What was the actual death toll from hurricane maria in puerto rico h data recovery registration code

The official figure has languished under a cloud of skepticism ever since it was announced last December by Puerto Rico’s Department of Public Safety. The Category 4 hurricane was the worst natural disaster ever to strike the United States territory and the third costliest storm on record, after all, having caused an estimated $90 billion in damage. Even before government officials locked the death toll in at 64, statistics-based estimates by a number of sources indicated that the actual number of Maria-related fatalities could top 1,000.

To arrive at the latest approximation, the Harvard researchers conducted a randomized survey of 3,299 households across Puerto Rico, and used the findings to calculate an overall mortality rate for the period of 20 September through 31 December 2017, which was compared to mortality rate during the same period in 2016.

The result was an “excess death rate” attributable to the hurricane and its aftermath, which the researchers then extrapolated to the population as a whole:

We calculated a 62% increase in the mortality rate from September 20 through December 31 in 2017 as compared with the same period in 2016, corresponding to an annual mortality rate of 14.3 deaths (95% CI, 9.8 to 18.9) per 1000 persons and an estimated 4645 excess deaths (95% CI, 793 to 8498) (Table S4 in the Supplementary Appendix).

One reason for the extreme disparity between the statistics-based estimates and the official death toll is that the latter was bound by strict criteria for determining the cause of death and statutory rules requiring certification by a medical examiner:

In Puerto Rico, every disaster-related death must be confirmed by the Institute of Forensic Sciences. This requires that bodies be brought to San Juan or that a medical examiner travel to the local municipality to verify the death, often delaying the issuance of death certificates. Furthermore, although direct causes of death are easier to assign by medical examiners, indirect deaths resulting from worsening of chronic conditions or from delayed medical treatments may not be captured on death certificates. These difficulties pose substantial challenges for the accurate and timely estimation of official all-cause hurricane-related mortality.

But statistical methods have their limitations, too. The Harvard estimate is based on an extremely small sample size, which means it could be off “by thousands,” according to a biostatistics expert consulted by Associated Press. The researchers maintain that their calculations included adjustments to minimize bias, however, and say their final estimate, if anything, is conservative:

Our estimate of 4645 excess deaths from September 20 through December 31, 2017, is likely to be conservative since subsequent adjustments for survivor bias and household-size distributions increase this estimate to more than 5000. These adjustments represent one simple way to account for biases, but we have made our data publicly available for additional analyses.

Clearly, there were many more than 64 fatalities directly attributable to the storm. Based on the common conclusions of news organizations and independent researchers who compared the total number of registered deaths throughout post-Maria Puerto Rico with historical averages for the same period, we can be fairly certain that at least 1,000 people died. The latest study suggests, extrapolating from polling data, that the total could have been as high as 5,000.

In sum, the best we can say at this point is that the actual death toll probably falls somewhere between 1,000 and 5,000 (for comparison’s sake, Hurricane Katrina — a far costlier storm in terms of property damage — officially caused 1,833 fatalities). Last February, Puerto Rico’s governor, Ricardo Rosselló, responded to criticisms of the government’s official death toll by enlisting George Washington University researchers to review its accuracy and, if necessary, revise it. After the findings of the Harvard study were released, Rosselló said there will be “hell to pay” if officials withheld mortality data. As of this writing, the GWU inquiry was behind schedule and the results had not yet been released.

Though it doesn’t close the book on the number of Maria-related fatalities (nor was it intended to), the Harvard study advances the effort to figure out how many really died, and also offers crucial insights into why the storm proved so deadly to Puerto Ricans in particular and who was most vulnerable. “In our survey, interruption of medical care was the primary cause of sustained high mortality rates in the months after the hurricane,” the researchers wrote, “a finding consistent with the widely reported disruption of health systems”:

Considerable disruptions to medical services were reported across all categories irrespective of remoteness, with 31% of households reporting an issue. The most frequently reported problems were an inability to access medications (14.4% of households) and the need for respiratory equipment requiring electricity (9.5%), but many households also reported problems with closed medical facilities (8.6%) or absent doctors (6.1%). In the most remote category, 8.8% of households reported that they had been unable to reach 911 services by telephone.

On average, households went 84 days without electricity, 68 days without water, and 41 days without cellular telephone coverage after the hurricane and until December 31, 2017. In the most remote category, 83% of households were without electricity for this entire time period.

All of which points up the need for more timely and accurate means of estimating death tolls after natural disasters, the researchers say, not just so the casualties are properly accounted for, but to improve preparedness planning for the future and better target interventions for recovery. This is all the more critical, they note, as the U.S. girds for the 2018 hurricane season, which was just beginning when their study was published.