How many Puerto Ricans died due to Hurricane Maria? This has been one of the most contested issues since the hurricane made landfall on September 20, 2017. In an earlier post, published in November 25, 2017, I explained the roots of this controversy. The post describes the work of Puerto Rico’s Centro de Periodismo Investigativo which’s investigative reports have demonstrated problems with the Rosselló administration’s accounting of hurricane-related deaths, President Donald Trump’s visit to the island, which sparked this controversy, and San Juan Mayor Carmen Yulín Cruz Soto’s views on the matter, which have been widely covered by the media.
In this post, I want to share some thoughts on the Harvard University-funded study, “Mortality in Puerto Rico After Hurricane Maria” which was conducted by Nishant Kishore, Domingo Marques, Ayesha Mahmud, Mathew Kiang, Imary Rodriguez, Arlan Fuller, Peggy Ebner, Cecilia Sorensen, Fabio Racy, Jay Lernery, Leslie Maas, Jennifer Leaning, Rafael Irizarry, Satchit Balsari and Caroline Buckee, and published in the New England Journal of Medicine on May 29, 2018.
But before looking at the study, it is worth recapping some of the developments that have taken place since I published my last post on this issue.
More Twists and Turns
Since my last post on hurricane-related deaths, a few things have taken place that have further politicized this sensitive issue. For example, the New York Times published the findings of its study, which estimated that the death toll could be as high as 1,052 people. Latino USA and the Centro de Periodismo Investigativo partnered to review the available demographic data, arguing that the number was closer to 985.
Intense public pressure forced the Rosselló administration to establish a commission to further study the controversy. But rather than appointing an independent panel, the governor asked Héctor Pesquera, the Secretary of Public Safety, to lead the commission. This was problematic in at least two ways. First, one of Pesequera’s responsibilities was to account for the number of hurricane-related deaths. Second, his repeated dismissal of journalists’ questions regarding the government’s figures created a public relations crisis, which tarnished the Rosselló administration’s credibility in both Puerto Rico and in the U.S. mainland.
For most of January, journalists working for the Centro de Periodismo Investigativo asked the Rosselló administration to share its data on hurricane-related deaths with the public. The New York Times, CNN, Buzzfeed and other news outlets asked for the same information. But Pesquera’s unwillingness to share these data forced the Centro de Periodismo Investigative and CNN to sue the Government of Puerto Rico in the local court system on February 7, 2017.
The next day Governor Rosselló admitted that there were flaws in his administration’s handling of the controversy. For that reason, the Government of Puerto Rico commissioned George Washington University’s Milken Institute School of Public Health to conduct a study that could “estimate the excess mortality tied to Hurricane Maria”. According to the Caribbean Business News, the Government of Puerto Rico agreed to pay $305,368 to finance the analysis. In exchange, the research team, led by Carlos Santos-Burgoa, agreed to share its preliminary findings by May 22, 2018 and a submit full report to the Rosselló administration before July 23, 2018. Due to unforeseen circumstances Santos-Burgoa’s team failed to deliver its preliminary report. After asking the Puerto Rican government officials for an extension, George Washington University’s public relations office announced that its team hopes to submit its findings by the end of the summer.
As noted above, on May 29, 2018 the New England Journal of Medicine published a study estimating that Hurricane Maria claimed the lives of around 4,645 Puerto Ricans. The official government death toll stands at 64. How can we explain this discrepancy, especially given the fact that other studies’ estimates, including Alexis Santos and Jeffrey Howard’s analysis, are much lower?
From 64 to 4,645
The Harvard-funded study did not have access to the Government of Puerto Rico’s records. Indeed, the New York Times reported that the Rosselló administration “refused to provide data to them.”
To estimate the number of death associated with Hurricane Maria, the authors of the study surveyed “a representative stratified random sample 3,299 households, of an estimated 1,135,507 total households, across Puerto Rico.” The authors decided to stratify the population “according to remoteness, defined according to the travel time to nearest city with a population of at least 50,000 persons.” According to the study, 93% of respondents agreed to complete the survey.
The Harvard-funded study estimates that Hurricane Maria claimed the lives of 4,645 individuals. Although this figure is larger than the estimates of past studies cited above, it is important to remember that the analysis covers a longer time period (September 20 – December 31, 2017). And while the 4,645 number has garnered lots of attention it is also critical to keep in mind that the authors are not saying that the hurricane caused this amount of deaths. Because of the survey’s margin of error, the authors estimate that deaths connected to Hurricane Maria could be as low as 793 and as high as 8,498. Thus, the 4,645 is the median between these two estimates.
One of the main benefits of this study is that it helps us understand the main causes of these deaths. For example, the survey asked respondents to estimate the days they lived without clean water, electricity or cell phone coverage. Thus, the authors can show how these variables may have affected mortality rates in the island after Hurricane Maria. Unsurprisingly, the respondents to the survey cite that “interruption of medical care was the primary case of sustained high mortality rates in the months after the hurricane.” Only 10% of the reported deaths seemed to have been caused directly by Hurricane Maria. These findings corroborate other investigative reports’ conclusions.
While survey research has its weaknesses, my first reading of this study suggest that the authors’ did a good job. The methodology is sound and the fact that the authors’ have publicly shared their data demonstrates their willingness to engage critiques and to let other social scientists use their observations to explore the impact Hurricane Maria had on Puerto Ricans’ lives.
My biggest question is whether the Harvard-funded study took into consideration the spike in the numbers of suicides that have taken place in Puerto Rico after Hurricane Maria. While the researchers’ survey does include suicide as a cause of death, their paper does not address this issue, which has received considerable attention in the last months.
The Study’s Fall Out
To figure out how many people died because of Hurricane Maria, it seems that we will have to wait for the findings of Santos-Burgoa’s team. Given that this group of researchers have complete access to the government’s data, they should be able produce a more precise accounting of the excess deaths following Hurricane Maria. But the fact that the Rosselló administration has spent over $300,000 on this study and that this team is the only one that has access to the government’s data will raise questions regarding these researchers’ independence and the legitimacy of their findings.
And here lies the dilemma Puerto Rican society faces today. This controversy has further eroded Puerto Ricans’ trust on their government’s capacity to address natural disasters and their elected leaders’ willingness to do the right thing. And while the Harvard-funded program did not consider the Trump administration’s role in this controversy, it is safe to say that many Puerto Ricans’ faith in the federal government has waned as well.
While the Harvard-funded study could have prompted a much needed conversation of what future actions the Puerto Rican government can take to prevent future hurricane-related deaths, it has had the opposite effect. The study has mobilized the island’s political factions and reduced the possibility of a sensible discussion of both the merits and limitations of this study. For example, in Twitter, supporters of Governor Rosselló have dismissed the study’s conclusions. Some have even questioned the independence of the study, arguing that Domingo Marques, one of the authors who teaches in Puerto Rico’s Carlos Albizu University, is a “communist” and an ally of Mayor Cruz. For her part, Cruz, who has challenged the Rosselló administration’s figures since early October 2017 and is thinking of mounting a run for governor in 2020, has been photographed wearing a baseball cap that reads 4,645. In different interviews, she has promised to honor the memories of those that died because of the government’s negligence. And while Governor Rosselló has refused to meet with journalists, including CBS News’ David Begnaud, Pesquera has questioned the findings of the Harvard-funded study, claiming that its methodology is unscientific.
What seems lost in this controversy is the experiences of those Puerto Ricans who lost a friend or a family member due to Hurricane Maria. It must be difficult to find closure in this political environment.
And what is even sadder is that this political controversy is overshadowing the fact that many of these deaths could have been prevented. It is important that the Government of Puerto Rico and the U.S. federal government can learn from their mistakes and also hold accountable those officials or healthcare professionals who were negligent and may have not done enough to save these people. This is not only necessary from a policy standpoint. It is a moral imperative.