President Donald Trump on Thursday dissed Puerto Rico’s official death toll from Hurricane Maria, claiming it was unfair to include thousands of deaths reported in the aftermath of the storm.
But federal guidance and independent researchers say it’s standard practice to include deaths that occur months or even years after a natural disaster.
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There are no formal state or federal regulations that govern disaster-related death tolls, and officials generally rely upon reports from local medical examiners to tally up the fatalities. These examiners are usually given wide discretion to determine what actually counts as a storm-related death, as hundreds if not thousands of people can subsequently die from a lack of access to health care, clean drinking water and other basic needs.
The Centers for Disease Control and Prevention, in a reference guide put out in October 2017, encouraged officials to cast a wide net when determining whether a death is disaster-related.
“Determining whether a death is disaster-related may be challenging. A wide variety of hazards and exposures may directly or indirectly cause or contribute to deaths before, during, and after disasters,” the CDC guidance states, adding, “Deaths may occur before, during, or immediately after the disaster, or months or years after the event.”
In the case of Hurricane Maria, which ravaged Puerto Rico last September, the death toll seemed stuck at an official count of 64 until last month. That’s when a study commissioned by the Puerto Rican government and conducted by researchers at George Washington University concluded that nearly 3,000 people died from the storm.
In a Thursday morning tweet, Trump discredited the higher death toll as a smear tactic orchestrated by Democrats, claiming there were only 6 to 18 deaths after his visit to the island following the storm.
But independent researchers have uniformly agreed that the death toll is in the thousands, said Alexis Santos, assistant professor in human development and family studies at Penn State University. Santos also calculated the death toll from Hurricane Maria independently from the researchers at George Washington, and he found numbers roughly in line with the official count.
Trump also accused unnamed Democrats of adding deaths “for any reason, like old age” to the death count. But the official study, which was conducted by non-partisan academics, controlled for deaths unrelated to the hurricane.
The GW researchers used a widely accepted method to determine the death toll – they calculated the average number of deaths in Puerto Rico from September to February year-over-year, and subtracted those figures from the number of deaths reported on the island during that same period after the storm.
“We stand by the science underlying our study,” said Ann Goldman, an epidemiologist and project manager on the George Washington study. “It’s the most effective method to come up with an excess mortality owing to a storm.”
Goldman said counting only deaths that occurred during the storm underestimates the magnitude of a storm’s damage.
Because of mass destruction from natural disasters, it’s important to include deaths that are the result of ruined infrastructure and public safety systems, Santos added, citing standards published by the CDC. Swaths of the island went without power for nearly a year after the storm. Many roads remain severely damaged and some Puerto Ricans remain wary of drinking tap water. Both Santos and the researchers at George Washington found a dramatic spike in deaths following the storm compared to the same months in past years.
Different studies have produced some variation between figures. One Harvard study placed the death toll between 793 to 8,498. The George Washington study controlled for migration out of Puerto Rico after the storm and estimated about 2,000 deaths from September to December. Santos, however, did not control for migration and estimated about 1,100 deaths during that period.
Craig Fugate, former FEMA administrator under President Barack Obama, noted the need for more standardized practices, and said the government only used official numbers based on medical examiners’ findings during the 2004 hurricanes in Florida, and did not estimate figures.
“We need to be using the same criteria on [these] critical issues,” Fugate said.
The current debate over Hurricane Maria’s fatality count has reignited issues that were discussed during Hurricane Katrina in 2005. There is still no definitive death toll from Katrina – bodies got lost in rubble or decomposed in heat, making it difficult to determine the cause of death for all those who died following the storm.
Other bodies were returned to families before death causes could be determined. The National Hurricane Center estimates the death toll from Katrina at about 1,800, but it acknowledges in a report that the “true number will probably not ever be known.”
Similarly, Puerto Rico had limited resources to verify the cause of death, Santos said. The CDC guidelines say ideally a coroner or medical examiner should issue a death certificate and mention if the death was related to a disaster.
But only about 30 percent of bodies got autopsies due to the lack of forensic officers on the island, Santos said, complicating efforts to determine the storm as the cause of death for each person.
The George Washington study also mentioned many doctors in Puerto Rico were not trained to fill out death certificates after a natural disaster and mislabeled deaths as unrelated to the storm. Goldman said ideally, she would like to examine the data to find deaths that were likely to have been caused by the disaster and interview community members.
Though calculated estimates may create some margin of error, Santos said researchers resoundingly deny the double-digit figures espoused by Trump.
“The number is certainly not 18. The number is certainly not 16,” Santos said. “And every study that has been done converges to that fundamental truth.”
Marc Caputo contributed to this report.