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(NEW YORK) — While COVID-19’s surge has ebbed, violence is on the rise across the United States.

There has been a rash of gun violence in what President Joe Biden called an “epidemic,” including several public mass shootings, increases in incidents in major metropolitan areas and an uptick in road rage clashes.

While dramatic declines in levels of coronavirus have engendered new hope and optimism for some, the effects of the pandemic and the measures taken to combat it linger, simmering tensions brought to a boil and manifesting themselves in anger, and in some cases, violence, experts say.

Federal authorities saw that swell in violence spurred on by COVID’s hardships coming — before the pandemic even got into full swing.

An internal Department of Homeland Security memo obtained by ABC News from spring of 2020 warned that the emotional, mental and financial strain exacerbated by the new coronavirus pandemic combined with social isolation — especially if prolonged — may “increase the vulnerability of some citizens to mobilize to violence.”

“The outbreak of Covid-19, and government’s response to it, have intensified concerns that could accelerate mobilization to violence with extended periods of social distancing,” the memo reads, noting such isolation is a “known risk factor” in inciting violent extremism, along with “financial stress and work disruptions, including unexpected unemployment and layoffs” also “increasing.”

Even as the nation and globe was locking down, the memo, which has not been previously reported, urged agency partners to develop an “action plan” for when communities begin to return to “normal” activities, predicting “the increase in mass gatherings, combined with the lengthy social isolation and other life stressors,” may create environs churned up by COVID, and ripe for violent upheaval.

When reached by ABC News regarding these early warnings, DHS declined comment.

As a tentative reopening got underway in May, DHS Secretary Mayorkas established the Center for Prevention Programs and Partnerships, and a domestic terrorism branch in the Department’s Office of Intelligence & Analysis, aimed at shoring up the Department’s “whole-of-society approach” to thwarting extremisim and other targeted violent acts in the U.S.

Attorney General Merick Garland announced a ‘renewed commitmen’t and multi-pronged Justice Department effort to reduce violent crime through community engagement, targeted enforcement, and interagency collaboration.

Violent crime has “spiked since the start of the pandemic over a year ago,” President Biden said in late June, announcing a range of actions and federal support towards targeting gun violence.

“And as we emerge from this pandemic with the country opening back up again, the traditional summer spike may even be more pronounced than it usually would be,” Biden said.

Pandemic a ‘tipping point’

It wasn’t just federal officials sounding the alarm last year. Doctors — including psychologists — say the pressure of the pandemic may be exacerbating acts of violence and aggression.

“COVID has been a tipping point,” Dr. Aimee Harris-Newon a clinical psychologist in Chicago who focuses on wellness and preventive care. “On top of too much chronic stress, the impact of all this trauma… now everything is starting to leak out.”

And some experts say psychological stressors were already mounting prior to the pandemic.

“We were already in a weakened condition when the pandemic hit — class divisions, overt racism, partisanship, a really poor social support infrastructure — so if you think about the effect of the pandemic on an ‘epidemic’ of shootings — it’s like the immune system of the United States was already suppressed,” Jeffrey Butts, director of the research and evaluation center at John Jay College of Criminal Justice, told ABC News.

“The social, psychological and economic distress in our country has surpassed people’s ability to cope, and there hasn’t been enough support,” added Dr. Marni Chanoff, a psychiatrist and founder of the integrative wellness group at McLean Hospital. “There is no road map on how to navigate this time.”

‘COVID turned up the volume’

When Mohammed Abdelmagied heard loud bangs near his Times Square kebab and hot dog stand the last Sunday in June, he thought it was firecrackers — someone celebrating an early Fourth of July, or maybe freedom from COVID-19.

It wasn’t: it was gunfire: something he never expected in the area where he’s worked for 13 years — a heavily policed place where shootings have been relatively rare.

“I turn my face to the square, I heard everything but I didn’t see nothing,” Abdelmagied, 46, told ABC News.

Two shootings in two months at the Crossroads of the World have brought a flood of police to the area, in a city that until recently had become a model of safety in major metropolitan areas. These flares of gunfire aren’t only in New York, nor have they remained only within city limits across the country.

Major U.S. cities have been rocked by spates of gun violence over the past few months, part of an already rising trend which did not stop during lockdown, but has become more visible as the country reopens.

“Shortly after a resumption of ‘normal’ life,” the memo from spring of 2020 says, tensions already brewing, then exacerbated during the pandemic, may provide an opportune moment for violent extremism, and violent attacks.

Not including suicides, more than 19,400 people died by gun violence in 2020, up from roughly 15,440 in 2019, and far past the rates in years prior, according to Gun Violence Archive, a nonprofit research group.

In 2021, there have already been more than 10,000 gun violence deaths — with nearly six months left to go.

“Covid turned up the volume,” and has fomented a disintegration of social connections and norms, Butts said.

“Then we see some of these horrible shootings — the actual magnitude of the increase is undeniable,” Butts added.

It’s not just gun violence on the rise: acts of aggression on airplanes have also hit new highs — and not only more flight disruptions, but more violent ones as well.

The Federal Aviation Administration is investigating a record number of potential violations of federal law in unruly passenger cases — identifying more than 490 cases this year so far where passengers potentially broke the law by “interfering with the duties of a crew member.” That’s more than double the amount of cases investigated in 2020; and more than two and a half times the amount in 2019.

Airlines have now reported more than 3,200 reports of disruptive passengers to the FAA this year; the vast majority — more than 2,400 — involve people who refused to wear a mask.

In a Homeland Security Threat Assessment released in October 2020, authorities also underscored concerns arising from COVID-19’s impact, where “anti-government and anti-authority violent extremists could be motivated to conduct attacks in response to perceived infringement of liberties and government overreach as all levels of government seek to limit the spread of the coronavirus that has caused a worldwide pandemic.”

Isolation effect

While social media helped maintain personal connections during quarantine, it can also be quite alienating, experts say — and present an opportunity for online radicalization.

In addition, pandemic job loss can be both heavy financial and psychological burdens.

And the unprecedented loss of life and loved ones to the virus, with more than 600,000 deaths in the U.S. alone, has taken an unspeakable toll, experts say.

Isolating factors like these can increase the risk of engaging — or attempting to engage — in violent extremism, according to the DHS memo.

“These risks are likely to become more widespread as public health measures are expanded — or the timeframe for maintaining social distancing increases,” the memo warned, underscoring the research-backed “need to build social links and bridges to prevent social isolation, which in turn, reduces the risk of radicalization to violence.”

Social distancing has been key to stopping the virus’ spread — but after more than a year of being fearful of anyone near potentially being infected, experts point out that self-preservation may have amplified feelings of mistrust in our communities.

“Someone who’s coming towards you on the sidewalk, and you’d think, you’re spraying your droplets at me!” Butts said. “People were afraid. More so than before, we had to see other people as a potential deadly threat.”

Americans are also still reeling from the economic and emotional blow dealt by COVID-19, despite the ebb of infection, and signs of improvement in the labor market, according to Pew polling this spring; those most vulnerable to the virus have also borne the brunt of its financial fallout.

Breaking the cycle

Tensions boiling over across the U.S. have fed what’s becoming a vicious cycle difficult to break; experts worry, that residual anxiety and collective trauma may outlast the pandemic itself.

“That kind of mental and emotional wear and tear doesn’t go away,” Butts continued. “All the harm that results will be festering for some time. That’s a huge concern.”

As some Americans’ anger about the state of the nation abates from where it was during the summer 2020 COVID surge — experts urge vigilance about what that receding rage might leave in its wake.

Even as the nation prepares to celebrate the Fourth of July and some measure of freedom from COVID, federal authorities are raising concerns about the possibility of domestic terror and violence, including mass shootings, as the 2021 summer season gets into full swing.

Whatever the new normal might be, Chanoff notes getting there will take time.

“The human spirit is resilient and the human capacity to heal is enormous,” Chanoff said. “But without support, I think that these things will likely continue to rise.”

Copyright © 2021, ABC Audio. All rights reserved.

(NEW YORK) — It’s been a school year like no other in recent memory — combining the challenge of remote and hybrid learning for millions with the agony and strain of a pandemic that has killed more than 600,000.

Mental health has taken a toll on many students and staff alike.

So as districts prepare for the fall after the first full year during the coronavirus pandemic, many are looking at ways to help best address the mental health needs of students, especially those who may have experienced trauma, anxiety or social isolation.

One Ohio school district will welcome back students with more counselors and social workers on hand. Hilliard City Schools in Columbus has added seven new school counselors, up to 42, and 10 more social workers, for 15 total, Director of Student Well-Being Mike Abraham told ABC News.

“Anxiety has always been high with this generation,” Abraham said. “With the pandemic, some students have become very comfortable with isolation, not having to deal with the anxiety that school might bring or their peers bring. That’s what all districts are dealing with coming back now that these kids are together — giving them strategies to be able to deal with their anxiety, to deal with whatever mental health issues that they’re struggling with.”

The school district, which has nearly 17,000 students, is tapping into federal relief money earmarked for K-12 public schools to pay for the new positions.

Last month, Iowa officials announced the state is launching a new pre-K-12 school mental health center that would expand training and resources that support mental health needs in schools.

The Iowa Department of Education is putting $20 million in federal pandemic relief toward the center, which aims to “address the impact pandemic-related disruptions have had on students and will focus on strengthening mental health support moving forward,” Iowa Department of Education Director Ann Lebo said in a statement.

And the Miami-Dade County school district is exploring using federal relief funds to hire more mental health clinicians as most of the district’s 334,000 students are expected to return to in-person learning this fall, the Miami Herald reported last month.

Other initiatives targeting school culture include adding mental health as an excused absence. That will be the case for Montgomery County Public Schools, Maryland’s largest school district, starting in the fall, Board of Education member Patricia O’Neill told ABC News Washington, D.C., affiliate WJLA-TV.

“I think coming off the pandemic this year, adults and students recognize the challenges that mental health has brought about,” O’Neill told the station. “We had to figure out how to make this change and elevate the importance of mental health, as it may be a barrier to learning.”

Range of mental health concerns

The full impact of the pandemic on students will take time to understand, Kelly Vaillancourt Strobach, director of policy and advocacy for the National Association of School Psychologists and a school psychologist, told ABC News. One area of concern is emergency department visits for attempted suicide or suicide ideation, she said.

In 2020, mental health-related emergency department visits among those aged 12 to 17 increased 31% compared to 2019, according to the Centers for Disease Control and Prevention. Visits for suspected suicide attempts in girls that age from Feb. 21 to March 20, 2021, were 50.6% higher than the same period in 2019, the agency reported.

A report published in Pediatrics also found “significant increases” in the number of emergency department visits for suicide ideation and attempts in youth for certain months in 2020 when compared to the previous year.

Isolation due to remote learning is another concern. A recent report from a team of researchers at the Graduate Center, City University of New York found that 91% of New York City parents surveyed agreed there should be “increased mental health supports for students due to social isolation from COVID-19.”

Meanwhile, some students may not have experienced any toll on their mental health, and may have even thrived virtually, Vaillancourt Strobach said.

“We don’t know the level of trauma that individual students have had. We don’t know their family situation, if they lost somebody, if parents have lost jobs,” she said. “So what we are encouraging schools to do is really in those first couple of weeks, just infuse a lot of social-emotional learning, give kids the opportunity to talk about what’s happened over the last year.”

“There’s a lot of focus and attention on learning loss, or lost instructional time. Certainly it’s important that we address student’s academic needs, but if we don’t have a handle on their social-emotional learning and their mental health needs, the academics are never going to come,” she added.

‘All about adjustment’

Summer to fall can often be a tough transition for students in general, Janine Domingues, a clinical psychologist at the Child Mind Institute and the manager of curriculum development and professional training for its school and community programs, noted.

“That first month of school is all about adjustment,” she told ABC News. “Now, even more so, it’s a whole different ball game.”

Students may experience anxiety and stress while getting acclimated to the classroom and a new routine, she said.

When Centennial High School in Corona, California, welcomed back students on campus for their last quarter this past school year, it was an adjustment for some students returning for in-person learning, Josh Godinez, a counselor at the school and chair of the board of the California Association of School Counselors, told ABC News.

“It was almost like the isolation allowed them to create almost somewhat of a fantasy of what they remembered about school. And then showing up to the social distancing partitions, only half their class being there, everybody in masks, it wasn’t that picture that they had created,” he said. “Things start to get back to normal, but aren’t really back to normal.”

As a counselor, Godinez said he worked with students on an individual level to address any anxiety, apprehension, grief or fears students had.

“There was no one response when they came back to school,” he said.

A call for lasting change

Come the fall, Centennial High School, which has about 3,300 students, will have brought on a new counselor, focusing on English learners, bringing them to nine total, Godinez said.

The pandemic has helped bring more attention to the importance of mental health support in school, particularly as districts have an infusion of federal funding that could be put toward more staffing or training, and how schools can foster a healing-centered environment “focusing on social-emotional well-being,” Domingues said.

“This year has kind of really helped propel that mission forward,” she said.

The attention and funding come as schools nationally are largely understaffed when it comes to support staff like social workers and psychologists, experts said.

The National Association of School Psychologists recommends a ratio of no more than 500 students per school psychologist. In the 2019-2020 school year, the national ratio was estimated to be more than double, and only one state met the recommended ratio, the organization said.

The National Association of Social Workers and American School Counselor Association both recommend a ratio of 250 students per social worker and counselor, which most states also fail to meet, according to a 2019 ACLU report.

“We’ve had 100,000 traumatized school communities in this country,” Robert Boyd, president of the School-Based Health Alliance, which promotes school-based health centers in the U.S., told ABC News. “We’re coming into this with not enough school behavioral health specialists. … We didn’t have it before the pandemic.”

The pandemic relief funds could help bring those ratios down, the experts ABC News spoke with said, though noted more rural areas often face a staffing shortage. Boyd’s organization is also focused on diversifying school support staff, which tends to be white women, he said.

Some schools may need to lean on community providers, Vaillancourt Strobach said. Trained grief counselors, for instance, may include pastors and morticians, Boyd noted.

Beyond dealing with staffing shortages, districts may build up their programs, only to not be able to sustain them in the long term.

“Are we going to make a lot of really good progress because there’s been so much attention paid to the importance of school mental health, and then with the American Rescue Plan dollars hit their limit, are we going to be back at square one?” Vaillancourt Strobach said.

Mental health professionals hope this spotlight leads to lasting change and funding support, beyond the pandemic.

“We don’t need to focus on student mental health just because of COVID,” Vaillancourt Strobach said. “The need has always been there; as a nation, we are finally paying attention to it.”

Copyright © 2021, ABC Audio. All rights reserved.

(NEW YORK) — One woman was prepared for every aspect of her daughter’s birth — except for the location.

Emily Geller Hardman, 35, was 37 weeks pregnant when she attended a family wedding in Lancaster, Pennsylvania, with her husband, Travis Hardman. Still far enough out from her projected due date, she figured it was fine to attend and felt nothing out of the ordinary during the wedding. Just hours later, when they were back in their hotel room, however, the opera singer said her water broke. But she didn’t rush to the hospital.

“The amniotic fluid was clear and there were no contractions,” Hardman told ABC News’ Good Morning America. “And this was a first-time labor for me. Statistically, most first-time labors are about 16 to 24 hours, so in my head we had plenty of time.”

When Hardman woke up to her first contraction around 3 a.m., she knew it was time to go even if it meant giving birth in the car.

“In my head I was thinking that I’ve been preparing for this for three years,” she said. “I can certainly do early labor in the car.”

Hardman’s firstborn, Wesley, 2, was born via cesarean delivery. She initially wanted to do a vaginal birth, but circumstances forced her into a C-section.

After what she described as a traumatic experience, she was determined to have an unmedicated vaginal birth at a hospital an hour away from their home in Briarcliff Manor, New York, with midwives and a doula on hand.

“I was very involved in the physiological birth world,” Hardman said, adding that she read books, listened to podcasts and did prenatal exercises to prepare herself mentally and physically for a second birth on her terms.

Armed with just her knowledge, signals from her body and the GentleBirth meditation app, Hardman guided herself through labor while her husband drove.

“My husband’s driving and the entire time I’m focusing on listening to the app to get me through each contraction,” she recalled. “I was just riding the waves and hoping we were going to make it back. We still didn’t realize how fast this was going.”

Around 5:30 a.m., they were able to pull over so Hardman could stand and stretch.

“At that point, once I stood up, I think gravity hit and I started bearing down,” Hardman said. “My water starts leaking again. But I knew that we had to get back in the car and get to the hospital so I willed myself back into the backseat.”

Hardman tried her best not to push so that she could hold on until they arrived at the hospital, but when her contractions started coming faster and even more intense, she knew she wouldn’t be able to help it.

“This baby was coming out of me one way or another,” she said. “I either needed to, for lack of a better word, get on board with what was happening and just allow my body to do what it was doing or I could fight it tooth and nail, which didn’t seem like it was going to be helpful.”

“I could feel myself bearing down and pushing,” Hardman continued. “I instinctively just reached down because I’m feeling so much pressure and I feel the top of a baby’s head starting to crown.”

She told her husband to pull over, but there was nowhere for them to do so safely.

“He’s trying to pull over anywhere he can and as he’s doing that, we’re still driving and her entire body just flies out in one contraction,” Hardman said. “There was no pushing stage of her head slowly coming and then waiting for the next contraction and resting. It was just a one-shot deal — she just flew out.”

What Hardman described is a phenomenon known as fetal ejection reflex, in which the body “expels” a baby involuntarily without any forced pushing on the person’s part.

Despite the circumstances surrounding her daughter’s birth, Hardman said the experience wasn’t stressful. As an opera singer, she’s used to high-stress situations and believes that experience, in addition to all the work she put in, helped her handle everything as smoothly as possible.

“You have to perform at a high level under stress, so you’re used to those types of situations and having to focus on what you’re doing and not how you’re doing,” Hardman said.

“I remember I felt relieved,” she said of her feelings after giving birth to her daughter, Rosemary Claire. “I thought something like, ‘I did it.’ It was empowering and a very healing experience. I do feel very lucky.”

Copyright © 2021, ABC Audio. All rights reserved.