Harvard University has determined that many more people died last fall in Puerto Rico as a result of Hurricane Maria than previously thought.
The island's government was way off the mark when it estimated the death toll at just 64, according to the study. The university found that 4,645 more people died in Puerto Rico between Sept. 20 and Dec. 31, 2017, than during the same period the previous year. “Our results indicate that the official death count of 64 is a substantial underestimate of the true burden of mortality after Hurricane Maria,” the researchers wrote in a report that appeared in the latest issue of the New England Journal of Medicine.
The study suggested that the number of fatalities could reach more than 5,740, due to infrastructure damage resulting from the Category 4 storm. Much of the island lost electricity and other utilities, and there was a disruption in essential services.
“Why did people die? Well, they died mostly because they didn't have access to medical care, they didn't have access to their medication, there was no pharmacy open, they didn’t have running potable, clean water," said Domingo Marqués, a psychology professor at Albizu University in San Juan who co-authored Harvard's report. He and his family endured more than three months without water in their home.
Marqués recalled that when he heard the government's death-toll estimate, he knew “there was no way” it was correct. “We had cases where people left the bodies of their loved ones in a car,” the professor told NBC News. “They had no access because of landslides or flooding or destroyed roads. People who buried their loved ones in their backyard.”
The research, which involved a survey of about 3,300 families on the island, revealed a mortality rate of 14.3 per 1,000 residents in the three months following the hurricane. The government has begun a review of its death count, enlisting the help of George Washington University. A report is due later this summer. University spokeswoman Mina Radman said the school will use “actual data about deaths — death certificates and other mortality data from September 2017 to the end of February 2018 — in order to estimate the excess deaths related to Hurricane Maria.” She noted that “estimating deaths using such mortality data is a time-consuming and difficult task, one that has rarely been done after a disaster of this magnitude.”
Carmen Yulín Cruz, the mayor of San Juan who has challenged the Trump administration to ramp up federal relief efforts, called the government's estimate of storm-related fatalities “unthinkable.” She tweeted: “There are many deaths caused by poor crisis management. … It took too long to understand the need for an appropriate response was NOT about politics but about saving lives.”
Another mayor, Rolando Ortiz Velázquez, also was not surprised to learn the government was wrong. “Based on the amount of people we saw when we visited communities, many of them sick, without power, incapacitated and without respiratory machines and the proper way to store medications and get to a hospital, we knew these people were going to die,” he said. Part of his town still lacked electricity eight months after the storm.
The problem is that officials have been relying on information provided by police, who consider only deaths directly resulting from the hurricane, according to Mario Marazzi of the Puerto Rico Institute of Statistics. “There’s a (Centers for Disease Control) guideline for disasters that defines what are directly related deaths and indirectly related disaster deaths, and we saw that those were not being applied properly in Puerto Rico,” Harvard's Satchit Balsari explained. The researcher called for “better training in order to count hurricane-related deaths on (death) certificates.”
Marazzi told NBC News that “when clear data is not available, it takes us more time to learn what the post-Maria reality is.” He warned that “when we don’t have clear information available, people die,” adding: “You lose a lot of credibility and time debating in what study to believe in. This is the way the scientific process works. You get information using different types of methodologies and that’s how you get closer to the truth.”
The hurricane damage has prompted more Puerto Ricans to leave their homeland. During the 10 years before Maria struck, almost a half-million residents had already fled. An estimated 3.3 million Puerto Rican natives now live in the U.S. mainland, according to the Pew Research Center. The number is expected to increase by about 200,000 by the end of 2018.
Tens of thousands of people on the island are still waiting for their electricity to be restored. The Federal Emergency Management Agency has provided funding to more than 437,000 residents to help them repair their homes. That represents only 40 percent of those who applied for assistance.