On October 3, the very day that US President Donald Trump stepped on battered Puerto Rico and declared that the damage caused by Hurricane Maria was not as catastrophic as that caused by Hurricane Katrina in Louisiana, 121 people died on the island, 40 more than the average daily deaths in 2016.
That morning, the official death toll remained in 16 cases, however different sectors were already warning of an increase in fatalities, many of them caused, or indirectly precipitated, by the hurricane.
The data released this week by the Demographic Registry also reveals that, during the first 20 days after Hurricane Maria, 2,320 people died.
This figure represents 700 deaths more than those that, on average, occurred in a period of 20 days during 2016. That year, the daily deaths average was 81.
"The first days were fatal. It is a large number. Among those cases, there must be many deaths of people whose health depended on electricity, "said demographer Judith Rodríguez.
The data also shows that deaths did not reach complete stabilization during the last five months of 2017. The frequency of deaths remained above the levels reported in 2016, according to calculations based on government demographic data.
The numbers also reveal, in some points, the scope of some problems experienced during the emergency. For example, in 2016, 25 bodies were cremated per day in Puerto Rico. After the hurricane, that figure reached 64 cases on September 24, four days after the hurricane, and remained relatively high until, at least, the end of October.
During those days, funeral services were limited due to the destruction caused by the winds and floods and to the lack of power and drinking water services in many areas of the island.
So far, the government maintains the number of fatalities associated with Hurricane Maria in 64 cases. However, authorities are waiting for the conclusion of a study conducted by George Washington University to have a clearer picture of the levels of mortality caused by the cyclone. The Demographic Registry data shows that, between the hurricane and the end of 2017, there were 1,397 more deaths reported, compared to those in the same period during 2016. A Harvard University study highlights that deaths associated with the hurricane could be between 793 and 8,498. The midpoint between both figures is 4,645 cases.
Healthcare Services experience
Dr. Víctor Ramos, president of the College of Physicians and Surgeons, agreed that the deaths associated with Hurricane Maria should be much higher than the official number of 64. However, he warned that it will take several years to know the real number.
Because of his participation in aid missions during the months following Hurricane Maria, the doctor acknowledged having identified people desperate for lack of medication.
"We rescue people,but in some cases, we are too late (to help them)," he said.
"In addition to people with problems to access medicines, we also saw people who had not received their chemotherapy, people who had problems (with storage) of insulin, dialysis patients who, due to problems with electricity and water, were not receiving their treatments completely," said Ramos.
He added that all these difficulties were observed more frequently in people from the center of the island, in addition to the southwest and southeast, including the island municipalities of Vieques and Culebra.
Dr. Carlos Mellado, who was also part of aid missions on the island, agreed that many people lacked their medications and could not go to pharmacies.
"We managed about 8,000 prescriptions," said the former Patient’s Advocate who channeled the orders through pharmacies around the island. The goal, he said, was that the drug was within 48 hours in the hands of patients.
The doctor warned that in the municipalities of Orocovis, Canóvanas, Aibonito, Morovis and Mayagüez they noticed many patients bedridden and with difficulties in accessing treatments and supplies, such as oxyge.
"In a center, there were more than 12 bedridden patients without oxygen. We also identified (in the missions) 42 dialysis patients without the service ... There must have been deaths (related to that)," he said.
Although the doctor said he doubted whether the number of deaths associated with Hurricane Maria was as high as it has been estimated in several instances, he acknowledged that the most affected ones were patients with chronic conditions, such as obstructive lung diseases and diabetes, among others.
"I remember that, in a neighborhood we visited, there was a patient with parenteral nutrition (intravenous administration of nutrients) and, as there was no electricity, we had to teach them (his relatives) how to do it manually ", he said.
Planning without data
Josué González Ortiz, attorney for the local chapter of the American Civil Liberties Union (ACLU), said that it is practically impossible to delineate preventive policies that minimize deaths during natural disasters, without accurate data showing the Island's vulnerabilities.
"Public policies related to disaster management cannot be established without a serious strategy to have transparent information," he said.
González Ortiz agreed that it was to be expected that the number of deaths related to Hurricane María would be much higher than what was announced by the government.
"It does not surprise me. Firstly, because of the strong atmospheric event and because the response of the government, during an economic and political crisis, was disastrous. That had a lot to do with the level of Puerto Rican deaths (after the cyclone)," said the lawyer, criticizing the lack of transparency in addressing the issue.
The Demographic Registry released the data after the San Juan district court ordered the disclosure of the information, thus resolving lawsuits filed by CNN and the Center for Investigative Journalism (CPI, Spanish acronym).
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