Hurricane Maria’s two legacies: One for Puerto Rico, one for the United States

Sep 21, 2018 by

By Nakonia (Niki) Hayes, 21 September 2018

Hurricane Maria left two legacies when she devastated Puerto Rico, an island territory of the United States, on September 20, 2017. The first one was in creating a reported $90 billion path of destruction to be cleaned up by its devastated three million residents. That mountain of dollars plus untold years will be needed to re-establish a functioning economy and safe living environment.

Add to the fact the island has been struggling under bankruptcy issues since 2015, and it appears that overhauling the entire Puerto Rico government’s decision-making system will have to be part of the rebuilding efforts. This becomes more than just rebuilding an infrastructure, new homes, and businesses. It means changing the complex dynamic of a government’s efficient responsibility to its citizens https://www.reuters.com/article/us-usa-puertorico/puerto-rico-governor-calls-for-bankruptcy-adviser-says-island-insolvent-idUSKCN0P91QA20150630.

The hurricane’s second legacy will be traced to August 27, 2018, almost a year later. On that date, a commissioned report by the governor of Puerto Rico was published that will set a precedent for all U.S. government levels on how to determine deaths related to a national disaster.

This new research project paper, “ASCERTAINMENT OF THE ESTIMATED EXCESS MORTALITY FROM HURRICANE MARÍA IN PUERTO RICO” https://publichealth.gwu.edu/sites/default/files/downloads/projects/PRstudy/Acertainment%20of%20the%20Estimated%20Excess%20Mortality%20from%20Hurricane%20Maria%20in%20Puerto%20Rico.pdf, shows the death toll for Hurricane Maria skyrocketed from 64, a figure quoted by Puerto Rico officials from December 2017 until August 2018, to a startling figure of 2,975 fatalities. That’s a 4,648% increase in deaths supposedly caused by the hurricane.

It turns out the first figure of 64 was based on “direct” deaths as determined by official death certificates. The second was on the official direct count plus “indirect” deaths as determined by those writing this new report.

On September 13, the media were full of President Donald Trump’s hostile response to the new death account. He and other federal officials had been assured by Puerto Rico government leaders for nine months that 64 persons had died due to Hurricane Maria. How could this new unbelievable figure (an almost 5000% increase) be accurate? Being subjected to frequent news stories full of inaccuracies about his administration’s programs, he said the figure had to be fake.

The story behind the commissioned report, however, was one about which he and other federal officials had evidently not been told. Someone dropped the ball by not notifying him that Puerto Rico officials had actually been waiting for word on a new, and much higher, death count for those same nine months.

His ripping apart the new number consumed the media as another emotional, public relations problem for the President. That is, the news media, the devastated people of Puerto Rico, and leading politicians on both sides of the aisle showed immediate negative reactions to the President’s criticism.

Anyone who disagreed with the report’s results was viewed as attacking the already devastated people of Puerto Rico. This refusal to discuss the report’s work meant it would stand, even if it were proven to be inaccurate.

Governor Ricardo Rossello of Puerto Rico had commissioned the research in December 2017. To be prepared by the Milken Institute School of Public Health at The George Washington University (GWU), a private research university in Washington, D.C., and assisted by the University of Puerto Rico, the project was to cover the six months from September 2017 through February 2018.

A final, peer-reviewed study will be released in February 2019. Total expenses for the project are reported to be approximately $1.5 million, with the Puerto Rico government spending $305,000 and $1.1 million coming from grants solicited by the University of Puerto Rico https://en.wikipedia.org/wiki/Hurricane_Maria_death_toll_controversy.

According to a BBC news story after the paper’s release to the media https://www.bbc.com/news/world-us-canada-45338080, “…the official recognition of this report by Puerto Rico officials will allow the island to focus on rebuilding its infrastructure and ‘extracting tens of billions of dollars needed from Congress to give the already bankrupt territory something of a future.’”

The island’s governor said, “Although this is an estimate [of deaths], it has a scientific basis.” He then officially accepted the findings of this report. Major decisions would be made based on its conclusions.

One wonders if the governor had actually read the full report. It gives a scathing account of the Puerto Rico government officials, bureaucrats, and local leaders. It points out incompetency, poor leadership, poor preparation and training, dishonesty about events and facts, and a willingness for Puerto Rico officials to lie about events to protect themselves.

There was little to no criticism of U.S. officials and agencies who had been sent to help Puerto Rico recover from Hurricane Maria. Only the mayor of San Juan was listed as vocal in her anger toward Pres. Trump and the United States’ assistance.

As one news outlet explained, “The government’s initial number was for those killed directly by the hurricane, crushed by collapsing buildings, drowned, or hit by flying debris. This new report over the following six-month period also counted deaths from poor healthcare provision and lack of electricity and clean water. Repeated power cuts also led to an increased number of deaths from diabetes and sepsis https://www.bbc.com/news/world-us-canada-45338080.

A CNN report gave further examples that related to indirect deaths https://www.cnn.com/2018/08/29/us/puerto-rico-growing-death-toll. These included a man who could not be reached at his home by emergency personnel due to road conditions, a case of exposure to carbon monoxide, a suicide, a person run over by his own vehicle, and a death from complications following a fall.

The news media had begun their own digging about deaths being indirectly related to the hurricane after President Trump visited the island in December 2017 https://www.cnn.com/2017/10/03/politics/president-donald-trump-puerto-rico-recovery/index.html.

He told the island leaders that he was grateful there weren’t more deaths similar to other hurricanes in the U.S. This angered some members of the media who had begun asking questions of funeral home staffs about deaths after the storm.

They ultimately talked with staffs in 112 funeral homes, or about half of those on the island. They determined there were “indirect” deaths not being listed by government officials. Rallying cries came from the people for more information. At that point, Governor Ricardo Rossello commissioned GWU for the report.

The GWU researchers followed the lead of the media and spoke with the same funeral home staffs. Since many of the deaths were not recorded officially as being the result of Hurricane Maria, it appears subjective judgments had to be made regarding some of the deaths as “indirectly” related to the hurricane.

As far as being able to count mainly on those death certificates for specific numbers, which was the key source of previous information given to federal officials and the media, the research report says the following:

  • …[T]here were gaps in the information provided by the Government of Puerto Rico, including limited explanation of the death certification process, distinguishing between direct and indirect deaths, or explanations of barriers to timely mortality reporting.
  • …Despite the potential for information gaps to increase the risk of the propagation of misinformation and rumors, the Government of Puerto Rico did not systematically monitor and address misinformation or rumors in news outlets and on social media platforms.
  • …Efforts undertaken by outside groups to fill information gaps and identify hurricane-related deaths added to conflicting mortality reports in the information environment.
  • [T]here was not transparency in reporting [deaths].
  • [I]nformation was intentionally withheld to evade blame.
  • [A]dequate systems were not in place to track the death count.

In addition:

“Our study shows that physician lack of awareness of appropriate death certification practices after a natural disaster and the Government of Puerto Rico’s lack of communication about death certificate reporting prior to the 2017 hurricane season limited the count of deaths that were reported as related to Hurricane María.

“When asked about the Centers for Disease Control (CDC) guidelines the Puerto Rico Vital Statistics Registry (PRVSR) circulated after the hurricane that recommended physicians fill out a section in the death certificate with information or other conditions that contributed to the death, interview respondents indicated lingering confusion about the guidelines, while others expressed reluctance to relate deaths to hurricanes due to concern about the subjectivity of this determination and about liability…”

Yet, amazingly, the GWU report concluded, “Nevertheless, based on our findings in the assessment of death certification quality, the disaster does not appear to have affected the completeness of the certificates.”

Will this precedent of accounting for both direct and indirect-related deaths during Hurricane Maria set a new standard for measuring deaths in future disasters for the United States and its territories? Of course it will.

As CNN explained, “The death toll has real-world ramifications. Experts say public aid follows higher death counts. The families of people who officially died in Hurricane Maria are eligible to have some of their loved ones’ funeral costs covered by the Federal Emergency Management Agency” https://www.cnn.com/2017/12/18/health/puerto-rico-maria-death-count-review/index.html.

After their data mining, personal interviews of citizens, funeral home staffs, and government officials, and their use of statistical models, the GWU researchers settled on 2,975 deaths actually being related to Hurricane Maria. That’s a 22%  mortality rate for that six-month period.

That leads to the discussion of the continuing decline of the island’s population. primarily due to years of emigration but also to decreasing birth rates (1.5 per 1,000 population) compared to death rates (8.1 per 1,000 population). Any financial costs of rebuilding Puerto Rico must also be configured around the fact the island’s population is proving not to be sustainable for future economic growth and development https://medium.com/migration-issues/how-low-will-puerto-ricos-population-go-c8d108ac8b3b.

How this GWU report will thus be used when making plans for the U.S. territory’s financial comeback and redevelopment from both bankruptcy and a major hurricane will be a piece of contemporary history worth watching.

How this GWU report will be used as a precedent to set up the expansion of governmental responsibilities after future national disasters should be cause for alert to all federal, state, and local government officials. There needs to be immediate recognition and planning for potentially increased care and costs for victims, as well as costs and methods for confirming those numbers.

This time, having a community or commissioned entity determine, and allow, a less-than-scientific “indirect” death count that will impact citizens and government responses and costs should not catch any President or administration by surprise.

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1 Comment

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    Barry Stern

    Excellent, well-balanced, researched and informative piece. Of course, there will be in-direct deaths from a hurricane that result from losing power, potable water, food, shelter, medical care, etc. Moreover, PR was poor to start with, and its infrastructure was in horrible shape. Add that to an incompetent bureaucracy that didn’t want accurate numbers fearing blame, PR has a very deep hole to climb out of. With outside help to rebuild the infrastructure (which is underway), a hearty population that commits to elect competent leaders and hold them accountable, and a mindset that rejects socialistic solutions to rebuild the economy, PR has a fighting chance. Let’s hope that those who have chosen to remain in PR do not squander this opportunity to get it right.

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