The difference between 4,645 and 64 deceased in the aftermath of Hurricane María is… science

, Climate Scientist | June 1, 2018, 3:30 pm EDT
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Over the last few decades, we have seen the Puerto Rican populace’s vulnerability to extreme weather hazards increase as the built environment and social services infrastructure decays, Puerto Ricans and their families flee at an increasing tempo to the United States, and the frequency and intensity of hurricanes in the Caribbean increases. Growing up in Puerto Rico, I lived through one hurricane (Hugo, 1989) and a few tropical storms, but nothing compared in ferocity and devastation to Hurricanes Irma and María.

Given the destruction and flooding from these two hurricanes, the ineptitude of the Puerto Rican government in handling the situation, and the unwillingness of the Trump administration to adequately assist the citizens of its territory, it was hard to believe that the death count had only reached 64 fatalities, as Puerto Rican Governor Ricardo Rosselló’s Department of Public Safety claims. In fact, Puerto Rican society widely mocked the government’s numbers and suspected either incompetence or a deliberate undercount to minimize the magnitude of human toll.

A new study offers evidence of what Puerto Rican communities suspected. Independent researchers at Harvard University estimated that at least 4,645 people lost their lives in the aftermath of Hurricane María, with one-third attributed to interrupted or delayed health care. The researchers used household surveys to calculate an all-cause mortality rate after the hurricane, and compared this rate to official 2016 (i.e., pre-María) mortality rates to estimate excess deaths from the hurricane. That number is supported by the researchers’ methods and data, but it is also symbolic, as it represents the central estimate of between 793 and 8,498 deaths. For perspective, and to underscore that Puerto Ricans experienced a real catastrophe (contra Trump’s false assertions that I debunked here) 4,645 is more than those killed by the terrible calamities of 9/11 and Hurricane Katrina.

Among the statistical estimate of 4,645 we can count real people

Who were these thousands of people who lost their lives after the hurricane? We will likely never know for sure, but among them was Gaspar Cruz Agosto, a 73 year-old Puerto Rican man who was scheduled for surgery before the hurricane, but who could not be operated on because the hospital lost power after María. Mr. Cruz Agosto died two weeks after the hurricane because the hospital could not provide him with the critical care he needed. This sad case does not appear to be isolated, as Puerto Rico’s independent Center for Investigative Journalism (CPI in Spanish) estimates that 60 percent of María-related fatalities ocurred in health care or retirement home facilities.

The difference between the official count and the estimate is vast—it is, in fact, more than 70 times the official figure. What can be the cause of the enormous discrepancy? Well, it’s clear that the answer is…science. The large undercounts appear to be due to established protocols that require that a medical doctor annotate a death certificate linking the clinical cause of death to the disaster event. As CPI explains, the attending physician in these cases is seldom the physician certifying the death of a patient. This means typically there was no contextual information included in a death certificate—information like lack of electricity, transportation services, or medicines, interrupted health care, dietary changes, temperature increases, or stress caused by the disaster. If we add to that the chaotic conditions after the hurricane, and the lack of communication with public health agencies, hospitals, and funerary homes, it becomes clear that obtaining an accurate count of fatalities was a very difficult task.

But the disaster conditions and the inadequacy of death certificate protocols in Puerto Rico do not excuse the Rosselló administration’s attempt to discourage at least two prominent Democratic senators from asking the Department of Homeland Security to ensure an accurate count of all storm-related deaths. The Puerto Rican government’s lobbyist who called Democratic congressional offices suggested that focusing on the death toll would negatively impact the image of Governor Rosselló, showing more concern for public relations fallout than for the well-being of our people. Didn’t we just see a similar disregard for human health and concern about a “public relations nightmare” in the Trump administration’s blocking of a study on hazardous chemicals on military bases in the U.S.?

Arguably, the lack of attention and resources given to Puerto Rico by the Trump administration also had a role in increasing the death count, as the President’s disparaging and dismissive tweets about Puerto Ricans and the disaster likely sent the message to all levels of the federal government that neither he nor his agencies should be very concerned about the plight of Puerto Ricans.

The public has a right to know the facts about natural disasters and their aftermath, and neither the Rosselló nor the Trump administrations have been honest with us about this. There is no way to overstate the severe public health crisis still unfolding in Puerto Rico nearly ten months after María. As we have seen in the botched attempts at restoring the electrical grid in anticipation of the next hurricane season (just a few days away from starting!), neither social nor economic justice has been prioritized. What is being prioritized by the Puerto Rican government are juicy contracts for unqualified (but well-connected to the Trump administration) contractors and government agency executives tasked with dismantling public schools, the social safety net, and labor protections. What is being prioritized is violent police repression to silence civil resistance to austerity measures by tear gassing children and other non-violent demonstrators.

Latinas lead the way towards a recovery in Puerto Rico

But there is hope. Leading the way towards an equitable recovery for Puerto Rico are multiple grassroots and national advocacy organizations—and Latinas are leading the way here. Recently I had a chance to see their work in action at a recent summit of Latina and Latino environmental professionals. The compañeras at the Fundación Fondo Acceso a la Justicia are providing legal assistance to appeal denied FEMA aid requests—a complicated and very cumbersome process. Local Sierra Club activists in Puerto Rico are providing solar panels and helping to increase the skills of local community leaders that can create strong and resilient neighborhoods for when the next hurricane hits. Latinas with Oxfam America have helped convene grassroots in Puerto Rico with FEMA officials so that the federal agency can have a better understanding of the language and cultural barriers that prevent people from accessing aid. Latina scientists from CienciaPR and other scientific organizations are convening a workshop in the fall in Puerto Rico to educate Puerto Rican and Puerto Rico-focused scientists on how to engage in the pressing science-policy debates and decisionmaking that are vital to safeguard our health, environment, and democracy.

We need to address climate change with the tools and knowledge produced by science. We need to do so with special attention to the most vulnerable populations, be they in the Caribbean, the Gulf Coast, or in inland cities or rural areas. If we do not, we will see more of these deadly impacts as climate change continues to fuel more intense and destructive hurricane seasons.

Posted in: Science and Democracy

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