59, which gives them access to discounts from the organization’s corporate partners, including gunmakers, and raffles for gun giveaways, according to its website.

The police killing of Michael Brown in Ferguson, Missouri, and the shooting death of Florida teenager Trayvon Martin helped spark early interest from doctors, lawyers, and others in joining the group, he said. But interest took off during the pandemic, he said, even among Democrats who had resisted the idea of owning a gun.

“Hundreds of people called me and said, ‘I don’t agree with anything you’re saying, but what kind of gun should I buy,’” Smith recalled.

Smith, describing himself as “quiet, nerdy, and Afrocentric,” said criticism of guns misses the point.

“My ancestors bled for us to have this right,” he said. “Are there some racist white people? Yes. But we should buy guns because there is a need. No one is forcing us to buy guns.”

‘American Amnesia’

During the pandemic, gun violence took its greatest toll on racially segregated neighborhoods in places such as Philadelphia, where roughly residents live in poverty.

A says a one-year period in the pandemic saw more than 2,300 shootings, or about six a day. Many of the cases haven’t been solved by police.

City officials cited the boom in gun sales in the report: Fewer than 400,000 sales took place in Pennsylvania in 2000, but in 2020 it was more than 1 million.

Gun sales since the pandemic ended, but the harm they’ve caused persists.

At a conference last year inside the Eagles’ football stadium, victims of firearm violence or their relatives joined activists to share accounts of near-death experiences and the grief of losing loved ones.

Paintings flanked the stage and the meeting space to commemorate people who had been fatally shot, nearly all young people of color, under messages such as “You are loved and missed forever” and “Those we love never leave.”

Marion Wilson, a community activist, said he believes the nation has forgotten the suffering Philadelphia and other cities endured during the pandemic.

“We suffer from the disease of American amnesia,” he said.

Harris was on his way home from a job at Burlington Coat Factory nearly two decades ago when robbers followed him from a bus stop and demanded money. He said he had none and was shot.

Harris had spent his early life fixing cars with his grandfather, when he wasn’t at school or attending church. He remembers lying in a hospital bed, overcome with a sense of helplessness.

“I had to learn to feed myself again,” he said. “I was like a baby. I had to learn to sit up so I could use a wheelchair. The only way I got through it was my faith in God.”

Harris endured years of rehabilitation and counseling for PTSD. As someone in a wheelchair, he said, he sometimes fears for his safety — and a gun may be one of the few ways to protect himself and his family.

“I’m mulling it over,” Harris said. “I’m afraid of my trauma hurting someone else. That’s the only reason I haven’t gotten one yet.”

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She found Forbes face down in the street in August 2023, two weeks before he had planned to move away from the empty storefronts, boarded-up houses, and poverty that make this one of the most troubled places in the nation.

Naketra Guy thought about how her son overcame losing his father at age 4 and was the glue of the family. She called him “humble” and “respectful,” a leader in the community and on the football field, where he shined.

Yet he could not outrun the grim statistics of his hometown. Bogalusa posts some of the worst health outcomes and poverty in Louisiana, a state that routinely ranks among the worst nationally in both. And Bogalusa has endured another indicator of poor public health: high levels of gun violence.

Since the beginning of the covid-19 pandemic, gun violence has shattered any sense of peace or progress here. Louisiana suffers the nation’s second-highest firearm — and Bogalusa, a predominantly Black community with 10,000 residents, has seen dozens of shootings and a violent crime rate approaching twice the national average.

A nearby team refused to play football at Bogalusa High School in fall 2022, .

Bogalusa’s mayor, Tyrin Truong, was elected in 2022 at age 23 on his promises to fix entrenched challenges: few youth programs and good jobs, and perpetual crime and blight.

“I ran for mayor because I got sick of seeing our city painted as mini-New Orleans,” he said, “due to the high levels of youth gun violence.”

In January, the Louisiana State Police , accusing him of soliciting a prostitute and participating in a drug trafficking ring that allegedly used illicit proceeds to buy firearms. He has . “I still haven’t been formally arraigned,” he told Ñî¹óåú´«Ã½Ò•îl Health News in late July, “and I haven’t been charged with anything.”

Every year tens of thousands of Americans — — are killed by gun violence on the scale of a public health epidemic.

Many thousands more are left to recover from severe injuries, crushing medical debt, and the mental health toll of losing loved ones.

Most headlines focus on America’s urban centers, but the numbers also reflect the growth of gun violence in places like Bogalusa, a pinprick of a town 75 miles north of New Orleans. In 2020, the gun violence death rate for rural communities than in large metropolitan areas, according to Johns Hopkins University.

Firearms are the No. 1 killer of children in the U.S., and no group suffers more than . More Black boys and men ages 15 to 24 in 2023 than from the next 15 leading causes of deaths combined. Though overall U.S. homicides after the pandemic ended, adolescent gun deaths climbed even higher in the years after, according to , an associate professor in the School of Public Health at Boston University.

“It has all the markers of an epidemic. It is a major driver of death and disability,” Jay said. “Gun violence does not get the attention it deserves. It is underrecognized because it disproportionately impacts Black and brown people.”

Rather than bolstering efforts to save lives, federal, state, and local government officials have undermined them. Ñî¹óåú´«Ã½Ò•îl Health News undertook an examination of gun violence since the pandemic, a period when firearm death rates surged. Reporters reviewed government reports and academic research and interviewed dozens of health policy experts, activists, and victims or their relatives. They reviewed corporate earnings reports from gun manufacturers and to politicians.

In polling published in 2023 by KFF, said they or a family member had been impacted by gun violence such as by seeing a shooting or being threatened, injured, or killed with a gun.

American politicians and regulators have put in place laws and practices that have helped enrich firearm and ammunition manufacturers — which tout — even as already damaged by white flight, systemic disinvestment, and other forms of racial discrimination.

President Donald Trump championed gun rights on the campaign trail and has from the National Rifle Association, , “No one will lay a finger on your firearms.” His administration has rolled back efforts under President Joe Biden to address the rise in gun violence.

Emboldened in his second term, Trump to in schools, weaken federal oversight of the gun industry, override state and local gun laws, permit sales , and cut funding for violence intervention.

Trump to review all Biden administration actions that “purport to promote safety but may have impinged on the Second Amendment rights of law-abiding citizens.”

The Biden administration said “” during the pandemic took its greatest toll on racially segregated and high-poverty neighborhoods.

Black youths in four major cities were as white ones to experience a firearm assault, research showed. Gun suicides reached an all-time high, and for the first time the firearm suicide rate among older Black teens surpassed that of older white teens.

In Bogalusa, the pandemic gun violence spread fear. Among the victims killed were a 15-year-old attending a birthday party and a 24-year-old nationally known musician. Thirteen people were injured at a memorial for a man who himself had been shot. Residents said neighbors stopped sitting in their yards because of stray bullets.

Researchers say communities like Bogalusa endure a collective trauma that shatters their sense of safety. Two years after , his mother says that when she leaves home her surviving children worry that she, too, might get shot.

Repercussions from the surge will last years, researchers said: Exposure to shootings increases risk for post-traumatic stress disorder, anxiety, suicide, depression, substance abuse, and poor school performance for survivors and those who live near them.

“We saw gun violence exposure go up for every group of children except white children, in the cities we studied,” Jay said. “Limits on government funding into gun violence research may stop us from ever knowing exactly why.”

Politics of Pain

The year before Forbes died in Bogalusa, Biden signed into law the Bipartisan Safer Communities Act, considered the in decades.

In a matter of months, Trump has systematically dismantled key provisions.

Efforts to regulate guns have long proven ineffective against the power of political and business interests that fill the streets with weapons. In 2020, the number of guns manufactured annually in the U.S. hit 11.3 million, more than double a decade earlier, according to . In 2022, the United States had nearly 78,000 , more than its combined number of McDonald’s, Burger King, Wendy’s, and Subway locations, according to Everytown for Gun Safety, an advocacy group.

The Biden administration it would attempt to reduce gun violence by adopting a “zero tolerance” policy toward firearm dealers who committed violations such as failing to run a required background check or selling to someone prohibited from buying a gun.

The federal Bureau of Alcohol, Tobacco, Firearms and Explosives, or ATF, which licenses gun dealers, has the authority to enforce laws meant to prevent illegal gun sales. In issuing an executive order, the Trump administration , under Biden, the agency targeted “mom-and-pop shop small businesses who made innocent paperwork errors.”

From October 2010 to February 2022, the agency conducted more than 111,000 inspections, recommending revocation of a dealer’s license only 589 times, about 0.5% of cases, an inspector general’s report said. Even when it cited serious violations, the ATF rarely shut dealers down.

ATF leaders that recommendations for license revocations increased after Biden’s zero-tolerance policy was implemented. In April, the Trump administration .

Surgeon General Vivek Murthy last year declared firearm violence a public health crisis. Within weeks of Trump’s inauguration, the advisory. Of the 15 leading U.S. causes of death, firearm injuries received less research funding from the National Institutes of Health for each person who died than all but poisoning and falls, according to in 2024 by Brady, an anti-gun violence organization. that funding, too.

Trump’s Department of Justice abruptly cut 373 grants in April for projects worth about $820 million, with a large share from gun violence intervention.

“We are going to lose a generation of community violence prevention folks,” said Volkan Topalli, a gun violence researcher at Georgia State University. “People are going to die, I’m sorry to say, but that is the bleak truth of this.”

Asked about its policies, the White House did not address questions about public health considerations around gun violence.

“Illegal violence of any sort is a crime issue, and President Trump has been clear since Day One that he is committed to Making America Safe Again by empowering law enforcement to uphold law and order,” White House spokesperson Kush Desai said.

Trump administration officials “want safer streets and less violence,” Topalli said. “They are hurting their cause.”

Garen Wintemute, an emergency medicine professor who directs the violence prevention program at the University of California-Davis, was among the first in the nation to consider guns and violence as a public health issue. He said race plays a significant role in perceptions about gun violence.

“People look at the demographic risk for firearm homicide and depending on the demographics of the people in the audience, I can see the transformation in their faces,” Wintemute said. “It’s like they’re saying, ‘Not my people, not my problem.’”

Eroding Gun Restrictions

Trump’s incursions against public health efforts to contain gun violence are backed by lobbying power.

Firearm industry advocacy groups made millions of dollars in political donations in recent years, mostly to conservative causes and Republican candidates. That includes $1.4 million to Trump, , which tracks campaign finance data.

The assassination of civil rights icon the Rev. Martin Luther King Jr. helped lead to the passage of the federal , which imposed stricter licensing rules and outlawed the sale of firearms and ammunition to felons.

While it remains the law of the land, over time, federal and state government actions have significantly weakened its protections.

Most states now concealed weapons without a permit or background check, even though the practice can increase the risk of firearm homicides.

In Louisiana, Democratic former Gov. John Bel Edwards, in office from 2016 to 2024, that would have allowed people to carry concealed firearms without a permit.

Elected in 2023, Republican Gov. Jeff Landry to allow any person over age 18 to conceal-carry without a permit.

The Trump administration has created his executive order to end most gun regulations and which would allow more people with criminal convictions, including for domestic abuse, to own guns.

Figures vary, but some researchers estimate as many as 500 million guns circulate in the U.S. Sales reached during the pandemic and publicly traded firearm and ammunition companies saw .

Donald Trump Jr. this summer of GrabAGun, an online gun retailer that went public in July under the stock ticker PEW. In a , the company, which markets guns to people ages 18 to 44, cited “ organizations that oppose sales of firearms and ammunition” as threats to its sales growth.

Dave Workman, a gun rights advocate with the , said firearms are not to blame for the surge in pandemic shootings.

“Bad guys are going to do what bad guys are going to do regardless of the law,” Workman said. “Taking away gun rights is not going to reduce crime.”

David Yamane, a Wake Forest University sociology professor and national authority on guns, said the U.S. firearm debate is complex and the industry is often “painted with too broad a brush.”

Most guns will never be used to kill anyone, he said. Americans tend to buy more guns during times of unrest, Yamane added: “It’s part of the American tradition. Guns are seen as a legitimate tool for defending yourself.”

‘A Low Level of Hope’

Once called “,” Bogalusa has become a grim symbol of deindustrialization.

Bogalusa emerged as Black people formed their own communities in the time of Jim Crow racial segregation at the turn of the 20th century.

Racism concentrated Black people in neighborhoods that , reflected in high rates of cancer, asthma, chronic stress, preterm births, pregnancy-related complications — and, over recent decades, .

Thousands flocked to Bogalusa after the Great Southern Lumber Company built one of the world’s biggest sawmills, establishing Bogalusa as a company town. Racial tensions .

Members of the local gained national attention in the 1960s for protecting civil rights organizers from the Ku Klux Klan, that burned houses and churches, terrorizing and killing Black people.

As the mill changed hands over the decades, Bogalusa’s fortunes slid. In the mid-20th century, the population surpassed 20,000, but it is now about half that.

International Paper, based in Tennessee, runs the mill as a containerboard factory, employing about 650 people. In 2021, the state announced incentives for the company that included a $500,000 tax break, saying the move would help bring “prosperity.”

Businesses remain boarded up along the main drag. Houses still bear damage from Hurricane Katrina, and many streets are eerily quiet.

Nearly 1 in 3 people in Bogalusa live in poverty — 2½ times the national average.

Bogalusa’s violent gun crime rate people in 2022, higher than Louisiana’s and 1.7 times the national one, according to the nonprofit Equal Justice USA, citing FBI Uniform Crime Reporting data.

In many rural towns across the South, “there is a level of desperation that is more apparent” than in other parts of the U.S., said , a of social justice and public policy.

“They don’t have the same infrastructure to have robust social services. People are like, ‘What are my life chances?’” Shaefer said. “People feel like there is nothing that can be done. There is a low level of hope.”

Missed Opportunities

Mayor Truong lamented the violence in Bogalusa after Forbes was killed, , “When are we as a community going to come together and decide enough is enough?”

The federal government had offered one path forward.

The Biden administration provided billions of dollars to local governments through the American Rescue Plan Act during the pandemic. Biden urged them to deploy money to community violence intervention programs, shown to by as much as 60%.

A handful of cities seized the opportunity, but most did not. Bogalusa has received since 2021. None appears to have gone toward violence prevention.

The Louisiana legislative auditor, Michael Waguespack, found that Bogalusa used nearly $500,000 for employee bonuses, which his report said may have violated state law. In some cases, says, payments were not tied to work performed.

Bogalusa officials did not respond to a public records request from Ñî¹óåú´«Ã½Ò•îl Health News seeking detailed information about its ARPA money.

Former Mayor Wendy O’Quin-Perrette, who served from 2015 through early 2023, told Waguespack that the city used ARPA money to improve streets and pay the bonuses. “We would not have done it without being sure it was allowed,” she said.

O’Quin-Perrette did not respond to requests for comment.

In a to Waguespack, O’Quin-Perrette’s successor, Truong, wrote that Bogalusa officials didn’t know how the federal money was spent. When he took office, Truong alleged, officials discovered “tens of thousands of dollars of checks and cash” stashed “in various drawers and on desks” in city offices.

Truong defended his stewardship of ARPA funds, saying that about $1 million remained when he assumed office but that the money was needed for more urgent sewer infrastructure repairs. “I wish we could have invested more, invested any money in gun violence prevention efforts,” he said.

In an interview, Truong said the city has been “intentional” about bringing down gun violence, including through a summer jobs program. He pointed to statistics that show homicides decreased from nine in 2022 to two in 2024. “If you keep them busy, they won’t have time to do anything else,” he said.

Asked about his January arrest, Truong said he has political enemies.

“I’m the only Democrat in a very red part of the state, and, you know, I’ve made a lot of changes at City Hall, and that ticks people off,” Truong told Ñî¹óåú´«Ã½Ò•îl Health News. He said that he ended long-standing city contracts with local businesspeople. “When you’re shaking up power structures, you become a target.”

Josie Alexander, for , said city officials missed an opportunity when they didn’t use ARPA funds for gun violence prevention. “The sad thing is people here can now see that money was coming in,” she said. “But it just wasn’t used the way it needed to be.”

‘Too Much Trouble Here’

Truong said the city is still reeling from the . He said he was at Bogalusa High School’s homecoming football game in 2022 when one teen shot another. Shots rang out, Truong said, and he grabbed his 3-month-old son and “laid in the bleachers.”

“It’s not a foreign topic to hardly anybody in town, whether you’ve heard the gunshots in the distance, whether you have attended a funeral of somebody who passed due to gun violence,” he said. Many still grapple with trauma.

In December 2022, Khlilia Daniels said, she hosted a birthday party for her teenage niece, praying no one would bring a gun.

The hosts checked guests for weapons, she said.

Yet gunfire erupted, Daniels said. Three teens were shot, including , who died, according to police.

“When someone you know is killed, you never forget,” said Daniels, 32, who held Taylor until emergency responders arrived.

Tajdryn Forbes was planning his future when he , likely because of a dispute that started on social media over lyrics in a rap song, Guy said.

In a in January, Bogalusa police said they had arrested someone in connection with Forbes’ killing. Authorities had the arrest of a teen in connection with the homicide.

Forbes had been a high school football standout, like his late father, Charles Forbes Jr., who played semipro. When Forbes scored a touchdown, he would look to the sky to honor his dad.

The school praised Forbes for his senior baseball season in : “This young man makes a difference on our campus and on the field with his strong character.”

When hopes for a college football scholarship did not pan out, Forbes worked as a deckhand for a marine transportation company. He saved money, looking forward to moving to Slidell, a suburb of New Orleans.

“He would always say, ‘There’s too much trouble here’” in Bogalusa, Guy recalled.

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