Hurricane Maria killed 4600 in Puerto Rico, 70 times official toll

Miguel Garcia removes debris in what is left of his home after Hurricane Maria hit the island in September 2017 in Maunabo Puerto Rico

Miguel Garcia removes debris in what is left of his home after Hurricane Maria hit the island in September 2017 in Maunabo Puerto Rico

A study published Tuesday in The New England Journal of Medicine estimates that almost 6,000 people died in Puerto Rico after Hurricane Maria, with a survey indicating the mortality rate is likely more than 70 times the highly contested official death toll of 64.

While cautioning that the estimate of 4,645 victims may be too low, the researchers said the numbers "underscore the inattention of the US government to the frail infrastructure of Puerto Rico".

"These numbers. underscore the inattention of the U.S. government to the frail infrastructure of Puerto Rico", authors from Harvard University and other institutions wrote in the New England Journal of Medicine.

In December, the New York Times reported that actual deaths from Hurricane Maria exceeded 64 people, but put their total estimate at about 1,052.

The official government count at the time of writing is 64 fatalities.

This time, they calculated that there were about 5740 excess deaths after Hurricane Maria, though it could have been as low as 1506 or as high as 9889.

Maria, a major hurricane with winds close to 150 miles (241 km) per hour, caused an estimated US$90 billion in damage to an island already struggling economically and many residents have subsequently left. That means there was at least 0.9 of an additional death per 1000 people in 2017, and perhaps as many as 10 extra deaths per 1000 people.

"These numbers will serve as an important independent comparison to official statistics from death registry data, which are now being re-evaluated, and underscore the inattention of the United States government to the frail infrastructure of Puerto Rico", concluded the report.

Boston Medical Center psychiatrist Dr. Lisa Fortuna - a Puerto Rico native who witnessed the dire aftermath of Hurricane Maria a year ago - said the new numbers come as no surprise.

"Statistically, it's like having interviewed the whole island", he said.

To get a better handle of Maria's true impact, interviewers fanned out across Puerto Rico between mid-January and late February. In Puerto Rico, every disaster-related death must be confirmed by the Institute of Forensic Sciences by bringing the body to San Juan or having a medical examiner travel to verify the death.

To find out, Kishore, a computational epidemiologist, and his research colleagues surveyed 3,299 households across the island-a sample that ranged across each of Puerto Rico's 900 barrios, from the densest districts to the most remote of outposts-and they counted up the deaths in the first months after the storm. The official death toll from 2005's Hurricane Katrina is 1,833. "We have always expected the number to be higher", said Federal Affairs Administration Executive Director Carlos Mercader in a statement.

Rossello's government has tapped researchers at George Washington University to conduct a review of the count, but those findings have not yet been released.

The Harvard study says the Puerto Rican and U.S. governments did not provide adequate services - including electrical power and medical assistance - after the hurricane.

The US Federal Emergency Management Agency (FEMA), which oversees disaster recovery, has said it encountered unique logistical challenges on the island after the storm that make comparisons between the response to Maria and other storms problematic.

CNN and the Center for Investigative Journalism (CPI) in Puerto Rico are suing the island's demographic registry for access to death records that have been withheld.

They counted not just direct deaths, but also those who died due to storm-related delays in medical treatment for injuries, infections, and chronic illness.

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