Everything that's been reported about deaths in Puerto Rico is at odds with the official count
We took a look at the numbers and they didn’t add up.
Death tolls are the primary way that we understand the impact of a disaster. And for nearly two weeks after Hurricane Maria hit Puerto Rico, as a humanitarian crisis was intensifying, the death toll was frozen at 16.
“16 people certified,” Trump said on October 3 during his visit to the island, repeating a figure confirmed by the territory’s governor. « Everybody watching can really be very proud of what’s taken place in Puerto Rico. »
It was a moment that crystalized two conflicting narratives about the Puerto Rico disaster. The first one, from the federal government and Puerto Rico’s governor, is of a disaster that’s been managed well, with lives being saved and hospitals getting back up and running.
Lives surely have been saved in the response. But images and reports from the ground tell a story of people, cut off from basic supplies and health care, dying. They tell of hospitals running out of medication and fuel for their generators and struggling to keep up with the “avalanche of patients that came after the hurricane,” as one journalist put it.
The death toll from the hurricane is now up to 45, according to Gov. Ricardo Rosselló. But 90 percent of the 3.4 million American citizens on the island still don’t have power, and 35 percent still don’t have water to drink or bathe in. And given how deadly power outages can be, 45 deaths seems low, according to disaster experts.
At Vox we decided to compare what the government has been saying with other reports of deaths from the ground. We searched Google News for reports of deaths in English and Spanish media from Puerto Rico since Hurricane Maria. We found reports of a total of 81 deaths linked directly or indirectly to the hurricane. Of those, 45 were the deaths certified by the government. The remaining 36 deaths were confirmed by local public officials or funeral directors, according to the reports. We also found another 450 reported deaths, most of causes still unknown, and reports of at least 69 people still missing.
The broader issue here relates to how storm deaths are counted. There are clear deaths from the storm, clear deaths indirectly from the storm, and then deaths that are harder to determine — for instance, a sick patient who died in a hospital experiencing frequent power outages. And then there’s the issue of how effective authorities are at finding and investigating the deaths to make sure they’re included in the count. The breakdown of these categories suggests that the government is being much more cautious in designating deaths as directly or indirectly hurricane related, given the public information available.
At a Sunday news conference, Karixia Ortiz, press officer for the Department of Public Safety, said that “every death must be confirmed by the Institute of Forensic Science, which means either the bodies have to be brought to San Juan to do an autopsy or a medical examiner must be dispatched to the local municipality to verify the death,” according to an audio recording obtained by Huffington Post.
John Mutter, a disaster researcher at Columbia University who studied the death toll in the aftermath of Hurricane Katrina, says he’s skeptical of this methodology. “This is the way to go about it if you want to come up with smallest number possible,” he said, adding he suspects the death toll in Puerto Rico from Maria should already be in the hundreds based on what’s known about the conditions on the ground.
Our review of reports certainly suggests the real death toll is far higher than what the government has, thus far, suggested:
“I don’t think there will be hundreds of deaths, but we will see,” Pesquera told reporters on Sunday. “We can’t speculate if there will be 100 or 200.”
Meanwhile, the situation on the ground remains life threatening in some areas. And reporters and first responders are continuing to paint a much more aggressive picture about life and death on the island.
« It’s horrible, it’s horrible. It’s a nightmare, » a resident of the town of Atlaya told CBS on Tuesday. « There’s barely any drinking water, not even in supermarkets, my fear is for my kids, » another said.
Given the disparity in storylines, it’s worth taking a hard look at the numbers.
There are no state or federal guidelines in the US for calculating storm death tolls for the medical examiners usually responsible for determining what constitutes a storm-related death. (And partly because many storm-related deaths aren’t recorded by the systems in place, the “official” Hurricane Katrina death toll is widely regarded as inaccurately low.)
Because we’ve had trouble reaching officials in Puerto Rico, it’s been difficult to decipher what exactly the process is for documenting and attributing deaths to disasters. But it is clear that the hurricane has disrupted it and that the government now insisting that every body be inspected directly by the Institute of Forensic Sciences in San Juan before any death is attributed to the storm.
Mutter, the disaster researcher at Columbia, said that it’s very difficult after the fact to separate out deaths that would have happened anyway. “If they’re dismissing ones would have happened anyway, that’s cheating,” he said.
The ideal way to calculate the death toll from the storm, he says, is to count all the deaths in the time since the event, and then compare that number to the average number of deaths in the same time period from previous years. Subtract the average number from the current number and that’s the death toll.
“When I first started hearing the deaths were only 16, and then 34, I thought there was something wrong,” he said. “Maria was bigger than the two previous storms, Harvey and Irma. And there’s no way to evacuate an island. All those people are still there. And then you look at damage and it’s profound. And now they’re saying only 45 people died, you’re saying come on, it couldn’t be.”
In a review of local and national news reports that cite local officials and funeral directors around Puerto Rico, Vox identified at least 36 people who may have died in connection to the hurricane who are not accounted for in the official tally.
In some of these cases, local public officials named the victims and gave specific details. In other reports, details were scarce. It’s not clear why these deaths were not included in the official death toll. (A media representative for the governor’s office did not respond to an inquiry from Vox.)
News reports cite the deaths of more than 450 additional people since the hurricane and 69 people have been reported missing. The additional deaths could be people who died as a direct result of the hurricane, or indirectly from the hurricane, or people who would have died even without the storm. For example, we found a report of one person who died because she didn’t have enough oxygen tanks — this would count as an indirect death.
Here’s how we came up with figure of at least 450:
We’ll probably never know precisely how many people’s lives were cut short by the disaster and the slow response. But even three weeks later, the aftermath of the storm is threatening people’s health.
As each day passes, Puerto Ricans on the island are becoming more susceptible to disease, says Andrea Dunne-Sosa, who is overseeing a medical relief team from Project HOPE, which deployed to the island after the storm. Two of the most recent official deaths were attributed to an outbreak of a bacterial infection called leptospirosis. The continuing lack of food and water in some towns is also alarming, she said. On Wednesday, field workers told her they visited a house in the coastal town of Loaiza, where the family literally had no food.
« They were eating the crumbs of the last slice of bread, » said Dunne-Sosa. « There’s a lot of fear about what’s still to come. »
CNN medical correspondent Sanjay Gupta also described his fears of much higher death toll in an essay he wrote after visiting Puerto Rico and meeting many very sick people. “There may be tens of thousands of hardy people who survived the hurricane and are now struggling to stay alive in its aftermath,” he wrote. “They are teetering on the edge, with hardly any reserve.”
The question is whether they will be part of the official story, or the unofficial one.
© Source: https://www.vox.com/science-and-health/2017/10/11/16424356/puerto-rico-official-hurricane-maria-death-toll
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