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Question

CNN reports:

Earlier this month, [Puerto Rico]'s governor formally raised the death toll from Hurricane Maria to an estimated 2,975 from 64 following a study conducted by researchers at The George Washington University.

It also reports that President Trump just tweeted this:

3000 people did not die in the two hurricanes that hit Puerto Rico. When I left the Island, AFTER the storm had hit, they had anywhere from 6 to 18 deaths. As time went by it did not go up by much. Then, a long time later, they started to report really large numbers, like 3000. This was done by the Democrats in order to make me look as bad as possible when I was successfully raising Billions of Dollars to help rebuild Puerto Rico. If a person died for any reason, like old age, just add them onto the list. Bad politics. I love Puerto Rico!

Is President Trump correct that the official death toll figure is grossly exaggerated?

I just came to post the same question. You beat me by a few minutes. I think we should reverse this, because I don't think Trump is actively claiming 6-18 deaths, but that the official (September) toll of 2,975 is grossly exaggerated. — 4 hours ago
I changed it. I hope you don't mind, but I think it is only fair to put the claimant's position in the most generous light. Under this wording, if it turns out that there were, say, 100 deaths, Trump would be substantially right, not wrong. — 4 hours ago
Is the claim that about 3000 died while Maria was going on or that 3000 died due to Maria? — 4 hours ago
I believe the latter, but if the official death toll uses unusual standards that increases the count far more than is expected (compared to similar natural diasters), I think that would make an excellent answer. [To be clear: I have no reason to believe that is the case.] — 3 hours ago
@Oddthinking yes, we cant determine the motivations of those who calculated the official toll, but determining what metrics where used to create the final count would certainly clarify the reality of the situation. Someone here is either being grossly misleading or is terribly mistaken, and I wouldn't be surprised either way. Love the fact that this site exists. — 3 hours ago

John Doe 1031 · Answer 1 · 2018-09-13 15:30:20Z

No, they didn't die in Hurricane Maria, but nearly 3,000 people likely did die as a result of Hurricane Maria.

The death toll of 2,975 is from this report by the school of public health at George Washington University. They are not claiming that nearly 3,000 people died during the hurricane, but that there were nearly 3,000 more deaths than expected in the months following the hurricane.

In other words, if past mortality rates predicted that 100 people would die from age-related issues in January and 125 people actually died, then the 25 people that were added to the list of deaths were likely caused by the hurricane.

As summarized in the report's methodology section:

We implemented the project as three studies, each
with specific yet complementary methodologies.
Our excess mortality study analyzed past mortality
patterns (mortality registration and population
census data from 2010 to 2017) in order to predict
the expected mortality if Hurricane MarÃƒÂa had not
occurred (predicted mortality) and compare this
figure to the actual deaths that occurred (observed
mortality).The difference between those two
numbers is the estimate of excess mortality
due to the hurricane.

...

Total excess mortality post-hurricane using the
migration displacement scenario is estimated to
be 2,975 (95% CI: 2,658-3,290) for the total study
period of September 2017 through February 2018.

This number was estimated with a high amount of confidence by comparing expected population changes had Maria not occurred with actual population changes:

To perform this analysis, we obtained vital registration mortality data
including deaths by age, sex and municipality of residence from the Puerto
Rico Puerto Rico Vital Statistics Registry (PRVSR) for the period July 1, 2010
to February 28, 2018. We derived baseline estimates of population size in
each month from annual census estimates of population size by age, sex
and municipality of residence. Cumulative monthly population displacement
after the storm in each month was estimated using Bureau of Transportation
Statistics (BTS) data on monthly net domestic migration provided by the
Puerto Rico Institute of Statistics and a survey of airline travelers provided
by the Puerto Rico Planning Board (Planning Board 2018).

Using the ~8 years of past population statistics, the researchers were able to estimate the expected number of deaths in the few months after the hurricane with the actual number of deaths:

Table of predicted/actual deaths in Puerto Rico after Hurricane Maria

As a side note, the purpose of the report wasn't necessarily to provide a fully accurate death count. Rather, the purpose was to show why this exact situation, where death estimates are so varied and potentially inaccurate, is dangerous and why it shouldn't even happen in the first place. It was meant to act as a policy guide for improvements to Puerto Rican mortality assessments and communication during natural disasters, so that a disaster of this magnitude doesn't happen again:

RECOMMENDATIONS ON MORTALITY
SURVEILLANCE FOR NATURAL DISASTERS

I. Strategic Objectives

To have a reliable and resilient institutional mortality surveillance process that provides
trustworthy and accurate evidence during natural disasters to: Establish the magnitude
of the impact of the disaster, identify areas and groups of highest risk, monitor the
performance of public health protection and prevention, and inform policy-making
and program implementation.

I think it is important to note the study compared to actual to expected deaths, so if a person died of old age, they wouldn't be part of the count, in contradiction to Trump's claim of the cause of the discrepancy. — 3 hours ago
Right, but you assume old-age deaths are predictable. The chart in the report clearly shows that their is significant variation in the monthly death tolls, prior to the hurricane as well. It's not as predictable as we are portraying, so that you could just back-out the old age deaths. Also, the fact that the excess deaths are hovering around 500 per months is also strange, it's as if the conditions aren't improving as would be expected. You would expect excess deaths in September/October to be much higher than February excess deaths. — 2 hours ago
@Gite I do have a statistics background and think there are serious attribution problems with the study. — 2 hours ago
@Underminer - That's why they also published a margin of error (which most people don't report) of 793 to 8498 deaths. It would of course be much more ideal if we instead had an official government count to work with that represented a good faith effort to achieve an objectively accurate count, so we wouldn't have to resort to a statistical forensics effort like this, but it appears we don't get to have one of those. — 1 hour ago
@Underminer of course the expected number of old-age deaths is predictable, in the statistical sense. Otherwise, how do you imagine life insurance companies stay in business and make profits? — 1 hour ago

Oddthinkingâ™¦ 96.4k30403502 · Answer 2 · 2018-09-13 14:05:49Z

There are a number of different institutions who try to quantify death tolls and other damages after natural disasters. The definitions and methodology differs between estimates and numbers vary depending on which method you choose.

For example, if somebody is injured badly during a hurricane and die months later in hospital from their injuries, should this be included in the toll?

A special article in the New England Journal of Medicine study, Mortality in Puerto Rico after Hurricane Maria was published in July. They used a survey methodology to make an estimate of the death toll. They did not count the deaths recorded by medical services, but surveyed over 3,000 people in Puerto Rico about damage and deaths. From the answers they calculated that the death toll was 4645 with a 95% confidence interval of 793 - 8498.

From the survey data, we estimated a mortality rate of 14.3 deaths (95% confidence interval [CI], 9.8 to 18.9) per 1000 persons from September 20 through December 31, 2017. This rate yielded a total of 4645 excess deaths during this period (95% CI, 793 to 8498), equivalent to a 62% increase in the mortality rate as compared with the same period in 2016. However, this number is likely to be an underestimate because of survivor bias. The mortality rate remained high through the end of December 2017, and one third of the deaths were attributed to delayed or interrupted health care. Hurricane-related migration was substantial.

According to these numbers, a death toll of 3,000 people is likely not an exaggeration.

To answer your question: Donald Trump's statement is most likely not accurate.

It would be interesting to know if similar statistical analyses have been performed for other natural disasters. I suspect that mortality rises significantly after any such event (due to infections, substandard nutrition (babies?), worse access to medical help even for unrelated conditions, stress, accidents even just due to more travel etc.) So one may compare apples and oranges with the 3000 number, and Trump may be essentially right (first time I'm writing that sentence, but science is impartial, even statistics ;-) ). — 2 hours ago
Famously, a similar statistical analysis was done for the Iraq war which showed 650,000 "excess deaths". — 2 hours ago
@PeterA.Schneider Like with a lot of things, Trump is technically correct because he's (potentially intentionally) misrepresenting the claims actually being made. Saying that 3,000 people didn't die in Hurricane Maria is correct, but it's also not what people are saying. — 2 hours ago
@AnthonyGrist See my comment to pjc. If the 3k number is used to allege bad disaster management (which I suspect is what people are saying in a subtext), one has to compare it with the results of a similar mortality analysis for other events, which I suspect will come up with enormous numbers as well. [Don't get me wrong: The disaster management was terrible. But I assume only a fraction of the 3k could have been prevented by better management.] — 2 hours ago
@PeterA.Schneider That's a perfectly valid argument, but it's also absolutely not the one Trump is making in his tweet. For what it's worth, I'd consider the majority of deaths due to infections or substandard nutrition following a disaster to be a direct result of bad disaster management. A good disaster management plan should include providing adequate food and medical care. — 1 hour ago

score 10 · Answer 3 · 2018-09-13 15:56:50Z

Other answers have discussed the statistical methodology of studies used to estimate the death tolls, but let me approach this from a different perspective: Do we have reliable on-the-ground reporting of significant deaths (in the hundreds or even thousands) during and immediately after the hurricane?

The answer: YES

Miami Herald: Hurricane MariaÃ¢Â€Â™s death toll in Puerto Rico is higher than official count, experts say (September 2017, 1 week after the storm):

The dead are at the hospital morgues, which are at capacity and in remote places where the government has yet to go. In many cases, families are unaware of the deaths....

Ã¢Â€ÂœWeÃ¢Â€Â™re finding dead people, people who have been buried, [people] have made common graves,Ã¢Â€Â RodrÃƒÂguez-Mercado told CPI. Ã¢Â€ÂœWeÃ¢Â€Â™ve been told people have buried their family members because theyÃ¢Â€Â™re in places that have yet to be reached.Ã¢Â€Â

BuzzFeed News: 911 People Died After The Hurricane Ã¢Â€Â” Of "Natural Causes" (October 2017, 1 month after the storm):

The Puerto Rican government told BuzzFeed News on Friday that it has allowed 911 bodies to be cremated since Hurricane Maria made landfall, and that not one of them were physically examined by a government medical examiner to determine if it should be included in the official death toll....

Without guidance, different funeral home and crematorium directors told BuzzFeed News they had vastly different ideas of what they considered hurricane-related deaths. Some said they counted heart attacks and people who died for lack of oxygen because there was no power, while others said they counted those as "natural deaths."

Disaster death toll experts told BuzzFeed News that these cases should definitely be counted, and that they were in the aftermath of Hurricane Katrina.

CNN: Survey of 112 Puerto Rican funeral homes (November 2017):

To check the accuracy of the Puerto Rican government's figures, we called nearly every funeral home in Puerto Rico.... Some funeral homes did not answer our calls, and several declined to provide data. CNN was able to collect responses from 112 of the island's funeral homes. That's about half the total number in Puerto Rico, according to Eduardo Cardona, director of the Puerto Rico Association of Funeral Home Directors.

Those funeral homes identified 499 deaths in the month after the storm -- September 20 to October 19 -- which they say were related to Hurricane Maria and its aftermath. That's nine times the official death toll. And, again, it represents only about half of funeral homes.

CNN: It's been almost six months since Hurricane Maria, and Puerto Ricans are still dying (January 2018):

Some of them died during the storm. A mudslide in Utuado, Puerto Rico, killed two "bedridden" sisters. Another person drowned in Toa Baja. But the aftermath of Hurricane Maria appears to have been most deadly....

In Corozal, farther into the mountains, Victor Manuel Belen Santiago wept as he told me that his mother, Zoraida Santiago Torres, 58, had saved his life by helping him kick drug addiction.

Their home was destroyed by the storm, and Belen Santiago rebuilt it by hand, puzzling scraps of the roof and walls together like a reassembled house of cards. But he couldn't restore the power his mother needed to run an oxygen machine. She died on February 13, he said, after getting fluid in her lungs that could not be cleared. Her death certificate lists organ failure and a bacterial infection among the causes of death, along with chronic liver disease.

NBC: Puerto Ricans knew the official Hurricane Maria death toll was fake. We saw too many dead to believe it. (May 2018):

When funeral directors started telling people that they were burying way more bodies than usual, or when our family members told us about their neighbors dying in still-darkened rooms, or being buried outside their homes, we knew that the official death toll was much higher than the 64 people the government had eventually admitted to.

When we heard the stories of people having no refrigeration for their insulin, that dialysis machines werenÃ¢Â€Â™t operational or that hospitals were still in the dark but had people on life support, we knew that it wasn't some small counting error.

So Puerto Ricans are not suddenly shocked by the Harvard study published this week estimating that a total of 4,645 excess deaths occurred between September 20 through December 31, 2017, because the proof was already there months ago.

But almost nobody else wanted to look for it.

Washington Post: I saw what Maria did to Puerto RicoÃ¢Â€Â™s hospitals. The death toll is no surprise (June 2018):

We found an ongoing human disaster during the months of September, October and November, when we made daily visits to more than 60 senior homes and independent-living facilities. At one high-rise, within walking distance of a hospital, residents were trapped on the upper floors because the backup generator had failed and they couldnÃ¢Â€Â™t walk down the stairs. Some folks I spoke with didnÃ¢Â€Â™t remember when they had last eaten. There was no potable water because the pump to get it up to the apartments also depended on electricity. Dialysis patients hadnÃ¢Â€Â™t been treated in days; diabetics couldnÃ¢Â€Â™t refrigerate their insulin....

The hospital couldnÃ¢Â€Â™t reach ambulance services for other residents who needed urgent care, because they had no means of communication. A nearby police car was similarly incommunicado. Four people were eventually evacuated from the building in municipal ambulances Ã¢Â€Â” stretchers and wheelchairs were carried down cramped stairwells Ã¢Â€Â” but I overheard the EMTs wondering where they would take the dialysis patients; they didnÃ¢Â€Â™t know if any centers would be open.

With conditions that bad at one of so many buildings, of course more than 64 people died. What is surprising is that the government has so far been unwilling to admit it.

While we can't extrapolate specific numbers from these stories, it is absolutely inconceivable that only a handful of people died due to Hurricane Maria. In my opinion, 3,000 deaths is absolutely plausible, if not understated.

Some further references:

CNN: How Puerto Rico's death toll climbed from 64 to 2,975 in Hurricane Maria

538: Media Reports About The Death Toll In Puerto Rico Are Needlessly Confusing

Snopes: Did All of the Patients in a Puerto Rican Intensive Care Unit Die?. This claim is rated as "unproven", but the article contains some other useful quotes and links.

Graham 1,279410 · Answer 4 · 2018-09-13 15:21:10Z

To add to the existing good answers, it's also important to understand what Donald Trump is being held personally responsible for.

It is well known that the most significant death toll from natural disasters is rarely directly from the disaster itself, but more normally from disease, exposure, famine or other preventable causes arising from the disaster. Puerto Rico still had substantial levels of infrastructure needing repair from Hurricane Irma before Hurricane Maria hit. However it took 43 days before Trump approved FEMA disaster relief for Puerto Rico. Most of the island was still without electrical power at this point, and a substantial part was without drinking water. The situation was so severe that Oxfam were required to assist, in the absence of the US intervening itself.

This does not compare favourably with Trump's handling of Hurricane Harvey in Texas, where FEMA disaster relief was approved in 10 days.

Donald Trump is not being held accountable for the deaths during the hurricane - those were largely unavoidable. However he is being held accountable for the increased deaths after the hurricane, which are directly attributable to the lack of FEMA assistance, and in turn to Trump's decisions on how to handle the disaster.

So he is possibly correct in his description of how the death toll changed over time. Where he is clearly incorrect is in his belief that this increase in deaths is (a) politically motivated, and (b) not his responsibility.

I think this is a useful perspective, perhaps it could be improved with some specific statistics in comparison to other storms like Katrina, where many of the deaths occurred after the storm had passed, but are still included in the official death toll. — 46 mins ago

John Doe 1031 · Answer 5 · 2018-09-13 15:30:20Z

No, they didn't die in Hurricane Maria, but nearly 3,000 people likely did die as a result of Hurricane Maria.

The death toll of 2,975 is from this report by the school of public health at George Washington University. They are not claiming that nearly 3,000 people died during the hurricane, but that there were nearly 3,000 more deaths than expected in the months following the hurricane.

In other words, if past mortality rates predicted that 100 people would die from age-related issues in January and 125 people actually died, then the 25 people that were added to the list of deaths were likely caused by the hurricane.

As summarized in the report's methodology section:

We implemented the project as three studies, each
with specific yet complementary methodologies.
Our excess mortality study analyzed past mortality
patterns (mortality registration and population
census data from 2010 to 2017) in order to predict
the expected mortality if Hurricane MarÃƒÂa had not
occurred (predicted mortality) and compare this
figure to the actual deaths that occurred (observed
mortality).The difference between those two
numbers is the estimate of excess mortality
due to the hurricane.

...

Total excess mortality post-hurricane using the
migration displacement scenario is estimated to
be 2,975 (95% CI: 2,658-3,290) for the total study
period of September 2017 through February 2018.

This number was estimated with a high amount of confidence by comparing expected population changes had Maria not occurred with actual population changes:

To perform this analysis, we obtained vital registration mortality data
including deaths by age, sex and municipality of residence from the Puerto
Rico Puerto Rico Vital Statistics Registry (PRVSR) for the period July 1, 2010
to February 28, 2018. We derived baseline estimates of population size in
each month from annual census estimates of population size by age, sex
and municipality of residence. Cumulative monthly population displacement
after the storm in each month was estimated using Bureau of Transportation
Statistics (BTS) data on monthly net domestic migration provided by the
Puerto Rico Institute of Statistics and a survey of airline travelers provided
by the Puerto Rico Planning Board (Planning Board 2018).

Using the ~8 years of past population statistics, the researchers were able to estimate the expected number of deaths in the few months after the hurricane with the actual number of deaths:

Table of predicted/actual deaths in Puerto Rico after Hurricane Maria

As a side note, the purpose of the report wasn't necessarily to provide a fully accurate death count. Rather, the purpose was to show why this exact situation, where death estimates are so varied and potentially inaccurate, is dangerous and why it shouldn't even happen in the first place. It was meant to act as a policy guide for improvements to Puerto Rican mortality assessments and communication during natural disasters, so that a disaster of this magnitude doesn't happen again:

RECOMMENDATIONS ON MORTALITY
SURVEILLANCE FOR NATURAL DISASTERS

I. Strategic Objectives

To have a reliable and resilient institutional mortality surveillance process that provides
trustworthy and accurate evidence during natural disasters to: Establish the magnitude
of the impact of the disaster, identify areas and groups of highest risk, monitor the
performance of public health protection and prevention, and inform policy-making
and program implementation.

I think it is important to note the study compared to actual to expected deaths, so if a person died of old age, they wouldn't be part of the count, in contradiction to Trump's claim of the cause of the discrepancy. — 3 hours ago
Right, but you assume old-age deaths are predictable. The chart in the report clearly shows that their is significant variation in the monthly death tolls, prior to the hurricane as well. It's not as predictable as we are portraying, so that you could just back-out the old age deaths. Also, the fact that the excess deaths are hovering around 500 per months is also strange, it's as if the conditions aren't improving as would be expected. You would expect excess deaths in September/October to be much higher than February excess deaths. — 2 hours ago
@Gite I do have a statistics background and think there are serious attribution problems with the study. — 2 hours ago
@Underminer - That's why they also published a margin of error (which most people don't report) of 793 to 8498 deaths. It would of course be much more ideal if we instead had an official government count to work with that represented a good faith effort to achieve an objectively accurate count, so we wouldn't have to resort to a statistical forensics effort like this, but it appears we don't get to have one of those. — 1 hour ago
@Underminer of course the expected number of old-age deaths is predictable, in the statistical sense. Otherwise, how do you imagine life insurance companies stay in business and make profits? — 1 hour ago

Oddthinkingâ™¦ 96.4k30403502 · Answer 6 · 2018-09-13 14:05:49Z

There are a number of different institutions who try to quantify death tolls and other damages after natural disasters. The definitions and methodology differs between estimates and numbers vary depending on which method you choose.

For example, if somebody is injured badly during a hurricane and die months later in hospital from their injuries, should this be included in the toll?

A special article in the New England Journal of Medicine study, Mortality in Puerto Rico after Hurricane Maria was published in July. They used a survey methodology to make an estimate of the death toll. They did not count the deaths recorded by medical services, but surveyed over 3,000 people in Puerto Rico about damage and deaths. From the answers they calculated that the death toll was 4645 with a 95% confidence interval of 793 - 8498.

From the survey data, we estimated a mortality rate of 14.3 deaths (95% confidence interval [CI], 9.8 to 18.9) per 1000 persons from September 20 through December 31, 2017. This rate yielded a total of 4645 excess deaths during this period (95% CI, 793 to 8498), equivalent to a 62% increase in the mortality rate as compared with the same period in 2016. However, this number is likely to be an underestimate because of survivor bias. The mortality rate remained high through the end of December 2017, and one third of the deaths were attributed to delayed or interrupted health care. Hurricane-related migration was substantial.

According to these numbers, a death toll of 3,000 people is likely not an exaggeration.

To answer your question: Donald Trump's statement is most likely not accurate.

It would be interesting to know if similar statistical analyses have been performed for other natural disasters. I suspect that mortality rises significantly after any such event (due to infections, substandard nutrition (babies?), worse access to medical help even for unrelated conditions, stress, accidents even just due to more travel etc.) So one may compare apples and oranges with the 3000 number, and Trump may be essentially right (first time I'm writing that sentence, but science is impartial, even statistics ;-) ). — 2 hours ago
Famously, a similar statistical analysis was done for the Iraq war which showed 650,000 "excess deaths". — 2 hours ago
@PeterA.Schneider Like with a lot of things, Trump is technically correct because he's (potentially intentionally) misrepresenting the claims actually being made. Saying that 3,000 people didn't die in Hurricane Maria is correct, but it's also not what people are saying. — 2 hours ago
@AnthonyGrist See my comment to pjc. If the 3k number is used to allege bad disaster management (which I suspect is what people are saying in a subtext), one has to compare it with the results of a similar mortality analysis for other events, which I suspect will come up with enormous numbers as well. [Don't get me wrong: The disaster management was terrible. But I assume only a fraction of the 3k could have been prevented by better management.] — 2 hours ago
@PeterA.Schneider That's a perfectly valid argument, but it's also absolutely not the one Trump is making in his tweet. For what it's worth, I'd consider the majority of deaths due to infections or substandard nutrition following a disaster to be a direct result of bad disaster management. A good disaster management plan should include providing adequate food and medical care. — 1 hour ago

score 10 · Answer 7 · 2018-09-13 15:56:50Z

Other answers have discussed the statistical methodology of studies used to estimate the death tolls, but let me approach this from a different perspective: Do we have reliable on-the-ground reporting of significant deaths (in the hundreds or even thousands) during and immediately after the hurricane?

The answer: YES

Miami Herald: Hurricane MariaÃ¢Â€Â™s death toll in Puerto Rico is higher than official count, experts say (September 2017, 1 week after the storm):

The dead are at the hospital morgues, which are at capacity and in remote places where the government has yet to go. In many cases, families are unaware of the deaths....

Ã¢Â€ÂœWeÃ¢Â€Â™re finding dead people, people who have been buried, [people] have made common graves,Ã¢Â€Â RodrÃƒÂguez-Mercado told CPI. Ã¢Â€ÂœWeÃ¢Â€Â™ve been told people have buried their family members because theyÃ¢Â€Â™re in places that have yet to be reached.Ã¢Â€Â

BuzzFeed News: 911 People Died After The Hurricane Ã¢Â€Â” Of "Natural Causes" (October 2017, 1 month after the storm):

The Puerto Rican government told BuzzFeed News on Friday that it has allowed 911 bodies to be cremated since Hurricane Maria made landfall, and that not one of them were physically examined by a government medical examiner to determine if it should be included in the official death toll....

Without guidance, different funeral home and crematorium directors told BuzzFeed News they had vastly different ideas of what they considered hurricane-related deaths. Some said they counted heart attacks and people who died for lack of oxygen because there was no power, while others said they counted those as "natural deaths."

Disaster death toll experts told BuzzFeed News that these cases should definitely be counted, and that they were in the aftermath of Hurricane Katrina.

CNN: Survey of 112 Puerto Rican funeral homes (November 2017):

To check the accuracy of the Puerto Rican government's figures, we called nearly every funeral home in Puerto Rico.... Some funeral homes did not answer our calls, and several declined to provide data. CNN was able to collect responses from 112 of the island's funeral homes. That's about half the total number in Puerto Rico, according to Eduardo Cardona, director of the Puerto Rico Association of Funeral Home Directors.

Those funeral homes identified 499 deaths in the month after the storm -- September 20 to October 19 -- which they say were related to Hurricane Maria and its aftermath. That's nine times the official death toll. And, again, it represents only about half of funeral homes.

CNN: It's been almost six months since Hurricane Maria, and Puerto Ricans are still dying (January 2018):

Some of them died during the storm. A mudslide in Utuado, Puerto Rico, killed two "bedridden" sisters. Another person drowned in Toa Baja. But the aftermath of Hurricane Maria appears to have been most deadly....

In Corozal, farther into the mountains, Victor Manuel Belen Santiago wept as he told me that his mother, Zoraida Santiago Torres, 58, had saved his life by helping him kick drug addiction.

Their home was destroyed by the storm, and Belen Santiago rebuilt it by hand, puzzling scraps of the roof and walls together like a reassembled house of cards. But he couldn't restore the power his mother needed to run an oxygen machine. She died on February 13, he said, after getting fluid in her lungs that could not be cleared. Her death certificate lists organ failure and a bacterial infection among the causes of death, along with chronic liver disease.

NBC: Puerto Ricans knew the official Hurricane Maria death toll was fake. We saw too many dead to believe it. (May 2018):

When funeral directors started telling people that they were burying way more bodies than usual, or when our family members told us about their neighbors dying in still-darkened rooms, or being buried outside their homes, we knew that the official death toll was much higher than the 64 people the government had eventually admitted to.

When we heard the stories of people having no refrigeration for their insulin, that dialysis machines werenÃ¢Â€Â™t operational or that hospitals were still in the dark but had people on life support, we knew that it wasn't some small counting error.

So Puerto Ricans are not suddenly shocked by the Harvard study published this week estimating that a total of 4,645 excess deaths occurred between September 20 through December 31, 2017, because the proof was already there months ago.

But almost nobody else wanted to look for it.

Washington Post: I saw what Maria did to Puerto RicoÃ¢Â€Â™s hospitals. The death toll is no surprise (June 2018):

We found an ongoing human disaster during the months of September, October and November, when we made daily visits to more than 60 senior homes and independent-living facilities. At one high-rise, within walking distance of a hospital, residents were trapped on the upper floors because the backup generator had failed and they couldnÃ¢Â€Â™t walk down the stairs. Some folks I spoke with didnÃ¢Â€Â™t remember when they had last eaten. There was no potable water because the pump to get it up to the apartments also depended on electricity. Dialysis patients hadnÃ¢Â€Â™t been treated in days; diabetics couldnÃ¢Â€Â™t refrigerate their insulin....

The hospital couldnÃ¢Â€Â™t reach ambulance services for other residents who needed urgent care, because they had no means of communication. A nearby police car was similarly incommunicado. Four people were eventually evacuated from the building in municipal ambulances Ã¢Â€Â” stretchers and wheelchairs were carried down cramped stairwells Ã¢Â€Â” but I overheard the EMTs wondering where they would take the dialysis patients; they didnÃ¢Â€Â™t know if any centers would be open.

With conditions that bad at one of so many buildings, of course more than 64 people died. What is surprising is that the government has so far been unwilling to admit it.

While we can't extrapolate specific numbers from these stories, it is absolutely inconceivable that only a handful of people died due to Hurricane Maria. In my opinion, 3,000 deaths is absolutely plausible, if not understated.

Some further references:

CNN: How Puerto Rico's death toll climbed from 64 to 2,975 in Hurricane Maria

538: Media Reports About The Death Toll In Puerto Rico Are Needlessly Confusing

Snopes: Did All of the Patients in a Puerto Rican Intensive Care Unit Die?. This claim is rated as "unproven", but the article contains some other useful quotes and links.

Graham 1,279410 · Answer 8 · 2018-09-13 15:21:10Z

To add to the existing good answers, it's also important to understand what Donald Trump is being held personally responsible for.

It is well known that the most significant death toll from natural disasters is rarely directly from the disaster itself, but more normally from disease, exposure, famine or other preventable causes arising from the disaster. Puerto Rico still had substantial levels of infrastructure needing repair from Hurricane Irma before Hurricane Maria hit. However it took 43 days before Trump approved FEMA disaster relief for Puerto Rico. Most of the island was still without electrical power at this point, and a substantial part was without drinking water. The situation was so severe that Oxfam were required to assist, in the absence of the US intervening itself.

This does not compare favourably with Trump's handling of Hurricane Harvey in Texas, where FEMA disaster relief was approved in 10 days.

Donald Trump is not being held accountable for the deaths during the hurricane - those were largely unavoidable. However he is being held accountable for the increased deaths after the hurricane, which are directly attributable to the lack of FEMA assistance, and in turn to Trump's decisions on how to handle the disaster.

So he is possibly correct in his description of how the death toll changed over time. Where he is clearly incorrect is in his belief that this increase in deaths is (a) politically motivated, and (b) not his responsibility.

I think this is a useful perspective, perhaps it could be improved with some specific statistics in comparison to other storms like Katrina, where many of the deaths occurred after the storm had passed, but are still included in the official death toll. — 46 mins ago

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Long meetings (6-7 hours a day): Being â€œbabysatâ€ by supervisor