The number of Puerto Ricans who died in the aftermath of Hurricane Maria is 70 times greater than official estimates released by U.S. territory officials, according to a study released Tuesday by Harvard University.
After Hurricane Maria devastated Puerto Rico in September, causing an estimated $90 billion in damages, the official death count was 64.
According to the Harvard T.H. Chan School of Public Health study published in the New England Journal of Medicine, the actual mortality number is closer to 5,000.
The result agrees with other independent estimates that indicated the death toll was closer to 1,000.
“The official death count of 64 is a substantial underestimate of the true burden of mortality after Hurricane Maria,” researchers wrote. “Our estimate of 4,645 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 5,000.”
Politicians reacted to the Harvard study with anger, blaming lack of government action and resources.
"How do you miss over 4,000 deaths?" Sen. Bill Nelson, D-Fla., tweeted. "The Trump administration failed the people of Puerto Rico in the wake of Hurricane Maria and it still isn't doing enough to help people recover."
The study found that the delay or interruption of medical care in the months after the hurricane was the No. 1 cause of death.
"It's breathtaking. This is a humanitarian crisis, it's an economic crisis and, frankly, it's a moral crisis," Democratic National Committee Chairman Tom Perez said. "The inaction of the federal government in the aftermath of this hurricane is unconscionable. We have to dramatically up our game in Puerto Rico. Throwing paper towels was insulting enough."
Researchers wrote that health care disruption in the U.S. after Hurricane Katrina, Superstorm Sandy and hurricanes Harvey and Irma were also a major contributor to storm-related deaths.
U.S. Rep. Darren Soto, Fla.-D, said he was shocked at the total, but not surprised it was higher than the government's death number.
"We saw in Katrina the death toll went from a few hundred to thousands," Soto said. "I really think there needs to be reform in how the federal government is associating which deaths are associated with hurricanes and other disasters."
Why is the official count so low?
To find the actual number of people who died due to Hurricane Maria, researchers surveyed about 3,300 random households, of an estimated 1,135,507 total households, across Puerto Rico in early 2018, including households in remote areas.
In the U.S., death certificates are the primary source of death statistics, and in the case of natural disasters, deaths can only be attributed to the storm by medical examiners.
How researchers determined the death toll
Before conducting the study, researchers requested the mortality data from the governor of Puerto Rico and were denied. The territory stopped sharing Hurricane Maria death numbers in December, according to the report.
Researchers took into account the migration of people from Puerto Rico due to the hurricane and looked at deaths between September and December 2017.
The study found that, on average, households went 84 days without electricity, 68 days without water and 41 days without cellular telephone coverage after the hurricane and until Dec. 31, 2017. Households in remote areas about 83 percent, were without electricity for the entire 84 days.
The Harvard T.H. Chan School of Public Health study is publicly available. Researchers wrote that they hope U.S. officials will use the data to better determine the scale and severity of disasters and prepare for recovery.
Florida Gov. Rick Scott's press secretary, Ashley Cook, said the governor remains "committed to helping Puerto Rico rebuild its infrastructure and making sure they have the support they need to avoid this kind of tragedy in the future.”
The Puerto Rican government has asked George Washington University to conduct an independent study to estimate the number of "excess deaths" that followed the storm.
Since the hurricane, the Institute of Statistics of Puerto Rico, an autonomous government entity, has been attempting to improve the counting of disaster-related deaths and publish all mortality data.
“The timely estimation of the death toll after a natural disaster is critical to defining the scale and severity of the crisis and to targeting interventions for recovery,” Harvard researchers wrote.