It’s almost hurricane season and to help focus attention on what happened in Puerto Rico after Hurricane Maria, the New England Journal of Medicine released a groundbreaking report on the death toll Tuesday.
By early December 2017, the official death count in Puerto Rico stood at 64, but several independent investigations concluded that additional deaths attributable to the hurricane were in excess of 1000 in the months of September and October.
The academic journal now estimates the real number to be much higher.
“Our results indicate that the official death count of 64 is a substantial underestimate of the true burden of mortality after Hurricane Maria. Our estimate of 4645 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 5000,” the report said.
The tropical cyclone Hurricane Maria, which made landfall in Puerto Rico, on September 20, 2017, compounded the destruction caused by Hurricane Irma 2 weeks earlier, damaging roads and interrupting the water supply, electricity, telecommunications networks, and access to medical care, the article said.
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.
In Puerto Rico, every disaster-related death must be confirmed by the Institute of Forensic Sciences. This requires that bodies be brought to San Juan or that a medical examiner travel to the local municipality to verify the death, often delaying the issuance of death certificates.
Furthermore, although direct causes of death are easier to assign by medical examiners, indirect deaths resulting from worsening of chronic conditions or from delayed medical treatments may not be captured on death certificates.
These difficulties pose substantial challenges for the accurate and timely estimation of official all-cause hurricane-related mortality. The Puerto Rican government has commissioned an external review of the death-registry data as a result of these issues.
This article was published on May 29, 2018, at NEJM.org.
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