Puerto Rico's Hurricane Maria Death Toll Could Be "More Than 70 Times" Official Estimate

An estimated 4,645 people perished when Hurricane Maria slammed into Peurto Rico, a territory of the United States, on September 20, 2017, and in the months after, according to an academic report published Tuesday in the New England Journal of Medicine. This shocking estimate dwarfs Puerto Rico’s official death toll of 64, which the researchers called a “substantial underestimate,” mostly due to delayed or interrupted medical services.

Maria caused an estimated $90 billion in damages across the island, making it one of the most expensive hurricanes for the United States since 1900. Tens of thousands of people were displaced from their homes, seeking shelter on higher ground or in the Continental United States. Accurate estimates of deaths, injuries, illness, and displacement have been extremely difficult to evaluate in the aftermath because infrastructure and healthcare systems were severely damaged.

“These numbers will serve as an important independent comparison to official statistics from death-registry data, which are currently being reevaluated, and underscore the inattention of the U.S. government to the frail infrastructure of Puerto Rico,” said researchers.

The team of researchers from the Harvard T.H. Chan School of Public Health and other academic institutions surveyed 3,299 randomly chosen households across Puerto Rico to produce an independent estimate of death after the hurricane. Respondents were asked a series of questions about “displacement, infrastructure loss, and causes of death,” the report said. Researchers estimated deaths by comparing estimated post-hurricane mortality rate with official rates for the same period in 2016.

Of the households researchers visited, 18 deaths occurred before September 20, 2017, and 38 after the hurricane. Household members reported nearly one-third of post-hurricane deaths as being caused by delayed or prevented access to medical care, and almost 1 in 10 was attributed directly to the hurricane by respondents, explained the report.

Researchers calculated a “62 percent increase in the mortality rate from September 20 through December 31 in 2017 as compared with the same period in 2016, corresponding to an annual mortality rate of 14.3 deaths per 1000 persons and an estimated 4,645 excess deaths.” The team used measurements from the survey and applied it to the broader population to reach their estimate of 4,645 deaths. While their assessment is more than 70 times the official number, researchers said it is still likely to be conservative.

 Estimates of Excess Deaths and Reported Causes of Death.

Panel A shows a comparison of estimates of excess deaths from official reports, press (New York Times) and academic (Santos–Lozada and Howard) reports, and from our survey. Panel B shows deaths according to the month of death and the age at death as reported in our survey, categorized according to the cause of death reported by the household member. Two persons who died of similar causes at the same age are represented by dots that are superimposed in December; thus, the 37 points shown represent 38 deaths after the hurricane. (Source: New England Journal of Medicine)

The survey found a strong positive correlation between remoteness on the island and the length of time without essential services. On average, houses went 84 days without electricity, 68 days without water, and 41 days without cellular service after the hurricane and until late December. There was also a significant disruption in medical services, the survey noted. About 14 percent of households surveyed said they were not able to access daily medications, while nearly 10 percent said they needed medical equipment that required electricity. Other problems included the destruction of medical facilities and missing doctors.

Number of Days without Basic Services and Disruption of Medical Services.

Panel A shows the distribution of the number of days that households reported being without water, cellular telephone coverage, and electricity between September 20 and December 31, 2017, according to remoteness category (from least remote [category 1] to most remote [category 8]). Remoteness was defined according to the travel time to the nearest city with a population of at least 50,000 persons. Box plots show the medians (dark bars), with boxes spanning the interquartile range; vertical lines indicate 1.25 times the interquartile range, and points denote outliers. Here, the number of days is the lower boundary of the total, since the number of days was reported as being within a particular time window. Panel B shows the percentage of all households reporting at least 1 day of disrupted medical services according to factors causing the disruption. These factors were not necessarily related to reported deaths, and households could report more than one issue. See Table S3 in the Supplementary Appendix for data regarding disruption across households in various remoteness categories. (Source: New England Journal of Medicine)

Puerto Rico Governor Ricardo Rossello ordered a review of the official death count in December, which could indicate a change in the total. This would be bad news for President Donald Trump, who has said the low number of deaths shows the federal government worked well to counter the aftermath of the storm when compared to a real catastrophe like (Hurricane) Katrina.”

Domingo Marqués, an associate professor of clinical psychology at Carlos Albizu University in Puerto Rico, who was one of the researchers, said, “the difference is that we went out and we had boots on the ground and we did the interviews,”

“Statistically, it’s like having interviewed the whole island,” he added.

Carlos Mercader, executive director of the Puerto Rico Federal Affairs Administration, said, “as the world knows, the magnitude of this tragic disaster caused by Hurricane Maria resulted in many fatalities.”

Mercader indicates that he welcomes the Harvard-led research and will study its contents. “We have always expected the number to be higher than what was previously reported,” he added.

As the United States prepares for the next hurricane season, “it will be critical to review how disaster-related deaths will be counted, in order to mobilize an appropriate response operation and account for the fate of those affected,” the report concluded.

If Puerto Rican officials readjust the figures, it could spell bad news for the Trump administration ahead of the midterms this fall, as the liberal media has been highly critical on his approach to counter the aftermath of the natural disaster.