According to a recent Harvard University study published in the New England Journal of Medicine the estimated death toll caused by Hurricane Maria in Puerto Rico was 4,645, making it one of the deadliest natural disasters in United States history. According to the study, the deaths recorded — between Sept. 20 and Dec. 31, 2107 — were primarily caused by the “unsafe or unhealthy conditions resulting in injury, illness, or loss of necessary medical services” due to the interruption of medical care. ADVERTISEMENT The government of Puerto Rico had already commissioned George Washington University for a similar study in advance of Harvard’s finding, which is expected out soon. The Harvard study contrasts with the low official death tolls provided by the government of Puerto Rico, which admittedly had difficulties in obtaining accurate information in the aftermath of the hurricane, and on occasion may have hindered it. As to be expected, this study is now being used for political purposes, particularly to highlight the Trump’s administration alleged poor handling of the disaster relief. In this context, San Juan Mayor Carmen Yulin Cruz statements that the federal government “was killing us” resonated in certain sectors interested in embarrassing President Trump Donald TrumpTrump lashes out after grand jury seated for New York criminal probe Schumer tees up vote on Jan. 6 commission bill Senators struggle to save Jan. 6 commission MORE for his cavalier remarks on the damages suffered in Puerto Rico as compared to the damages caused by Hurricane Katrina. In light of the findings, the San Juan mayor has positioned herself as some sort of tropical “Pasionaria” defending Puerto Rico from Washington’s colonial neglect, while promoting her political ambitions for the 2020 general election in Puerto Rico. Carmen Yulin Cruz is a well-known populist member of the Popular Democratic Party that favors a watered down version of independence for Puerto Rico in the form of an associated republic, with American citizenship of course. Any discussion of the Harvard study and the estimated death toll in Puerto Rico needs to be mindful of the overlapping and at time conflicting interests involved. From the perspective of national politics, the Harvard study argues powerfully against the premature dismissal of Puerto Rico from the national discussion. In this regard, the study does justice to those that died during and in the aftermath of the hurricane, and to those of us that continue struggling in Puerto Rico to recover from the natural disaster and its continuing fiscal and economic crisis. An essential component of this recovery process is working towards overcoming our political disenfranchisement. The study should not be read— as it is by a vocal minority still trapped in the pseudo-romantic rhetoric of national liberation— as a condemnation of American presence in Puerto Rico as an instance of colonialism. Whether the federal government has been dragging its feet in aiding Puerto Rico after Hurricane Maria is fundamentally a factual question that needs to be answered looking at the specific measures adopted by Congress and implemented by the Trump administration. As in any event of this magnitude, mistakes are surely to have been committed both by the federal and territorial government. That does not necessarily mean however that they should be characterized as intentional or willfully negligent. According to some estimates Puerto Rico thus far has received approximately $35 billion in diverse assignments for various purposes from Congress since Hurricane Maria. The short-term economic impact of these assignments will not be felt immediately, although all concerned recognize that without them the island’s recovery would not be possible. Looking beyond these assignments it must be kept in mind that Puerto Rico is mired in a bankruptcy-like procedure in the Federal District Court under Title III of PROMESA, with an outstanding $74 billion public debt, teetering government pension plans, a collapsed and costly electrical grid infrastructure, dysfunctional government services, a decade long shrinking economy and a continuing population loss due to stateside migration. The damages and death toll caused by Hurricane Maria was the “coup de grace” to our misfortunes. In the last few weeks the Financial Oversight Board charged with the responsibility of overseeing the government’s fiscal recovery has reached some tentative understandings regarding its annual budget, and which are now pending approval in the territorial Legislature. These understandings are an improvement from the earlier tense conversations that threatened what little political viability the government of Puerto Rico might have. Although disagreements persist, there seems to finally be a growing consensus among government officials that they need to address its fiscal mismanagement in collaboration with the Financial Oversight Board. In Puerto Rico, the Harvard study is viewed by the political opposition to the current pro-statehood administration as a blunt instrument with which to bludgeon it with for its lack of transparency and competency. In the world of practical politics this is perfectly understandable. What is missing from this criticism though, is the acknowledgement that the thousands of people who died did not have political representation in Congress to defend their interest in the immediate aftermath of the hurricane. Had it been otherwise, things might have turned out differently. Andrés L. Córdova is a law professor at Inter American University of Puerto Rico, where he teaches contracts and property courses. He is also an occasional columnist on legal and political issues at the Spanish daily El Vocero de Puerto Rico.<doc-sep>Neither the commonwealth nor the federal government appear to have been aware of the reality on the ground. It’s as if officials were either intent on measuring their success in dealing with the emergency in terms of how many people died, or were oblivious to the fact that not all hurricane-related deaths are caused by falling trees, drownings and other immediate storm effects. President Trump essentially admitted the former during his visit to Puerto Rico, when he asked Gov. Ricardo Rosselló about the number of deaths — then “certified” at 16, according to Rosselló — and compared it favorably to what happened in “a real catastrophe like Katrina.” The latter was most tactlessly admitted by Puerto Rico’s health secretary, who nine days after the storm said on a local radio station that “people die in hospitals every day for any number of reasons.” He added that these were “things that are unavoidable.”<doc-sep>A study released last week by researchers from Harvard had lots of important things to say about life and death in Puerto Rico after Hurricane Maria. In the weeks and months after the storm, hospitals were overwhelmed, pharmacies were low on drugs, and households went without clean water and electricity. The devastation of the island’s health care infrastructure likely led to hundreds of deaths. But those points are likely not what you’ve heard about the study. The part that garnered the most headlines was a central number in the report: 4,645. “Hurricane Maria Killed 4,645 in Puerto Rico, 70 Times Official Toll,” Democracy Now reported. “Harvard study: Hurricane Maria death toll exceeds 4,000” NBC News wrote. CNN led its report with something similar: “An estimated 4,645 people died in Hurricane Maria and its aftermath in Puerto Rico, according to an academic report published Tuesday in a prestigious medical journal.” But that number is not a count of the death toll in Puerto Rico caused by Hurricane Maria. Instead, it’s just the midpoint of a wide-ranging estimate of the possible number of deaths; the full range goes from 793 to 8,498 people. What that estimate means — that if you randomly sampled households over and over, 95 percent of the ranges extrapolated from those surveys would include the actual death count — doesn’t easily lend itself to headlines. And in focusing on that single number, news stories often overlooked much of the qualitative information about how people died. Here’s how the Harvard study worked: In January and February of 2018, researchers surveyed more than 3,000 randomly selected households across Puerto Rico and asked residents how many people from those households had died in the months after the storm made landfall. They found 38 deaths in those 3,300 households, and they used that figure to calculate a mortality rate, which was compared to the mortality rate from the same time the previous year, before the storm hit. The difference was then used to come up with a very broad estimate for the number of people who died above what you’d expect to see in a normal year. The Harvard study is not the only attempt to measure the toll on the island, and each has its own quirks and timelines. The Center for Investigative Journalism in Puerto Rico calculated around 1,000 excess deaths from Sept. 20, 2017, when the hurricane swept through the islands, through the end of October, as did the New York Times and researchers working with Penn State. Professors at the University of Puerto Rico-Mayagüez estimated somewhere between 605 and 1,039 additional deaths during that time. The Harvard study covered a longer period than the others– through the end of the year — and suggested that the number of deaths was elevated for months after the storm. Despite the different numbers, there is a clear takeaway from all these studies: a lot of people died after Hurricane Maria. Even the lowest bounds of the Harvard estimate would be more than 12 times the official death toll of 64 and would make Hurricane Maria one of the deadliest natural disasters in U.S. history. And that’s not including the deaths in other countries and U.S. territories, such as the U.S. Virgin Islands, whose infrastructure was also devastated by the storm. The Puerto Rican government has frequently acknowledged that it needs to improve its own count. In the face of intense criticism of its official statistics, the government commissioned a study from researchers at George Washington University, supplying them with official death records and other data, which should be available later this summer. What happens if GWU finds the death count is closer to 1,000 or 1,500, as other studies have estimated? It would be thousands of fewer deaths than was widely reported in the news, but it would be well within the estimates made by the Harvard researchers. And estimates along those lines would still mean the disaster was of epic proportions and resulted in many deaths that likely could have been prevented. The authors of the Harvard study are well aware of its limitations, which is why they didn’t include the 4,645 figure in the headline of their press release, and also why they made sure that the range of estimates was front and center in all communication, said Rafael Irizarry, a Harvard biostatistician who was a co-author on the paper. But the true number? That’s not something that could come from the Harvard research, said Irizarry. The house-to-house survey only allows for a broad range of estimated deaths. It does suggest that deaths remained high for months after the storm, after the time period covered by previous media outlets and researchers. But perhaps the most important contribution of this study is the information surveyors gathered on how difficult it was to access basic health care services after the storm and how consequential that lack of access may have been. About a third of the deaths documented by the survey were caused by an interruption of medical services. And in addition to those who died, many more people faced trouble getting care. Fifteen percent of households in the survey said they had trouble getting medicine, and around 10 percent had trouble using breathing equipment. Now, with hurricane season already underway and the infrastructure for both Puerto Rico the U.S. Virgin Islands still in bad shape, perhaps the most important takeaway from the study is that the islands are facing a lot more potential death if there isn’t a faster, stronger response to storms in the future.<doc-sep>Blue tarps are still the only roofs for some homes in Corozal. A Puerto Rico Electric and Power Authority brigade work in a remote off-road location to repair a downed power transmission line in Ponce, Puerto Rico on November 29, 2017. / AFP PHOTO / Ricardo ARDUENGO / TO GO WITH AFP STORY By Leila MACOR, US-PuertoRico-power-weather-reconstruction-hurricane (Photo credit should read RICARDO ARDUENGO/AFP/Getty Images) MOROVIS, PUERTO RICO - DECEMBER 20: A resident, whose home remains without electricity, watches as debris is removed on December 20, 2017 in Morovis, Puerto Rico. Barely three months after Hurricane Maria made landfall, approximately one-third of the devastated island is still without electricity and 14 percent lack running water. While the official death toll from the massive storm remains at 64, The New York Times recently reported the actual toll for the storm and its aftermath likely stands at more than 1,000. Puerto Rico's governor has ordered a review and recount as the holiday season approaches. (Photo by Mario Tama/Getty Images) SAN ISIDRO, PUERTO RICO - OCTOBER 05: Kids bike in an area without grid power or running water about two weeks after Hurricane Maria swept through the island on October 5, 2017 in San Isidro, Puerto Rico. Puerto Rico experienced widespread damage including most of the electrical, gas and water grid as well as agriculture after Hurricane Maria, a category 4 hurricane, swept through. (Photo by Mario Tama/Getty Images) Guest: Mayor Carmen Cruz from San Juan, PR (Facetime) Anderson in Studio 73 / Control 71 (channel 67) Please record CTL 7100 Switched Please record CTL 7103 Clean Switched Please record CTL 7138 AC ISO Please record CTL 7139 Splits Please record CTL 7140 Big Smalls Please record GFX 905 Cruz ISO With hurricane season starting June 1, CNN returns to Puerto Rico to see if the island is ready for another storm. Nine months after Maria, 20,000 homes are still without power- and going into the season, many mayors are worried that even a small storm will plunge them back into darkness and repeat the crisis all over again. We witness desperate Puerto Ricans illegally and dangerously turning on their own power, and press officials for answers on what will change this time around. MOROVIS, PUERTO RICO - DECEMBER 20: A resident, whose home remains without electricity, watches as debris is removed on December 20, 2017 in Morovis, Puerto Rico. Barely three months after Hurricane Maria made landfall, approximately one-third of the devastated island is still without electricity and 14 percent lack running water. While the official death toll from the massive storm remains at 64, The New York Times recently reported the actual toll for the storm and its aftermath likely stands at more than 1,000. Puerto Rico's governor has ordered a review and recount as the holiday season approaches. (Photo by Mario Tama/Getty Images) title: duration: 00:00:00 site: author: published: intervention: yes description: Radio Isla had access to vans that contained water, food, medicine and hundreds of open boxes, many of them with reptile waste and in a state of decomposition. According to sources, the supplies were for the victims of the hurricanes. SAN ISIDRO, PUERTO RICO - OCTOBER 15: Uncollected debris stand near damaged homes in an area without electricity on October 15, 2017 in San Isidro, Puerto Rico. Puerto Rico is suffering shortages of food and water in many areas and only 15 percent of grid electricity has been restored. Puerto Rico experienced widespread damage including most of the electrical, gas and water grid as well as agriculture after Hurricane Maria, a category 4 hurricane, swept through. (Photo by Mario Tama/Getty Images) (CNN) — Puerto Rico’s governor defended his government’s efforts to account for deaths on the island following Hurricane Maria after a new study called the official tally a “substantial underestimate.” The official death toll in Puerto Rico has been the subject of substantial controversy since Hurricane Maria hit the island, a US territory, on September 20. Gov. Ricardo Rosselló said he welcomed the results of a Harvard study published Tuesday in the New England Journal of Medicine. Researchers surveyed 3,299 randomly chosen households across the island and compared it to official mortality statistics from 2016. They concluded that an estimated 4,645 people died in Hurricane Maria and its aftermath in Puerto Rico – almost 70 times the government’s official tally of 64. Rosselló said he does not stand by the official death toll. But he said his government did the best it could with information-gathering protocol available to them at the time. “We had established that this number was going to be much, much higher than what we had as an official tally,” he told CNN’s Anderson Cooper. “It’s not sticking with the number. It was just establishing that the process that we had prior led us to that number, which is what we got from doctors and death certificates.” CNN and other news outlets have used government statistics and extensive interviews with families of the deceased and funeral home directors to question the Puerto Rican government’s official tally of deaths. Previous estimates suggested Maria contributed to about 1,000 deaths. Rosselló cited the government’s commissioning of a study to be carried out by George Washington University as a sign of its intentions to reach an accurate number. He acknowledged that the GW study is behind schedule and blamed the delay on the difficulty of obtaining accurate data from death certificates. He said he hoped the results of the GW study, along with the Harvard survey results, could inform decision-making about how to handle similar catastrophes. One researcher who worked on the Harvard study told CNN that the Puerto Rican government did not provide them with data they requested. Rosselló said there would be “hell to pay” if officials from his government were found to be withholding mortality statistics from researchers. “I really want this to be very transparent. I want the truth to come out. That’s the bottom line. And I want us to learn from this tragedy.” CNN’s Leyla Santago and John Sutter contributed to this report.<doc-sep>
(CNN) — An estimated 4,645 people died in Hurricane Maria and its aftermath in Puerto Rico, according to an academic report published Tuesday in a prestigious medical journal. That figure dwarfs Puerto Rico’s official death toll of 64, which the article’s authors called a “substantial underestimate” of Hurricane Maria’s death toll. “These numbers … underscore the inattention of the US government to the frail infrastructure of Puerto Rico,” authors from Harvard University and other institutions wrote in the New England Journal of Medicine. The official death toll in Puerto Rico has been the subject of substantial controversy since Hurricane Maria hit this island, a US territory, on September 20. CNN and other news outlets have used government statistics and extensive interviews with families of the deceased and funeral home directors to question the Puerto Rican government’s official tally of deaths. Previous estimates suggested Maria contributed to about 1,000 deaths. The team from Harvard arrived at its much-higher estimate by surveying 3,299 randomly chosen households across the island earlier this year. Authors compared results of that survey – which asked island residents about deaths in their homes, among other things – with official mortality statistics from 2016. That allowed researchers to estimate the number of deaths that likely occurred as a result of Hurricane Maria between the date of the storm and December 31, 2017. “The difference is that we went out and we had boots on the ground and we did the interviews,” said Domingo Marqués, an associate professor of clinical psychology at Carlos Albizu University in Puerto Rico, who was among the report’s authors. “Statistically, it’s like having interviewed the whole island,” he said. Still, the exact death toll is likely to remain a mystery. Experts tell CNN it is difficult to say with certainty whether a hurricane “caused” certain deaths, especially those that occurred because of the chaotic and unsafe conditions that have lingered for months in Puerto Rico. Marqués and colleagues say 793 to 8,498 hurricane deaths occurred. In a news conference on Tuesday, Hector Pesquera, head of Puerto Rico’s public safety department, said the government did not have reason to question the latest estimates, which come from researchers at Harvard University as well as Beth Israel Deaconess Medical Center, the University of Colorado and universities in Puerto Rico. US territory officials stressed that the Puerto Rican government has hired George Washington University to conduct an assessment of Maria’s death toll and that the results of that review are still forthcoming. Previously, officials had expected the George Washington University report to be released this spring, before the Atlantic hurricane season, which begins on June 1. “The Government of Puerto Rico welcomes the newly released Harvard University survey and we look forward to analyzing it,” Carlos R. Mercader, executive director of the Puerto Rico Federal Affairs Administration, said in a press release. “As the world knows, the magnitude of this tragic disaster caused by Hurricane Maria resulted in many fatalities. We have always expected the number to be higher than what was previously reported. That is why we commissioned The George Washington University to carry out a thorough study on the number of fatalities caused by Hurricane Maria which will be released soon. Both studies will help us better prepare for future natural disasters and prevent lives from being lost.” The Harvard study says the Puerto Rican and US governments did not provide adequate services – including electrical power and medical assistance – after the hurricane. It also notes that Puerto Rican officials have refused to make public basic mortality statistics. 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. In November, CNN surveyed 112 funeral homes – about half the total – across Puerto Rico, in a moment when many communication systems remained inoperable. At that time, funeral home directors identified 499 deaths they considered to be hurricane-related. Puerto Rico added at least two people to its official count following CNN’s investigation. Erika P. Rodriguez for CNN Grave of Natalio "Pepito" Rodríguez Lebrón at the Municipal Cemetery of Maunabo in Puerto Rico. His family says they couldn't afford to power a breathing machine that helped keep him alive.