A new study has put Hurricane Maria’s death toll in Puerto Rico at 4,645—a massive departure from the government’s official estimate, which sat at 64 in December.
The study, which was published Tuesday in the New England Journal of Medicine, involved researchers from Harvard’s T.H. Chan School of Public Health and Puerto Rico’s Carlos Albizu University, among others. The results were closer to previous independent estimates.
The study arrived at the number by surveying 3,299 households around Puerto Rico, from which they got about 14.3 deaths per 1000 people between September 20—the day the hurricane hit the region—to December 31. The resulting mortality rate was roughly 62 percent higher compared with the same period in 2016. One third of the deaths were due to “delayed or interrupted health care,” the researchers found.
But while the study’s number is more than 70 times bigger than the official death toll, the researchers cautioned that it’s in fact “likely to be conservative,” and described the government’s official number as “a substantial underestimate.”
Gilbert Burnham, a professor of international health at Johns Hopkins University and the founder of its Center for Humanitarian Health, agreed in a phone conversation with Motherboard that the study’s findings were “likely an underestimate.”
He said that the massive discrepancy in the numbers may partially stem from the government’s “passive surveillance,” or a reliance on numbers that merely roll in, versus “active surveillance,” which gathers numbers by going out and looking for them (and which was used in this study).
Although he wasn’t involved with the research, Burnham has conducted similar surveys in the Middle East, and emphasized their importance to public health and disaster preparedness.
“That’s the power of data—it’s not [assigning] blame, but, ‘How do we not have this happen [again]?’ … You find these numbers, now what does this cause you to do? What kind of actions are you going to take?” he said. “This is not like doing a census and finding out how many people died in the last six months. This is a much more complex issue.”
Still, Puerto Rico’s government was roundly criticized for its low estimate and the lack of transparency around how it arrived there. According to the New York Times, the government repeatedly asserted that the increase in deaths after Maria was a coincidence. (The researchers wrote that their request for mortality data was turned down.)
Finally, in December, governor Ricardo Rosselló said that officials would review every death that followed the hurricane. Then, in February, he announced that George Washington University would review the data. According to the New York Times, the report, which was expected in May, will now come this summer.
The immediate governmental response to the storm’s destruction also came under intense scrutiny, as headline after headline made clear that the electric grid was in tatters, few hospitals were up and running, water and food were in short supply, and hundreds of residents had been made homeless.
Even in the best of circumstances, death tolls following natural disasters are difficult to measure precisely, and Burnham noted that if you went back and performed the same study today, you would most likely get a different number. But the Puerto Rican response was compounded by the fact that the US government seemingly failed to adequately respond to the crisis as well.
When President Trump visited the island in October, the official death toll stood at 16. “You can be very proud of all of your people, all of our people working together,” he said. “Sixteen versus literally thousands of people. You can be very proud.” The administration’s response to Maria was contrasted to that of Hurricane Harvey and Hurricane Irma, both of which hit the US mainland a few weeks earlier.
According to the study, “[Our numbers] ... underscore the inattention of the US government to the frail infrastructure of Puerto Rico.”
As for what the future might hold, the study’s authors reiterated the need for proper preparation.
“As the United States prepares for its 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,” they wrote.