The official death toll from Hurricane Maria in Puerto Rico — which stands at just 64 according to the government of the still struggling U.S. territory — has been widely regarded as a serious underestimate.
The actual toll was more likely 70 times higher or worse, according to a Harvard University study — an astonishingly higher figure that bolsters critics on and off the island who have complained about a slow and inadequate effort to chronicle losses from the Category 4 hurricane eight months ago.
To calculate a more realistic toll in the wake of the hurricane, researchers went door to door to question nearly 3,300 families earlier this year, coming up with a death toll estimate of 4,645 — with many deaths coming after the storm's passage as a result of gaps or delays in medical care. Because family members may have misremembered details, researchers warned that the final number is likely higher.
"These numbers will serve as an important independent comparison ... and underscore the inattention of the U.S. government to the frail infrastructure of Puerto Rico," researchers said.
Puerto Rico's government, which has been criticized for its process of tallying deaths, said Tuesday that it always expected the number to climb and welcomed the new findings.
"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," said Federal Affairs Administration Executive Director Carlos Mercader in a statement. He pointed out that the agency had commissioned its own outside investigation, which is not yet complete.
In the days after Maria slammed the island as a near Category 5 hurricane, the island has struggled to return to normalcy. Electricity across the island was lost, and continued to be for months, complicating rescue efforts and communications. The financially strapped island, already struggling with a troubled power grid, remained in emergency response mode for months.
Puerto Rico also requires that deaths be confirmed by a medical examiner, a standard that researchers said could contribute to undercounting deaths on an island where no corner was left undamaged.
To come up with a more realistic number, they turned to a community-based survey methodology and grouped the island's 900 barrios into eight categories based on their location and remoteness. They randomly sampled 35 households, totaling 9,522 people, in 13 barrios and then compared the number of deaths reported between Sept. 20 and Dec. 31 to the same period a year earlier since the island's death rate has not fluctuated significantly since 2010.
Families were not offered compensation and were told responses would not result in benefits. More than 93 percent agreed to answer questions.
In addition to deaths, the study published in the New England Journal of Medicine also revealed other telling details about the storm's impact. Families reported that nearly 3 percent of their members had left their homes because of the hurricane. The average age of those who left was 25. Of those, 52 percent stayed in Puerto Rico and 41 percent fled to the mainland U.S.
About a third of the deaths were blamed on poor medical care and patients' inability to get prescriptions or use respiratory equipment. The finding should inform future hurricane responses, researchers said.
"Health care disruption is now a growing contributor to both morbidity and mortality in natural disasters," they said, citing such deaths following Katrina, Sandy and Harvey. After Irma, a dozen patients at a Fort Lauderdale nursing home died when the facility lost power and inside temperatures climbed.
Counting deaths, researchers urged, is one of the ways emergency managers can better prepare for future hurricanes and "account for the fate of those affected." Hurricane season begins Friday.
Herald Staff Writer Jim Wyss contributed to this story.