A new report from the New England Journal of Medicine indicates that the death toll in Puerto Rico from Hurricane maria was higher than official numbers indicate.
The report calculated the death rate from September 2017 through the end of December for that calendar year.
In early December 2017, the official death count in Puerto Rico stood at 64, but a household-based survey funded by outfits that included the Harvard T.H. Chan School of Public Health suggests the number of excess deaths related to Hurricane Maria in Puerto Rico is more than 70 times the official estimate.
Rather than 64 deaths directly from Hurricane Maria and later causes attributable to it, authors say the number is probably closer to 4,645.
The Journal reports that, from the survey data, study authors estimated a mortality rate of 14.3 deaths per 1000 persons from September 20 through December 3 of 2017.
Study authors stressed that they believed this number was likely to be an underestimate, due to survivor bias.
The study data noted that the mortality rate remained high through the end of December 2017, and that one third of the deaths were attributed to delayed or interrupted health care.
According to the Centers for Disease Control and Prevention, deaths can be directly attributed to a tropical cyclone if they are caused by forces related to the event, such as flying debris, or if they are caused by unsafe or unhealthy conditions resulting in injury, illness, or loss of necessary medical services.
The study cited multiple post-hurricane difficulties that would have contributed to the discrepancy between the official death toll and the strikingly higher number presented in the study.
Officials involved in the study note that the Puerto Rican government has commissioned an external review of the death-registry data as a result of these issues.
The full evaluation can be found here: https://www.nejm.org/doi/full/10.1056/NEJMsa1803972