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Chaotic and unending recovery after Hurricane Maria leads to far more dead than official government estimates

The death toll from Hurricane Maria in Puerto Rico last year was far larger than known, according to a new study. At least 4,645 people on the island are estimated to have died as a result of the storm and devastation that followed, far exceeding the official number of 64. Judy Woodruff talks with Sarah Varney of Kaiser Health News.

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  • Judy Woodruff:

    As the start of hurricane season approaches this week, a new estimate says that the death toll from Hurricane Maria in Puerto Rico last year was far larger than known.

    A new estimate finds that at least 4,645 people in Puerto Rico died as a result of last year's storm and the devastation that followed. That far exceeds the official toll from the island's government officials, which stands at 64.

    Writing in The New England Journal of Medicine, Harvard researchers surveyed nearly 3,000 households across Puerto Rico. They found a 62 percent increase in the mortality rate by comparing what happened three months after the hurricane with the same time frame a year earlier.

    The estimate finds the death toll could range from 800 to more than 8,000. The study attributes one-third of the excess deaths to delayed or interrupted health care. Hurricane Maria's 150 mile-per-hour winds destroyed Puerto Rico's already struggling power grid, shuttering hospitals and elderly care facilities.

    Communities were isolated entirely by damaged roads. And residents were left for weeks, if not months without access to water, cellular service, medical care and power.

    Initially, the territory reported only 16 people died from the storm.

    In October of last year, President Trump visited the devastated island and celebrated the initial numbers in comparison to those from Hurricane Katrina.

  • President Donald Trump:

    You can be very proud of all of your people, all of our people, working together — 16 vs. literally thousands of people.

  • Judy Woodruff:

    Critics were skeptical of the official count even when it increased.

  • Gov. Ricardo Rossello:

    It could be the case.

  • Judy Woodruff:

    When Puerto Rico's Governor Ricardo Rossello appeared on the "NewsHour" last October, he acknowledged the death toll might climb, but didn't suggest how dramatic it could be.

  • Gov. Ricardo Rossello:

    You have to brace yourself for the reality that that number could certainly increase.

  • Judy Woodruff:

    Under pressure, Rossello enlisted researchers at George Washington University to review their death certification process this winter to guarantee an accurate death toll. Today, Puerto Rico's Federal Affairs Administration says those findings will be released soon.

    Let's learn more about why the death toll is likely much higher and how getting medical care and treatment remains a problem on the island.

    Sarah Varney of Kaiser Health News is in Puerto Rico with our team for a joint series of stories about health care there. And she joins me now.

    Sarah, welcome back to the program. This new estimate number is so much higher than the official count. And then there's a range. How confident are researchers at Harvard that they have got this right?

  • Sarah Varney:

    The researchers say this is a very typical way that you would try and count disaster-related deaths, that you would do what's called a community survey, where you would go into in this case 3,000 homes and then you would extrapolate from those 3,000 homes to the island of Puerto Rico.

    And so they say they're quite confident. Yes, the range is quite large, but they say that's pretty typical of these types of community surveys.

  • Judy Woodruff:

    So what are some examples of the kinds of deaths that the researchers believe are a direct result of the hurricane, but that were not part of the official count?

  • Sarah Varney:

    Well, if you look at the study, they believe about a third of the deaths are the result of a delay in medical care or not getting medical care at all.

    And I can tell you this is now my second trip down to Puerto Rico. I was here for several weeks a couple months ago and spent quite a bit of time up in the mountains that have been hardest-hit, places that — actually, just… we were at a home yesterday, and they just got their power back two days ago.

    And in the home, they have a 92-year-old woman. She has Alzheimer's. She's had a heart attack. She's bedridden. You have people up in the mountains who need respirators or nebulizers. They need sleep apnea machines. And they have been unable to plug these things in.

    People who don't have — haven't had any refrigeration, of course, because they haven't had any electricity. Puerto Rico has a very high rate of diabetes, so many people I have met around Puerto Rico are diabetic and have had to take other measures to try and keep their insulin cool.

    We have seen a worsening of many kind of chronic conditions, whether it's hypertension from all of the canned foods that people are eating, because people can't go and buy fresh foods and keep them in their refrigerator, or perhaps their asthma has gotten out of control or their diabetes is out of control.

    I met a man who has been having a very difficult time keeping the diabetic ulcers on his feet properly clean. We have met a lot of people who are bedridden who need to be on these inflatable mattresses, and they haven't been able to inflate the mattresses, so they have been getting ulcers, which is worsening their conditions.

    I met another woman up in the mountains who had a gentleman, who, because he had sleep apnea and was unable to plug in his machine, he slept outside on his driveway at night. And he died. So that's an example of a death that would not have absolutely been in the government's list of disaster-related deaths. But clearly that's what these researchers were intending to get at — those kinds of deaths that were accelerated or exacerbated because of the hurricane.

  • Judy Woodruff:

    So not always a lack of access to medical care or a medical center or a doctor, but often things that happen in their own home.

  • Sarah Varney:

    Well, there is an incredibly high burden of chronic disease here in Puerto Rico.

    You have to remember Puerto Rico, if it were a state, it would be the poorest state in the country. Half of the population here is on Medicaid. The burden of diabetes, of hypertension, of asthma, all sorts of things is just that much higher here.

    So, then you add in Hurricane Maria, you add in seven, eight months without electricity or without water or without communication. People haven't been able to use cell phones or landlines have been down. So the burden of Maria, plus the burden already of chronic disease and poverty on the island has really just been too much for so many households to bear.

  • Judy Woodruff:

    And, Sarah, this survey extended through the end of 2017. We are now six months into 2018. What are circumstances right now like?

  • Sarah Varney:

    Well, I can tell you that the government puts out these reports every day of the percentage of households that have electricity back. And it always sounds very uplifting — 92 percent, 95 percent.

    But you have to remember that that 5 percent, those are individual households. You may have five, 10 people living in individual households. So, still, there are tens of thousands of people living here in Puerto Rico, particularly up in the mountains — we're right down here in Ponce today, which is on the southern part of the island. But we have just come down from the mountains, where we were interviewing people over the last several days. And there are people up there, as I said, who just got power back or who still don't have power. They're also — the roads are still in quite bad condition.

    People here, you have to remember, hurricane season starts on Friday, on June 1. So you see crews now up in the mountains. They're scraping the sides of the mountains to try and prevent further mudslides from happening.

    But there were many communities up there in Adjuntas, in Castaner, in Utuado that were blocked off after the hurricane for weeks at a time. So people who had emergencies in those situations obviously were unable to get down the mountain, unable to get to the hospitals.

    I was at a hospital a while ago up in Castaner that was still running off of a generator just a few months ago. And, yes, power is back now largely throughout many parts of the island. But if you will remember, just a few weeks ago, there was a power outage across the entire island.

    More than three million people lost their power. So even people who are getting power back now are very skittish about it. A woman I interviewed yesterday, I asked her to show me what was in her refrigerator. She was so excited that she could finally buy vegetables and milk and have eggs.

    And she said, "Yes, like, you can see that I have lettuce now in my refrigerator, but I don't buy too much because I'm worried that somehow the power is going to go back out."

    So people are still very skittish and very anxious, especially as we head into hurricane season, just starting this Friday, June 1.

  • Judy Woodruff:

    Such a tough story.

    Sarah Varney with Kaiser Health News, reporting for the "NewsHour." Thank you, Sarah.

  • Sarah Varney:

    Oh, my pleasure. Thank you.

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