August 29, 2018

Puerto Rico says nearly 3K people died because of Hurricane Maria—not 64

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    Puerto Rico Gov. Ricardo Rosselló on Tuesday announced that that officials will revise the commonwealth's official mortality count for Hurricane Maria from 64 to 2,975, following an independent assessment showing the U.S. territory had undercounted the hurricane-related deaths.

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    Background: Reports offer differing counts of Hurricane Maria's death toll

    Hurricane Maria, a powerful Category 4 storm, tore through Puerto Rico on Sept. 20, 2017, with 140 mph winds. The storm knocked out electricity across Puerto Rico and affected the water supply for nearly half of its residents.

    Puerto Rico's Department of Health (DOH) originally estimated that 64 residents died because of Hurricane Maria. DOH in June released mortality data that showed an additional 1,397 deaths occurred between September 2017 and December 2017, when compared with the same period in 2016. However, the data did not directly or indirectly attribute the additional deaths to Hurricane Maria.

    Several independent researchers and news outlets have challenged Puerto Rico's official count of deaths related to Hurricane Maria.

    Puerto Rico officials in a draft report to Congress dated July 9 acknowledged that the death count could be higher than 64. However, officials had said they were waiting on an independent assessment from the George Washington University's Milken Institute School of Public Health to be completed before updating their numbers.

    Puerto Rico will revise official death toll

    Rosselló on Tuesday said he is directing Puerto Rico officials to update the commonwealth's official Hurricane Maria death count because the independent assessment he had commissioned in February  found there were nearly 3,000 excess deaths related to the hurricane in Puerto Rico from September 2017 through February 2018.

    For the assessment, researchers from George Washington University's Milken Institute School of Public Health examined death certificates and other mortality data from Puerto Rico spanning July 2010 to February 2018. The researchers compared the number of deaths that occurred before and after the hurricane and calculated the number of excess deaths that likely occurred because of the hurricane.

    Overall, the researchers estimated that 22% more people died in the six months following Hurricane Maria's landfall in Puerto Rico than would have died if the hurricane had not struck the commonwealth. The researchers found low-income and elderly people were the most likely to die as a result of the hurricane. Although the researchers noted that the hurricane had affected all areas of the commonwealth, they found that people living in lower-income municipalities had a 45% higher risk of death when compared when people living in higher-income municipalities.

    Why Puerto Rico officials had undercounted Maria-related deaths

    The researchers partly attributed Puerto Rico's original undercount to a lack of training among health officials, forensics officials, and physicians on how to document such deaths. The researchers found Puerto Rico's government had not implemented an appropriate disaster communications strategy, and therefore had not effectively communicated how to properly report hurricane-related deaths before 2017. When the researchers interviewed people who are part of the commonwealth's death certification process, they found "confusion about the guidelines" and "reluctance to relate deaths to hurricanes due to concern about the subjectivity of this determination."

    To address the issue, the researchers recommended that Puerto Rico's government:

    • Increase emergency planning;
    • Increase physician training on how to appropriately complete death certificates; and
    • Strengthen the commonwealth's public health system.

    Rosselló said he intends to launch a commission to implement the researchers' recommendations, but he noted that Puerto Rico already has implemented a number of changes since the hurricane. For example, Rosselló said Puerto Rico's government has improved the commonwealth's communication systems and created a network for the distribution of food and medicine. He said, "We never anticipated a scenario of zero communication, zero energy, zero highway access," adding, "I think the lesson is to anticipate the worst. ... Yes, I made mistakes. Yes, in hindsight, things could've been handled differently."


    Several researchers said the assessment's estimate is likely the most accurate.

    Alexis Santos, a Penn State demographer who was involved in a separate study on deaths related to Hurricane Maria in Puerto Rico, said the researchers from George Washington University accessed more detailed mortality data from Puerto Rico's government than other researchers, which makes their study "a quite comprehensive analysis of the issue."

    White House press secretary Sarah Sanders said, "The federal government has been, and will continue to be, supportive of Gov. Rosselló's efforts to ensure a full accountability and transparency of fatalities resulting from last year's hurricanes. The federal government will continue to support the government of Puerto Rico and the Puerto Rican communities in their recovery from Hurricanes Irma and Maria for years to come."

    Rep. Bennie Thompson (D-Miss.) said, "The latest study … puts the tragedy of Hurricane Maria on the same scale as the Sept. 11 attacks." He added, "Because [the Federal Emergency Management Agency] and the federal government were simply unprepared, thousands of our fellow American citizens have perished—and we now know that the poor and elderly were the most at risk" (Coto, Associated Press, 8/28; Florido, NPR, 8/28; Campo-Flores, Wall Street Journal, 8/28; Mason, Reuters, 8/28; Morin, Politico, 8/28).

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