Study Puts Puerto Rico Death Toll From Hurricane Maria Near 5,000 
 
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 Updated 12:43 p.m. ET 
 
 Perhaps 5,000 people died in Puerto Rico in 2017 for reasons related to September's Hurricane Maria, according to a study that dismisses the official death toll of 64 as "a substantial underestimate." 
 
 A research team led by scientists at the Harvard T.H. Chan School of Public Health didn't simply attempt to count dead bodies in the wake of the powerful storm. Instead, they surveyed randomly chosen households and asked the occupants about their experiences. 
 
 From that approach, they concluded that between Sept. 20 and Dec. 31, 2017, there were 4,645 "excess deaths" — that is, deaths that would not have occurred if the island hadn't been plunged into a prolonged disaster following the devastating storm. 
 
 But the estimate isn't as precise as the figure implies.The researchers calculate a statistical term called a 95 percent confidence interval, which encompasses a broad range – from 800 to 8,500 deaths. Their figure of 4,645 lies near the middle of that range, and they round up to something over 5,000 to account for some assumptions they made. 
 
 The findings were published Tuesday by The New England Journal of Medicine. 
 
 The research team randomly selected 3,299 households in Puerto Rico. Local scientists surveyed them over the course of three weeks in January. People in those homes reported a total of 38 deaths. The scientists then extrapolated that finding to the island's total population of 3.4 million people to estimate the number of deaths. The researchers then subtracted deaths recorded during that same period in 2016 and concluded that the mortality rate in Puerto Rico had jumped 62 percent in the three months following the storm. 
 
 The death rate is a contentious subject, in part because federal and island governments haven't responded as rapidly to the disaster as they have in other hurricane emergencies. The study notes that 83 percent of the households in Puerto Rico were without electrical power for the time period looked at, more than 100 days, from the date of the hurricane until the end of 2017. 
 
 Puerto Rico residents and outside observers have long argued that the official death toll is hopelessly inadequate. It captures the number of deaths the medical examiner attributed directly to the storm — the high water and howling winds in the worst natural disaster on record for the U.S. territory. Maria came ashore as a Category 4 hurricane, with winds gusting at over 110 mph and drenching rainfall. 
 
 CNN surveyed funeral homes after the storm and tallied 499 hurricane-related deaths. The New York Times compared official death records from September and October 2017 and identified more than 1,000 excess deaths, compared with the average for 2015 and 2016. Alexis Santos, a researcher at Penn State University, and a colleague, used death certificates to come up with a similar estimate. 
 
 The government of Puerto Rico commissioned researchers from George Washington University's Milken Institute School of Public Health to estimate excess deaths. Results of that study have been delayed and are due out this summer. "We have always expected the number to be higher than what was previously reported," said Carlos Mercader, executive director of the Puerto Rico Federal Affairs Administration. He says that's why it commissioned the study from GW. "Both studies will help us better prepare for future natural disasters and prevent lives from being lost." 
 
 Caroline Buckee, a lead author of the news and epidemiologist at the Harvard T.H. Chan School of Public Health, says, "Our approach is complementary to that and it provides a different kind of estimate and a different kind of insight into the impact of the hurricane." The researchers suggested that the government in Puerto Rico could use its methods in an even larger survey to reduce the large uncertainties in their findings. 
 
 The Harvard study covers a greater time period than The New York Times' calculation, a difference that could partly account for the much higher figure. 
 
 The household survey is a widely accepted technique for estimating casualties following a disaster. But it can be misleading if the sample isn't truly random or if some households have been wiped out altogether and are therefore missing from the survey. In the latter, the result would underestimate the true toll. In fact, the Harvard team says its results are "likely to be an underestimate" because of this bias. 
 
 National Communication Issues In Puerto Rico Make It Hard To Register Deaths Communication Issues In Puerto Rico Make It Hard To Register Deaths Listen · 4:04 4:04 
 
 The survey looked at deaths through the end of 2017, but the scientists suspect that the excess deaths continued into this year. "We saw consistent, high rates, in September, October, November, December," says Rafael Irizarry, a biostatistician on the research team. "There's no reason to think that on Jan. 1 this trend stops." 
 
 "Hurricane Maria caused massive infrastructural damage to Puerto Rico," the Harvard team writes in its study. 
 
 "In our survey, interruption of medical care was the primary cause of sustained high mortality rates in the months following the hurricane," the wrote. Hospitals and doctors struggled to provide care, and many people simply had trouble getting to the doctor or the hospital to seek medical care. The survey finds that one-third of the total deaths in the months following the storm were caused by delayed or interrupted health care. 
 
 Understanding the true number is important for many reasons. "There are ramifications not only for families, not only for closure, but also financial ramifications" such as for aid and preparedness, says Dr. Satchit Balsari, one of the lead investigators, who is a physician at the Harvard FXB Center for Health and Human Rights. ||||| Puerto Rico Gov. Ricardo Rosselló tore into President Trump Donald John TrumpPaul McCartney slams Trump in new song: 'We've got a mad captain sailing this boat' George Conway rips Trump over tweet about Obama's '57 states' gaffe Pompeo doubles down on criticism of Kerry: The Iran deal failed, 'let it go' MORE on Friday as he continued to deny a scientific study which found that 3,000 people died on the island following a series of hurricanes last year. 
 
 “Mr. President — I’d very much be willing to walk you through the scientific process of the study and how @Gwtweets arrived at the excess mortality number estimate. There is no reason to underscore the tragedy we have suffered in the aftermath of Hurricane Maria,” Rosselló tweeted. 
 
 “In the meantime, I hope you consider sending a message of support to show you stand with all of the US Citizens in Puerto Rico that lost loved ones. It would certainly be an act of respect and empathy,” he continued. 
 
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 Mr. President— 
 
 
 
 I’d very much be willing to walk you through the scientific process of the study and how @Gwtweets arrived at the excess mortality number estimate. There is no reason to underscore the tragedy we have suffered in the aftermath of Hurricane Maria. 1/2 https://t.co/HGENQOu6fQ — Ricardo Rossello (@ricardorossello) September 14, 2018 
 
 In the meantime, I hope you consider sending a message of support to show you stand with all of the US Citizens in Puerto Rico that lost loved ones. It would certainly be an act of respect and empathy. 2/2 — Ricardo Rossello (@ricardorossello) September 14, 2018 
 
 Rosselló’s rebuke came after Trump doubled down on his claim, saying there was “no way” the death toll was that high after casting doubt on the researchers at George Washington University (GWU). 
 
 During a Friday night series of tweets, Trump said he was originally told the death toll following Hurricane Maria last fall was 16. 
 
 “Over many months it went to 64 PEOPLE. Then, like magic, ‘3000 PEOPLE KILLED,’ ” Trump wrote. 
 
 “When Trump visited the island territory last October, OFFICIALS told him in a briefing 16 PEOPLE had died from Maria.” The Washington Post. This was long AFTER the hurricane took place. Over many months it went to 64 PEOPLE. Then, like magic, “3000 PEOPLE KILLED.” They hired.... — Donald J. Trump (@realDonaldTrump) September 14, 2018 
 
 ....GWU Research to tell them how many people had died in Puerto Rico (how would they not know this?). This method was never done with previous hurricanes because other jurisdictions know how many people were killed. FIFTY TIMES LAST ORIGINAL NUMBER - NO WAY! — Donald J. Trump (@realDonaldTrump) September 14, 2018 
 
 Rosselló also issued a scathing statement when Trump said his administration’s response to the hurricanes in Puerto Rico was an “unsung success” and “one of the best jobs that’s ever been done” with respect to emergency response. 
 
 “The historical relationship between Puerto Rico and Washington is unfair and unAmerican,” Rosselló said. “It is certainly not a successful relationship.” 
 
 Rosselló called on Trump to extend federal coverage for the housing restoration and cleanup that is still ongoing on the island. 
 
 “This was the worst natural disaster in our modern history,” he said. “Our basic infrastructure was devastated, thousands of our people lost their lives and many others still struggle.” 
 
 "Now is not the time to pass judgement; it is time to channel every effort to improve the lives of over 3 million Americans in Puerto Rico," he added. 
 
 Trump also this week claimed — without evidence — that Democrats inflated the death toll in Puerto Rico to make him look bad. 
 
 “This was done by the Democrats in order to make me look as bad as possible when I was successfully raising Billions of Dollars to help rebuild Puerto Rico. If a person died for any reason, like old age, just add them onto the list. Bad politics. I love Puerto Rico!” he tweeted Thursday. 
 
 .....This was done by the Democrats in order to make me look as bad as possible when I was successfully raising Billions of Dollars to help rebuild Puerto Rico. If a person died for any reason, like old age, just add them onto the list. Bad politics. I love Puerto Rico! — Donald J. Trump (@realDonaldTrump) September 13, 2018 
 
 Rosselló last month updated the government's official death toll for Hurricane Maria to match the results of the study commissioned from GWU. 
 
 "We stand by the science underlying our study which found there were an estimated 2,975 excess deaths in Puerto Rico after Hurricane Maria," GWU's Milken Institute School of Public Health said in a statement this week. "We are confident that the number — 2,975 — is the most accurate and unbiased estimate of excess mortality to date." 
 
 The study reached its death toll figure by comparing estimates of typical non-disaster death rates over six months to the actual mortality rate in Puerto Rico six months after the storm. A number of studies have found that the number of people who died as a result of the hurricane's impact was much higher than the number originally counted lost during the storm itself.
– The official government death toll in Puerto Rico from devastating Hurricane Maria stands at 64. A new assessment led by Harvard researchers puts the figure closer to 5,000, reports NPR. More specifically, the researchers calculate that Puerto Rico had 4,645 "excess deaths" between Sept. 20, 2017, and Dec. 31, they write in the New England Journal of Medicine. How they got the figure: Researchers surveyed 3,299 homes in January and February and turned up 38 deaths in the time period after the hurricane, then extrapolated the figure to the island's population of 3.4 million. They concluded with a 95% certainty that the death toll attributable to the hurricane is between 800 and 8,500, with the figure of 4,645 a likely estimate. They also found that when comparing the number of deaths to 2016, the island's mortality rate increased 62% in the three months following the storm. "Our results indicate that the official death count of 64 is a substantial underestimate of the true burden of mortality after Hurricane Maria," the authors write. The toll of 64 mostly counts people killed directly by rising water or wind, and the Washington Post provides an example of a death that went uncounted. Ivette Leon, 54, died at home in November, less than a day after being released from the hospital. As her condition deteriorated, it took family members 20 minutes to get cell reception to summon help, and then nonworking traffic lights delayed the arrival of an ambulance. The new study suggests there are thousands more like her. "That is an astonishing undercount," a Columbia professor who wasn't involved with the study tells BuzzFeed News. "Something has gone terribly wrong here if they have a 70-times-higher death rate."