By Dr. Emmy Betz

(A version of this essay first appeared on STAT.)

Colorado is a beautiful state and usually a year-round playground of sunshine and skiing. But Colorado also has a big problem: suicide rates that are among the highest in the country.

It’s a growing crisis. The National Center for Health Statistics recently reported that the suicide rate across the U.S. increased 35% between 1999 and 2018, the last year with complete statistics.

Suicide is a complex issue, usually without a single reason for its occurrence. Risk factors include social stressors, substance abuse, and mental illness like depression. When I talk with patients in the emergency room or teach medical students and residents, I point out the common thread of hopelessness.

I also talk with them about another reason why suicide rates are high in Colorado and the rest of the Mountain West: available firearms. If someone is feeling hopeless and can’t see another way out, and if that person reaches for a gun to attempt suicide, in 9 out of 10 cases they will die. There won’t be a chance for family or friends to intervene, for 911 to send paramedics, or for us to stabilize them in the ER with antidotes or other treatments.

Over the past years, Colorado has been tackling its suicide problem through innovative programs, private-public partnerships, and a comprehensive approach with attention to the various at-risk subpopulations, including youth. A concerning emerging trend over the past few years has been rising suicide rates among black youth and young adults.

And then the coronavirus showed up. It brought fear and anxiety. It brought panic-buying of toilet paper and a spike in sales of firearms and ammunition. School buildings closed and at one point, Coloradans had been – under “stay at home” orders and other directives to prevent spread of disease. There are concerns about increased alcohol use, social isolation, and abuse among trapped families. Skyrocketing unemployment rates and a looming recession add stress.

So will COVID-19 increase suicide rates in Colorado and other states over the coming months?

Maybe. It does seem like a perfect storm, with an explosion of risk factors, existential anxiety, and increased access to firearms. And calls and texting to crisis lines have increased.

But maybe not. Maybe there is hope.

In Colorado, neighborhoods started “howling” outside every evening. It’s our version of Italians singing and New Yorkers clapping, with an outdoorsy twist. The howling shows support for frontline health care providers, grocery workers, and other essential employees. But it’s also a cry that we’re still here, that we’re a pack. It’s a simultaneous expression of communal grief and celebration.

The stress of isolation has brought focus to creative ways to connect with others, be it through virtual religious observance or best practices for teleworking. There’s renewed attention to the importance of sharing emotions and the mental health benefits of exercise. For many, it has slowed down life by cancelling business trips and social commitments, resulting in more time with family and potentially stronger and healthier emotional connections.

There are glimmerings on the horizon that the COVID-19 epidemic might eventually lead to an improved medical and public health infrastructure. Racial disparities in COVID-19 fatality rates are highlighting the need to address disparities in health conditions and health care access. The navigation of daily life during the pandemic highlights disparities in socioeconomic status, where staying home is, in so many ways, a privilege. The protests against police brutality and racism in the U.S. are highlighting injustices that permeate our culture, and this new movement may generate meaningful reforms.

With luck, leadership and the actions of many, our country’s experience with COVID-19 can lead to positive changes to address homelessness, joblessness, food and housing insecurity, racism, and the many other social issues that plague our society and may increase suicide risk. We can hope that the COVID-19-induced shift to virtual health care will increase availability to services for mental health and addiction. We can hope for – and demand – resources for comprehensive national suicide prevention programs like the U.S. Department of Veterans Affairs PREVENTS initiative.

Positive outcomes are up to us. We don’t have to be passive passengers riding the COVID-19 wave. Each of us has a role to play, and even small steps can help prevent suicide and save lives.

Look out for your friends, family, and neighbors. Know how to spot when someone might be thinking of suicide or at risk for it. If you’re worried, ask! It’s ok to ask someone if they’re having thoughts of suicide – and don’t worry what words you use just show you care. Make sure you lock up guns, toxic medications, and other potential methods for suicide. If you’re having thoughts of suicide, reach out for help.

When I get discouraged about my state’s suicide rate, I remember that our history is full of stories of colorful, tough characters. My favorite pioneer is the “Unsinkable Molly Brown,” an immigrant who lived in a two-room log cabin before striking it rich in the mining boom. Her story, like ours, is not just about being a stoic individual. She survived an unexpected and unprecedented disaster: the sinking of the Titanic on April 15, 1912. And she saved others by loading lifeboats before she got on one and by encouraging the women in her boat to keep rowing.

We can all be Molly Browns and get through COVID-19 and whatever comes after, especially if we’re in it together.

Dr. Emmy Betz is an emergency physician and researcher at UCHealth University of Colorado Hospital, where she directs the Firearm Injury Prevention Initiative. In 2015 she gave a TEDxMileHigh talk on firearm suicide prevention.