A long-awaited analysis of Hurricane Maria's fatal persecution by Puerto Rico prompted the government on Tuesday to dramatically increase the official death toll. The government now estimates that 2,975 people were killed in a disaster, which in some cases only took months of damage.
The new rating is orders of magnitude higher than the previous figure of 64, which, despite nearly a year of official death, was convincing evidence that the deaths reported on official death certificates produced the deadly and often far-reaching consequences of the storm not fully considered the island.
It was about assessing the severity of a storm The devastating effects on basic needs – water, electricity, communications, and medical care – seemed to be competing with or even surpassing the deadliest storms in recent years, but many have so far was lower. By comparison, Hurricane Katrina, which shook the Gulf Coast in 2005, has probably killed 1,000 to more than 1,800 people.
The last revision of the government ended a year of debate and the scientific review of deaths seemed to vary – in some cases by the thousands. Governor Ricardo Rosselló faced constant political challenges stemming from the discrepancy between the official death toll released within a few weeks of the disaster and what was happening to most scientific researchers and reporters investigating deaths. The inability to provide a reliable death count seemed to many critics to reflect the dysfunction seen in the island's lack of preparation or a quick, effective response from local and federal governments.
Aid supplies were bottled in the port, gas and food were in short supply and electricity was shut off for months on large parts of the island. The full power supply was restored only in this month in the last houses .
On Tuesday, Mr Rosselló said he would move immediately to improve the process of certifying deaths and communicating information between public and private health workers.
Everyone will be held accountable and everyone is expected to make changes, "he said at a press conference in San Juan, adding that the island would set up a register for people who might be most vulnerable, such as
The White House issued a statement that the Federal Government supported Mr Roselló's "efforts to ensure full accountability and transparency of deaths following last year's hurricanes."  905] When visiting the island about two weeks after Hurricane Maria, when the official death toll was 16, President Trump put the number "hundreds and hundreds of people who died after Hurricane Katrina" can really be very proud of what happened in Puerto Rico, "he said.
The new research that unite Dependent on the government performed, the actual death rate compared with what one might have expected – a method used in several previous analyzes. In December the New York Times found that 1052 people died more than usual in the 42 days after Hurricane Maria landed.
A study by Harvard researchers published earlier this year in the New England Journal of Medicine estimated death The number of victims is between 800 and over 8,000 people and is based on a household survey.
The findings of the new study reveal what the government had already recognized before officially increasing the death toll, officials said Tuesday.
"Hurricane Maria has been a catastrophe of historical proportions never before seen or lived in the United States," said Carlos Mercader, executive director of the Puerto Rico Federal Affairs Administration, via email. He said the new analysis "is sobering and their findings make it clear that Congress and FEMA need to work with us to create a better system for preparing and distributing supplies for future disasters."
The researchers at George Washington University have very much published some details of their methodology or analysis that make it difficult to assess the quality of their work, which was conducted at a cost of $ 305,000, and also an analysis of how government deaths certified and reported on them. They wrote that "national and international experts in different fields" had reviewed their methods. The report has not yet been subjected to the stricter process of publication in a peer-reviewed Medical Journal, although it was submitted for publication.
The new study is mainly different from most previous analyzes. Researchers looked at deaths for a longer period of time, from September 2017 – when two hurricanes, Irma and Maria reached the island in quick succession – until February 2018. Deaths continued to increase during this period.
The researchers have also adjusted their values According to calculations, they estimated the population decline by eight percent after the storm and continued power outages when thousands of people fled to the mainland. Using data from the Bureau of Transportation Statistics of the Territory, as well as from a government survey of air travelers, the researchers estimate that by February 2018, nearly 280,000 fewer people lived on the island than in September 2017. This exodus made deaths even more significant than the deaths Previous years increased.
People in poorer communities and older men had a higher risk of dying throughout the study period, the researchers found.
"As a result, efforts to help and recover need to be focused as much as possible in low-income areas, in the elderly, in people who are more vulnerable because they have fewer of their own resources," Dr. Lynn Goldman, dean of the Milken Institute, at a press conference on Tuesday. She said a similar analysis had not been done in previous disasters. "I think we do not know how these major disasters affect people's health and lives."
The researchers also tried to understand why the number of deaths was so low despite the general increase in deaths. Englisch: www.comece.org/comece.taf?_function…&language=en , based on the official census, followed conventions that saw the disaster as a factor in contributing directly to death – for example, "structural collapse, flying debris, floods and drowning." At that time, there were no new guidelines from the state Centers for disease control and prevention, published one month after the hurricane, recommend that doctors also consider the indirect effects of a natural disaster, such as late access to healthcare.
Some doctors told researchers in interviews that they were confused about the new guidelines, or that listing the hurricane as a contributor was not enough
"Most doctors have no formal education in obtaining a death certificate and are up to date therefore not aware of appropriate death certificate practice, especially in a disaster environment, "the study found
Researchers found that this problem was not isolated to Puerto Rico. "The lack of training to complete the death certificate is also a problem on the mainland," they wrote. "To date, there are no official death certificate death certificates for individuals who complete death certificates."
Researchers also concluded that delays in registering deaths ranging from about one week to one month of delay seemed not to affect the overall quality of the process. The vital statistics office was damaged and lost power after the storm. Records were kept on paper until electronic systems could be used again.
The researchers reported that in the recording of vital signs the number of deaths per day was higher than normal, but only a few death certificates these deaths were associated with the hurricane department, the CDC spread guidelines for hospitals, doctors and funeral directors by e – mail and in meetings
Dr. Gilbert Burnham, a professor of international health and founder of the Center for Humanitarian Health at Johns Hopkins University, said the study was a good complement to earlier Harvard research, as it included the post-storm exodus into the over-death assessment ] "The protracted higher mortality rate, especially in males, is interesting and raises many questions about possible causes," Dr. Burnham, who has conducted similar death assessment studies, including in Mosul, Iraq. The study found that there was a lack of disaster preparedness, "he added, adding," The failure to Communicating events and risks resulted in a loss of credibility. "
The proposed next phase of the George Washington Study will be the death certificates that were recorded in the months following the hurricane and will be tried through interviews with family members and to tell other people whether individual deaths are attributable to the storm. Researchers said they did not know when this next phase would be completed.
The research was conducted in collaboration with the Graduate School of Public Health of the University of Puerto Rico. The actual number of excessive deaths was statistically estimated at 2,658 to 3,290.