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Puerto Rico’s hurricane death toll may be 70 times higher than official count, study says

REUTERS/Alvin Baez
Ana Maria Jimenez, 89, lying on a bed after Hurricane Maria destroyed the town's bridge and the surrounding areas, in San Lorenzo, Morovis, Puerto Rico, Oct. 5, 2017.

The number of Puerto Ricans who died in 2017 because of Hurricane Maria is more than 70 times higher than the official estimate, according to a study published online Tuesday in the New England Journal of Medicine.

The official Puerto Rican death count for the hurricane, which struck the island on Sept. 20, 2017, is 64. The new study, however, estimates that 4,645 people lost their lives as a result of Hurricane Maria, either because of injuries sustained in the storm itself or because of delayed or interrupted medical services during the ensuing three months.

“According to the Centers for Disease Control and Prevention,” the study authors note, “deaths can be directly attributed to a tropical cyclone if they are caused by forces related to the event, such as flying debris, or if they are caused by unsafe or unhealthy conditions resulting in injury, illness, or loss of necessary medical services.”

Puerto Rico’s official Hurricane Maria-related death count is based on bodies that were examined by a medical examiner. For the cause of death to be verified, therefore, the bodies had to be brought to an examiner in San Juan or the examiner had to travel to local municipalities, many of which were inaccessible after the hurricane hit. 

That meant many hurricane-related deaths in Puerto Rico were not officially counted.

This new study’s findings are important beyond what they say about deficiencies in how government officials responded to Hurricane Maria, however.

“Growing numbers of persons have chronic diseases and use sophisticated pharmaceutical and mechanical support that is dependent on electricity,” write the study’s authors. “Chronically ill patients are particularly vulnerable to disruptions in basic utilities, which highlights the need for these patients, their communities, and their providers to have contingency plans during and after disasters.”

How the study was done

For the NEJM study, researchers at Harvard University, the University of Colorado and Carlos Albizu University in Puerto Rico surveyed 3,299 Puerto Rican households. The households, in which 9,522 people lived, were randomly selected to be representative of Puerto Rico’s 900 barrios, including the most remote ones. One adult in each household was surveyed. Among the questions were several about the number and cause of household or neighborhood deaths that occurred during the hurricane and in the three months that followed (through Dec, 31, 2017).

An analysis of all that data revealed that Puerto Rico’s death rate was 62 percent higher during the period of the study than it was during the same period in 2016. The higher rate meant 4,645 people died as a result of Hurricane Maria, the researchers calculated.

The number rose even more — to 5,740 — after the researchers adjusted for estimates on how many people lived and died alone as a result of the hurricane.  

The researchers also determined that about a third of the excess deaths were due to delayed or interrupted health care. The most frequently cited disruptions to medical services identified in the survey were an inability to access medications or to use respiratory equipment that required electricity. But people also said they had problems finding doctors or medical facilities that were open. And almost 9 percent of the people surveyed said they were unable to call 911 because phones weren’t working.

More deadly that Katrina

In October 2017, two weeks after Hurricane Maria devastated Puerto Rico, President Donald Trump told Puerto Ricans that they should be “proud” that so few people had died in the storm compared to the hundreds that died in a “real catastrophe” like Hurricane Katrina, which killed 1,833 people in New Orleans and other Gulf Coast communities in 2005. 

But the findings of this new study suggest that the death toll from Hurricane Maria may have been three times higher than that of Hurricane Katrina.

The current study comes with several caveats, including the possibility that the people surveyed did not provide accurate information or do not fully represent what happened across Puerto Rico during and after the hurricane. Furthermore, although the study’s authors estimate that 4,645 deaths resulted from Hurricane Maria, they also point out that the actual number could be as low as 793 and as high as 8,498.

Last December, an investigation by the New York Times estimated that the death toll was about 1,052. A Pennsylvania State University study has put the number at 1,084.

Few people believe that the official death count — 64 — is accurate, however.

FMI: You can read the NEJM study in full on the journal’s website.

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