Study: Storm killed 4,600 in Puerto Rico
Findings important amid concerns government tally was an undercount
As hurricane season begins this week, experts are still trying to count the number of deaths caused by last year’s devastating Hurricane Maria in Puerto Rico. The latest estimate: roughly 4,600, many of them from delayed medical care.
Residents of Puerto Rico died at a significantly higher rate during the three months following Maria than they did in the prev ious year, according to the results of a new study by a group of independent researchers from the Harvard T.H. Chan School of Public Health and other institutions.
The researchers say their estimate, published Tuesday in the New England Journal of Medicine, remains imprecise, with more definitive studies still to come. But the findings, which used methods that have not been previously applied to this disaster, are important amid widespread concerns that the government’s tally of the dead, 64, was a dramatic undercount.
Winds, flooding and landslides swept away homes and knocked out power, water and cellular service, which remained largely unrepaired for months.
An analysis of vital statistics by the New York Times last December found that 1,052 more people than usual died across the island in the 42 days after the storm. Other news organizations, including Puerto Rico’s Center for Investigative Journalism and CNN, and Alexis Raúl Santos, a demographer at Penn State, have also challenged the government’s figure, finding evidence for hundreds of excess deaths in the weeks following the hurricane.
Researchers for this lat-
est study visited more than 3,000 residences across the island and interviewed their occupants, who reported that 38 people living in their households had died between Sept. 20, when Hurricane Maria struck, and the end of 2017. That toll, converted into a mortality rate, was extrapolated to the larger population and compared with official statistics from the same period in 2016.
Because the number of households surveyed was relatively small in comparison to the population’s size, the true number of deaths beyond what was expected could range from about 800 to more than 8,000 people, the researchers’ calculations show. The toll exceeded previous estimates, researchers said, in part because they looked at a longer time period.
About 15 percent of the people interviewed reported that someone in their household was unable to get medicine for at least a day after the storm. Roughly 10 percent said that a household member had trouble using breathing equipment, which often relies on electricity. Fewer than 10 percent reported closed medical facilities and 6 percent said doctors were unavailable. The study estimates that about a third of the deaths were caused by a delay in medical care or the inability to obtain it.
Under pressure, the government announced in December that all deaths that occurred after Maria hit would be reviewed and that people who died either directly or indirectly from the storm and its aftermath would be included in a revised tally. The government commissioned a review by researchers at the Milken Institute School of Public Health at George Washington University, who had promised an initial report in May. But that analysis has barely begun. “They’re still acquiring data,” said Dr. Lynn R. Goldman, the school’s dean. The study will use the territory’s vital records and information from funeral homes, the medical system and the larger public.
Goldman now says she expects to deliver the initial review, which will cost $305,000, some time this summer, with a more definitive analysis involving interviews with survivors and requiring additional funding following perhaps nine months later. She said she and her colleagues were delayed because they had failed to anticipate the need for the university to navigate different tax laws in preparing their contract with the government of Puerto Rico.
The newly released study, by contrast, was conducted for about $50,000 without the participation of the territory’s government, which the researchers said refused to provide data to them.
On Tuesday, the government of Puerto Rico said it welcomed the new survey and looked forward to analyzing it. “We have always expected the number to be higher than what was previously reported,” said Carlos S. Mercader, executive director of the Puerto Rico Federal Affairs Administration, in a statement. Mercader said that both the Harvard survey and the George Washington University study will help Puerto Rico “better prepare for future natural disasters and prevent lives from being lost.”