How to count the dead

Donald Trump, the president of the US, is at it again. Recently, he rejected a study that claimed 2,975 people had died due to Hurricane Maria. Initially, only 64 deaths were attributed to the hurricane. Trump said the claim was politically motivated triggering a debate over how to measure the death toll in a natural disaster.

In September, 2017 Maria ravaged Puerto Rico. Recently, a study by George Washington University's (GWU) Milken Institute School of Public Health came out with a new figure. The researchers from the university stand by their estimate saying it "is the most accurate and unbiased estimate of excess mortality to date". The analysis looked at death certificates filed between September 2017 and February 2018 to attribute deaths "in excess of what would have been predicted if there had not been a hurricane, regardless of if a physician says it was related or not".

According to US Centers for Disease Control and Prevention (CDC), indirect deaths should be counted and attributed to a natural disaster. But doctors are not well trained on this aspect to report deaths due to a disaster. In fact, CDC in the immediate aftermath of Maria came out with detailed guidelines on what qualifies as a disasterrelated death.

"You have to think of [64 and 3,000] as two different indicators," says Carlos Santos-Burgoa, one of the GWU report's authors and a professor of global health at the school. "The 64 comes from death

certificates that have stated that the death is related to the hurricane," such as those caused by drowning, falling buildings or projectile debris, Burgoa explains.