Puerto Rican deaths from Hurricane Maria far higher than reported, researchers say

Hurricane Maria claimed 73 times morelives in Puerto Rico than the official death toll of 64,according to new calculations based on a survey of thousands ofresidents by a team from Harvard and elsewhere.

The group estimates that 4,645 people died between Sept. 20and Dec. 31, 2017 as a direct or indirect result of the Category4 storm, and one-third perished because of delayed orinterrupted medical care.

The researchers say even that estimate may be too low, andthe numbers "underscore the inattention of the U.S. governmentto the frail infrastructure of Puerto Rico."

The findings, reported online Tuesday in the New EnglandJournal of Medicine, are likely to be controversial because thetally is far higher than previous independent estimates, themargin of error is wide, and the emergency response to thedisaster has become highly politicized after it sparkedcriticism of U.S. President Donald Trump, who promoted a much lowerdeath toll and was faulted when much of the territory remainedwithout power for months.

The chief author of the new study, Caroline Buckee of Harvard T.H. Chan School of Public Health in Boston, did not
respond to repeated emails requesting an interview.

The storm and its winds of close to241 km/hr caused an estimated $90 billion US in damage to an island that hadbeen struggling economically. Many residents subsequently left.

The Buckee number is more than four times higher than aDecember estimate by the New York Times, which reported that theactual death toll was probably about 1,052 excess deaths basedon data from the island's vital statistics bureau and acomparison of deaths during a comparable period in the twoprevious years. The count included suicides.

At the same time, the Center for Investigative Journalismsaid it found 985 additional deaths during September and
October. A Pennsylvania State University study put the number at1,085 (which the Buckee team appears to misreport as 1,218). ACNN survey of funeral directors found 499 additional deaths.

To come up with its dramatically larger estimate, the Buckeeteam randomly conducted in-person surveys of 3,299 of theestimated 1.1 million Puerto Rican households earlier this year,making sure to include remote areas.

93% completed survey

Respondents were not paid and were asked if a householdmember had died directly or indirectly as a result of the storm.Missing people were not counted as deaths. They were also askedabout deaths within a five-minute walking distance. More than 93per cent of the people approached completed the survey.

"Increases in post-hurricane death rates were observedacross age groups and were not a reflection of the migration ofyounger persons out of Puerto Rico after the disaster," the teamreported.

The Buckee team also said that households went, on average,68 days without water, 84 days without electricity and 41 dayswithout cell phone coverage. In the most remote areas, 83per cent of the households were still without power by Dec. 31.

Just over 14 per cent said they couldn't get their medicines.

The Times analysis found spikes in deaths from severeinfections, diabetes, pneumonia, and breathing disorders such asemphysema.

The 2018 hurricane season begins June 1.