Jonathan P. Baird

A new study released by Harvard’s Chan School of Public Health estimated that 4,645 people died in Puerto Rico in the three month period after Hurricane Maria. The government of Puerto Rico is still quoting a death tally of 64 people.

The Harvard study is a figure 70 times higher than the official death count. It is more than double the number of people who died in Hurricane Katrina. The Harvard study ranks Hurricane Maria the deadliest natural disaster to hit the United States in the last 100 years. As the study says:

“Our results indicate that the official death count of 64 is a substantial underestimate of the true burden of mortality after Hurricane Maria.”

While no study like this can be absolutely accurate, the Harvard study is the most reliable accounting to date. The researchers from Harvard worked with graduate students at the Carlos Albizu University and Ponce Health Sciences University in Puerto Rico and others in Colorado and Boston to conduct a survey of 3,299 randomly selected households in Puerto Rico – about 9,522 people.

The researchers asked those surveyed about all deaths and their causes between September 20, 2017, the date of Hurricane Maria, and December 31, 2017. They tried to compare the normal death rate from the year prior to the late 2017 period. The researchers found a 62% increase in mortality in the three months after the hurricane.

How to explain the vast death undercount? The Harvard researchers present a persuasive explanation. What was deadly was not just the storm itself, it was the loss of electricity, power, and cellphone service in the aftermath of the storm which deprived thousands of medical care.

Health care disruption for the elderly and loss of basic utility service for the chronically ill had a devastating impact. Wendy Matos, a physician who supervises 468 doctors working at 29 sites across Puerto Rico has said her clinics saw increases in cardiac arrest and intracranial hemorrhage (bleeding inside the skull), more waterborne and infectious disease and more suicides after Maria.

Dr. Matos blamed lack of access to potable water. More patients presented with illnesses related to drinking water contamination. She also described acute mental health issues. She felt the elderly have suffered the most extreme anxiety and depression.

After the storm, heath care was effectively crippled on much of the island. Even by mid-December 2017, one-third of the island’s 68 hospitals lacked power. As late as March 2018, 11% of Puerto Rico’s community health centers had limited or no power. The researchers wrote:

“Interruption of medical care was the primary cause of sustained high mortality rates in the months after the hurricane.”

The government of Puerto Rico’s way of counting deaths led to a skewed picture of the real harm. The government was not using any guidelines for deciding what was counted as a hurricane-related death. It simply did not count deaths that could not be attributed to direct storm damage itself. Indirect deaths from the worsening of chronic conditions or from delayed medical treatments did not count. The picture presented minimized the damage done.

Puerto Rico was also the victim of a public relations sales job. When President Trump lobbed paper towels two weeks after Maria, he was anxious to brag about a successful relief effort. Trump said only 16 died and he said Puerto Rico had not experienced “a real catastrophe” like New Orleans with Katrina. In an interview on Fox and Friends, he graded himself an A-plus for effort and an A for achievement.

Aware of the disaster Katrina had been for President George W. Bush, Trump wanted to get ahead of the story. I would have to say his scam worked. He pre-empted the disaster by messaging that Maria was no Katrina. Then he and the mass media largely moved on and forgot Puerto Rico.

This is an instance where a false narrative of recovery governed and still governs popular perception. The storyline of recovery overshadows facts on the ground. The public stopped paying attention.

By almost any measure, the federal response has been a fiasco. Recovery has been conducted at a snail’s pace. On average, Puerto Ricans went 84 days without electricity, 68 days without water and 41 days without cellphone coverage after the storm. According to the Washington Post, 20,000 residents in remote areas of the island are still without power.

I think we can safely say that if such a performance had occurred on the U.S. mainland, it would have been deemed absolutely unacceptable. The federal government was underprepared for the storm. It failed to properly position supplies in advance and it failed to make provisions for military assets. Puerto Rico had a frail infrastructure even before the storm.

Considering the history of increasingly powerful storms to wrack the Caribbean and the Gulf areas, there was an anti-scientific dimwittedness behind the poor response. You have to wonder how many more monster storms will it take before climate change is even acknowledged.

There are deeper dimensions to this tragedy as well. Puerto Rico exists in a political twilight zone. Although it is called an unincorporated territorial possession, it is actually a colony of the United States. Even though the Puerto Rican people are U.S. citizens, they have no representatives in Congress or the Senate. Puerto Rico has no votes in the Electoral College and Puerto Ricans on the island cannot cast votes for President in the general election.

The political powerlessness of Puerto Rico makes it easier to ignore the crisis on the island. Politicians do not worry about blowback because the island can’t vote.

Adding to its invisibility, Puerto Rico’s military value has disappeared. Puerto Rico is less consequential now because the U.S. has no rival in the Southern hemisphere as it previously did with the Soviet Union and Cuba.

I think the racial dimension also deserves mention. Puerto Rico is 99% Latino. In an administration that panders to anti-immigrant sentiment and white supremacy, Puerto Rico remains a low priority. Neglect is the outcome.

June 1 marks the start of a new hurricane season which is a frightening prospect. The experience of Hurricane Maria and its ongoing legacy is beyond sobering. It is hard not to worry about history repeating itself.