Review finds jump in Puerto Rico deaths

Homes were flattened. Power was knocked out. And all across Puerto Rico, bodies began showing up at morgues. Hospitals barely functioned. Even so, after Hurricane Maria devastated Puerto Rico the government there reported a relatively low death toll.

Now, a review by The New York Times of daily mortality data from Puerto Rico's vital statistics bureau indicates a significantly higher number of deaths after the hurricane than the government there has acknowledged.

The Times' analysis found that in the 42 days after Hurricane Maria made landfall Sept. 20 as a Category 4 storm, 1,052 more people than usual died across the island. The analysis compared the number of deaths for each day in 2017 with the average of the number of deaths for the same days in 2015 and 2016.

Officially, 62 people died as a result of the storm that ravaged the island with winds of nearly 150 mph, cutting off power to 3.4 million Puerto Ricans. The four most recent fatalities were added to the death toll Dec. 2.

"Before the hurricane, I had an average of 82 deaths daily," Wanda Llovet, director of the Demographic Registry in Puerto Rico, said in a mid-November interview. "That changes from Sept. 20 to 30. Now I have an average of 118 deaths daily."

Since then, she said Thursday, both figures have increased by one.

Data for October are not yet complete, and the number of deaths recorded in that month is expected to rise. Record-keeping has been delayed because Puerto Rico's power grid is operating at less than 70 percent of its capacity, and some parts of the island still do not have power.

The deadliest day was Sept. 25, the day the governor of Puerto Rico, Ricardo Rossello, warned that a looming humanitarian crisis could prompt a mass exodus from the island.

President Donald Trump responded that night by taking to Twitter to say the island had to deal with its debt: "Food, water and medical are top priorities -- and doing well. #FEMA."

It was over 90 degrees, and power was out on most of the island, even in most hospitals. Bedridden people were having trouble getting medical treatment, and dialysis clinics were operating with generators and limiting treatment hours. People on respirators lacked electricity to power the machines.

On that day, 135 people died in Puerto Rico. By comparison, 75 people died on that day in 2016 and 60 died in 2015.

One mayor went to the Federal Emergency Management Agency command post that day and shouted for help. Statistics show his city, Manati, had among the highest mortality rates in September.

With communications down throughout the island and bodies piling up in hospital morgues, the government was still clinging to its early death count estimate of 16.

On Sept. 29, Hector Pesquera, Puerto Rico's public safety secretary, said in an interview that the death count would not swell by much.

"Will it go up?" he said. "I am pretty sure it will go up. It won't double or triple. It's not like an earthquake where you have a building and you don't know whether there were 20 in the building or 300 in the building until you get all the rubble out."

The day he said that, 127 people died, 57 more than the year before.

On Oct. 3, nearly two weeks after the storm, Trump visited the island and praised the low official death toll. He referred to the 1,833 deaths in 2005 during Hurricane Katrina as a "real catastrophe."

"Sixteen people certified," Trump said. "Sixteen people versus in the thousands. You can be very proud of all of your people and all of our people working together."

By that visit, an additional 556 people had died in Puerto Rico compared with the same period over the two previous years.

The Times estimates that in the three weeks after the storm, the toll was 739 deaths. If all those additional deaths were to be counted as related to the hurricane, it would make Maria the sixth-deadliest hurricane since 1851.

The method used to count official storm deaths varies by state and locality. In some parts of the United States, medical examiners include only deaths directly related to the storm, such as those caused by drowning in floodwaters. In Puerto Rico, Pesquera said, the medical examiner includes deaths caused indirectly by storms, such as suicides. That is why the gap between the official death toll and the hundreds of additional deaths is so striking.

A study, which has not been peer-reviewed, by a Pennsylvania State University professor and an independent researcher estimated that the death toll could be 10 times the official count.

The Center for Investigative Journalism published its own estimate Thursday, finding that nearly 1,000 more people than usual died in the months of September and October.

Records from Puerto Rico's government show that some of the leading causes of death in September were diabetes and Alzheimer's disease, although the causes of death are still pending for 313 of the September deaths. The number of diabetes deaths was 24 percent higher than it was last year and 39 percent higher than it was in 2015.

The highest surge was in deaths from sepsis -- a complication of severe infection -- which jumped 50 percent over last year. That change is notable and could be explained by delayed medical treatment or poor conditions in homes and hospitals.

Deaths from pneumonia and emphysema also increased sharply.

Robert Anderson, chief of the mortality statistics branch of the National Center for Health Statistics, said Puerto Rico's jump in deaths was statistically significant and unlikely to be a fluke. Not even a bad flu season would make the mortality rate increase that much, he said.

"I think there's fairly compelling evidence that that increase is probably due to the hurricane," Anderson said. "That's a lot."

A Section on 12/10/2017