The study’s main finding was that residents of Puerto Rico died at a significantly higher rate during the three months after the hurricane than they did during the same period in the previous year, and that roughly a third of those deaths resulted from delayed medical care. The researchers said in the report that their conclusions were consistent with the analyses of The Times and others.
“All these methods complement each other,” said Dr. Satchit Balsari, one of the study’s senior authors. “By no means is the number we’re estimating the end-all.”
What was the official death toll?
At the time our analysis was released, the official death toll was 64. That number included only people whose death certificates listed Hurricane Maria as a contributor, as certified by the Puerto Rico Forensic Sciences Institute in San Juan. But under pressure from a skeptical public, the Puerto Rican government announced in December that all deaths that had occurred in the months after Hurricane Maria would be reviewed and that people who died either directly or indirectly from the storm and its aftermath would be included in a revised tally.
What are direct and indirect deaths?
In relation to hurricane deaths, the term “direct” means those that occurred from drowning or other effects of the storm itself. “Indirect” deaths include those in which related factors, such as difficulty reaching a hospital for care, or trouble refilling medical prescriptions, played a role. The Centers for Disease Control and Prevention recommends that medical examiners record both types of deaths as associated with disasters, and the government of Puerto Rico says that it does so.
Why was the official count so low?
The government acknowledged that its tally of 64 was likely to be a significant undercount. In the days after the storm, with widespread power outages and extreme difficulty moving around the island, it was likely that many storm-related deaths went uninvestigated by the island’s medical examiner.
In November, CNN compiled figures from half the island’s funeral homes to report that funeral directors believed that 499 more deaths than the official count were tied to the hurricane. In many instances, local doctors had not sent the cases to the forensics bureau for analysis.
Also in November, BuzzFeed reported that 911 bodies were cremated following Hurricane Maria without being examined, and that in many cases, funeral home and crematory directors believed that those people had died as a result of the hurricane.