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Data shows hurricane deaths in Puerto Rico could be over 1,000

Puerto Rican officials say only 62 people died from the storm. Researchers estimate more than 1,000 people did.

A man  plays his accordion in front of a closed down business in Old San Juan, Puerto Rico on November 7, 2017.
A man plays his accordion in front of a closed-down business in San Juan, Puerto Rico, on November 7, 2017.
Ricardo Arduengo/AFP/Getty Images

More than two months after Hurricane Maria slammed into Puerto Rico and devastated the island — knocking out its power grid and leaving millions without potable water — the official death toll has stayed surprisingly low at 62.

Yet no one who’s been following Puerto Rico’s hurricane disaster closely believes that to be an accurate representation of the lives taken by the storm. Journalists on the ground in Puerto Rico and here on the mainland have helped paint a very different picture of underreported deaths, prompting members of Congress to demand audits of the death count.

Now two social science researchers have shown that the actual death count may be closer to 1,085, a number that exceeds the government’s official figure by a factor of 18. (By comparison, at least 1,800 people died in connection to Hurricane Katrina in 2005 — the deadliest hurricane to hit US soil in the past 50 years.)

Alexis Santos, a Puerto Rican demographer at Penn State, and Jeffrey Howard, an independent health scientist and epidemiologist, calculated average monthly deaths from 2010 through 2016 using a methodology that other researchers have told Vox is one of the best ways to calculate estimates of disaster deaths.

Santos and Howard used the Puerto Rico Vital Statistics System to compare the historical averages for September and October of the past seven years to the total number of September and October 2017 deaths recently reported by the Puerto Rico Department of Public Safety to see if there were notable differences.

The results were staggering: They found that in September 2017 — the month that Maria hit — there were 518 more deaths than the recent historical average for September and 567 more deaths in October 2017 than the recent historical average for October. That’s a total of 1,085 deaths likely linked to the hurricane. And given that widespread power outages have continued into November, the number of indirect deaths from the hurricane is probably higher still.

The finding supports reports from several media outlets, including Vox, CNN, and BuzzFeed, that found hundreds of hurricane-related deaths that were not included in the official count. These reports were based on interviews with funeral home directors, doctors, and local officials. On November 21, a CNN investigation found 499 hurricane-related deaths reported by funeral homes from September 20 to October 19, for example.

The government of Puerto Rico has defended its methodology of counting storm deaths, repeating that its figure, last updated to 62 on December 2, is accurate. But rather than actively trying to find and investigate reports of deaths in the aftermath of the storm, it has been passive, counting only deaths where all the information was easily accessible. The government has also been overly cautious in linking deaths to the hurricane, despite the strong evidence indicating that the real number is more likely in the hundreds, if not thousands.

To be sure, the hurricane severely damaged not just Puerto Rico’s power infrastructure and health care system but also basic government functions and medical data collection. And the island’s death processing system has been totally overwhelmed.

Santos and Howard’s work is still in preprint form, which means it has not yet been through peer review. And the government still has not released its official death totals for September and October. So treat these findings as preliminary.

But they suggest that the official toll is far from accurate and does not convey the extent of the impact of the hurricane. (A New York Times analysis of the same data from Puerto Rico’s Vital Statistics System also found that in the 42 days after the storm hit, 1,052 more people than usual died across the island.)

“The issue of how many deaths there were from the devastation goes hand in hand with the attention this is going to get in Congress,” said Santos.

Puerto Rico Gov. Ricardo Rosselló recently asked that Congress and federal agencies give $94.4 billion in funds for recovery, on the grounds that it will be the “most transparent” recovery effort in US history.

But there isn’t much transparency around this statistic that is fundamental to understanding this disaster — the death toll shapes how we perceive the extent of the harm, how we assess the response, and how many resources we allocate for recovery. And Puerto Ricans, meanwhile, are being left in the dark, wondering if their loved ones lost after the storm will ever be acknowledged by their government.

Hospital employees and nurses at the Centro Medico Puerto Rico gather to pray in late September following Hurricane Maria.
Carolyn Cole/Los Angeles Times via Getty Images

Media isn’t buying the government’s death toll

The dispute between the government and the media over the Hurricane Maria death toll began when an investigative reporter on the island, Omaya Sosa Pascual, questioned the official death toll of 16 in a story on September 28, eight days after the storm hit. Sosa confirmed that there were dozens of hurricane-related deaths the government had not yet accounted for and that the true number was likely in the hundreds.

Yet the official number didn’t rise.

The number, still 16, then became politicized on October 3 when President Donald Trump visited the island and insisted that the alleged 16 deaths were evidence that Puerto Rico wasn’t a “real catastrophe” like Hurricane Katrina. "Everybody watching can really be very proud of what's taken place in Puerto Rico," he said.

Since then, the death count has slowly risen to 62. But several media outlets, including Vox and Sosa’s organization, the Center for Investigative Journalism (CPI), have collected ample evidence that the real number is much higher — and that the government continues to underreport it.

The government tried to put the issue to rest forever in a press conference on November 8 that was intended to provide reporters with more details about how it had calculated the official toll, by then 55.

"We want to explain this to you all so that all doubts about how we counted the deaths will finally end here," Héctor Pesquera, head of the Department of Public Safety, said.

But instead of resolving doubts, officials presented new data suggesting that the true number is likely much higher (the same data that Santos and Howard used in their analysis). According to the government, there were a little under 3,000 deaths registered on the island in September 2017. That's over 500 more deaths than were reported in September 2015 and 2016.

“The reality is that this is not normal and we have to realize that there was a phenomenon here,” said José A. López Rodríguez, a government demographer at the press conference. Yet he stopped short at attributing any of them to the storm. “There needs to be evidence to document it,” he said.

The storm really did cause more than 62 deaths

But in fact, there’s plenty of additional evidence to suggest that the number of people who died directly or indirectly from Hurricane Maria is in the hundreds, if not more than 1,000.

For an initial investigation published October 11, Vox 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 investigation prompted two members of the House of Representatives to request an audit of the Puerto Rico death toll from the Department of Homeland Security. Sens. Elizabeth Warren and Edward Markey then demanded the same.

Since then, additional sources and reports continue to point to the same conclusion: that hundreds, not dozens, of people died from the storm, despite claims by President Trump and Puerto Rican officials that the count is 62 or fewer.

  • A CNN investigation surveyed 112 funeral homes on the island — about half of all funeral homes. According to CNN, “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.”
  • A prominent former senator for Puerto Rico, Ramón Luis Nieves, told members of Congress at a November 2 hearing that the government's official death count can't be trusted. "That statistic is misleading. Recent reports state that the government authorized almost 1,000 cremations. Also, on a personal note, dozens of friends have shared with me countless stories of their elderly loved ones dying as a result of the lack of electricity in their homes, hospitals, and care centers. The actual death toll ... has not been properly disclosed by the government of Puerto Rico," Nieves said in his prepared testimony.
  • Puerto Rico’s office of vital statistics has sent 2,747 death records to the Centers for Disease Control and Prevention for review since Maria hit the island, said Wanda Llovet, the head of Puerto Rico's office of vital statistics, at the November 8 press conference. (In response to a Freedom of Information Act request from Vox, a FOIA officer at the CDC stated on November 28 that it has not received these records.)
  • As of November 3, there were 388 cadavers at the Bureau of Forensic Sciences, some of which had been examined and some of which had not.
  • BuzzFeed News reported on October 27 that 911 bodies were cremated before being inspected by the medical examiner to determine if the deaths occurred because of the storm. (The government later said that all of those people died of "natural causes," but none of the bodies were examined by medical professionals.)
  • The Federal Emergency Management Agency told Vox it had received 2,339 applications for burial and funeral assistance in Puerto Rico since Maria hit, as of November 6. The federal agency helps cover some funeral and burial expenses for disaster-related deaths, or to rebury cadavers and repair graves that were disturbed during a storm.

FEMA has determined that 537 of those burial applications were not related to Hurricane Maria, including people who erroneously asked for funeral assistance while seeking other FEMA aid. There were an additional 168 pending cases where applicants had provided the required documentation, or were in the process of getting it to FEMA, as of November 6. It's unclear how many of the 2,339 applications are seeking help to bury people who died from the storm, or to repair grave sites disturbed by the hurricane.

Puerto Rico’s death toll problem seems to be partly a data collection problem

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, the “official” Hurricane Katrina death toll is widely regarded as inaccurately low.)

In the case of Puerto Rico, the government was only counting deaths that doctors clearly stated were related to the storm on death certificates. For example, a doctor who writes that a person died from head trauma because they were hit by a brick while cleaning up storm debris would be a clear hurricane-related death.

Other scenarios are less clear: A doctor states that a person died from respiratory problems, and then mentions in the death certificate that the hospital didn't have enough oxygen tanks. Pesquera, head of Puerto Rico’s Department of Public Safety, says that in such a case, medical examiners are supposed to contact the doctor to find out if the hospital didn't have oxygen because of the hurricane. If that's the case, then the death is counted in the official death toll.

Another problem with the data collection system is that some hurricane-related deaths don't fit into either of those categories. These are the death certificates that do not mention whether a hospital had no power, or water, or oxygen. If a doctor didn't include those details, then medical examiners do not check to see if crucial information has been left out. The government will simply not include it in the storm-related death count.

“How are we going to question the authority of a licensed doctor?” Pesquera said at a November 8 press conference, when asked why medical examiners aren't investigating each reported death.

But many doctors don’t have the time to investigate each death and are not directly asked to. So there may be no way for many deaths to ever be counted in the official toll.

Why the death toll matters

As much as the death toll is a literal number, it means so much more. It affects how we perceive the extent of the harm caused by a disaster, how we assess the response, and how many resources we allocate for recovery.

Some 32 percent of the 3.4 million American citizens on the island still don’t have power, and 9 percent still don’t have water to drink or bathe in. And while the government of Puerto Rico claims that most people now have running water, that is highly misleading, as Vox has explained. People may get running water in their homes on one day and then lose it the next. Thousands of people still don't have roofs on their homes, and are waiting for the US Army Corp of Engineers to install blue tarps.

This harsh reality isn't reflected in the public narrative.

FEMA and the US Army have been winding down their emergency response in Puerto Rico, even though access to food, water, and power is still precarious. The USS Comfort, a military medical ship deployed to Puerto, left weeks ago.

Meanwhile, the government of Puerto Rico continues to downplay the impact of the storm, which is most evident in the strangely low death count. Underreporting the number of people who died from the storm is serious, writes Carlos Yordán, an economist and international relations professor at Drew University.

It damages trust in government, reinforcing views that public officials will always put politics before the needs of the people they represent, he writes. It also lets government officials off the hook from doing the hard work needed to prevent mass casualties from future storms.

"[It] minimizes the need for a full fledge[d] investigation to determine if some of these deaths could have been prevented, or whether the island’s medical facilities were negligent in terms of providing treatment to their most vulnerable patients," writes Yordán, who is from Puerto Rico.

By not fully investigating and accurately reporting the death toll, the government of Puerto Rico is choosing not to hold itself accountable to protect the lives of the people it represents. And that weakens faith in the entire democratic system.