Why there’s controversy on the death toll after Hurricane Maria in Puerto Rico, in context

by Jul 22, 2018Headlines, Puerto Rico0 comments

Recently, the New England Journal of Medicine released a shocking report based on new data found on the death toll caused by Hurricane Maria. The Harvard University study found that last September’s hurricane may have been the nation’s deadliest natural disaster in 100 years. Moreover, the report says, Maria caused at least $900 billion in damages, which impaired the effectiveness of existing health surveillance infrastructure. The lack of accurate methods to determine mortality rates led to a gross miscalculation of the hurricane’s deadly impact. Recent new investigations estimate as many as 4,600 “excess deaths” between the hurricane’s onset and the end of the 2017 calendar year. The new estimate poses a startling figure in contrast to the government’s initial count of 64.

These convoluted death counts in the hurricane’s aftermath may be best explained by two factors: first, inaccurate and inconsistent methods of calculation; and second, the lack of top-down transparency. One report last December, conducted by Puerto Rican demographer Alexis Santos and health scientist Jeffrey Howard, used the Puerto Rico Vital Statistics System to compare yearly average mortality rates with the ones reported in September and October of 2017. For these two months, they found a total of over 1,000 excess deaths, indicating an alarming inconsistency with previous estimates.

What remains fuzzy is a basis of classification for determining whether a case was caused directly, indirectly, or not at all by the storm. This requires a nitty-gritty analysis of case-by-case mortality and its connection to hurricane impact. For example, power outages and supply shortages cut hundreds, and possibly thousands off from accessible medical care. The Harvard survey found that “interruption of medical care was the primary cause of sustained high mortality rates in the months after the hurricane.”

What confuses matters is the difficulty of assessing to what degree hurricane-related complications may have led to an individual death. The convoluted data results from differing approximations and varying methodologies, which are bound to produce inconsistent numerical outcomes. How did the December estimate of 1,000 become refigured as 4,600? Presumably, the initial study used a stricter classification of what qualifies a case as directly hurricane-related. If we were to aggregate all deaths either directly or indirectly related to Hurricane Maria, we should assume to find the actual death toll to be closer to the 4,600 count than the initial 1,000 estimate.

Further compounding the numerical challenges posed to assessing Maria’s impact is the lack of government transparency from the islands. The Puerto Rican government initially withheld data of the actual mortality count. Puerto Rican governor Ricardo Rosselló responded to the controversy by contrasting researchers at George Washington University who compiled the numerical data. To the suspicion of many in the journalistic community, the report fell far behind its release schedule. Finally, on June 5, a superior court judge ordered the government to issue a detailed report on every reported death since Maria. The Health Department reported 1,397 deaths since the hurricane, after the Harvard report had already estimated over 4,000 storm-related casualties.