A new reminder that we may never know Hurricane Maria’s full toll on Puerto Rico

It has been more than a month since Hurricane Maria made landfall in Puerto Rico. A little less than three-quarters of the island still lacks electricity; earlier this week, the island’s former governor shared a photograph of surgeons performing an operation by the light of their cellphones.

Let’s assume a worst-case scenario for a patient who is being treated under such conditions. Power is out because of Maria, but, should something go wrong during that surgery, does Maria bear the blame? It’s easy to tick off a number of qualifying conditions that would need to be considered: The original condition, what went wrong during the surgery, etc. But this is an example of where data on fatalities in Puerto Rico post-Maria get blurry. Each death is unfortunate, but which deaths might not have happened if Maria had never come ashore?

We looked at this question earlier this month, speaking with Joe Trainor of the University of Delaware’s Disaster Recovery Center.

“The long and short of it is, no matter what system exists, there’s a lot of gray involved in how you will attribute any specific death during this time period,” Trainor said, “whether you decide it’s directly or indirectly related to the event itself.” Getting hit by a tree branch during hurricane-force winds is one thing. Being unable to immediately get medicine for a chronic condition and dying weeks later? That’s another.

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Why does that tally matter? A number of reasons, but perhaps the most immediate is that President Trump, during his visit to the island, praised the low death toll (at that point, 16) as an indicator of how much less devastating Maria was to Puerto Rico than Hurricane Katrina was to New Orleans in 2005. (By extension, Trump was saying that his handling of Maria was better than President George W. Bush’s of Katrina.) Since that visit, the official total has risen to 51.

On Friday, CBS News’ David Begnaud, who’s been doing exceptional coverage of the storm’s aftermath, relayed a statement he’d received from the spokesperson for the secretary of public safety on the island, the person responsible for the certified tally of deaths from Maria.

The statement:

“From the 20th of September to the 18th of October, the medical examiner [for the entire island] authorized 911 cremations of natural deaths. Keep in mind that not all the bodies of persons who died in Puerto Rico go to the medical examiner. But, by law, the medical examiner gives authorization for cremations. The medical examiner analyzes the death summary and the death certificate. If something is suspicious, they assign the case to the pathologist and they can stop the process. They can claim the body and/or call the families for an interview.”

That 911 people have been cremated suggests a death toll much higher than 51. But notice the caveat: “natural deaths.” Even had Maria not hit Puerto Rico, people would still have died from old age or car accidents or disease. The implication is that these 911 deaths fit into that category — and therefore shouldn’t be added to the total.

The question that arises is whether or not that total is abnormally high. If 911 is a lot of deaths for a normal month in Puerto Rico, it may indicate that some hurricane-related deaths are not being counted as such.

In 2014, the most recent year for which data were available, 30,152 people died in Puerto Rico. We know from an analysis of national fatality data compiled by ABC News several years ago that there are more deaths in the winter months, correlated to flu season.

Between 1995 and 2002, 8.5 percent of deaths in the U.S. occurred in October. If we assume the same distribution applies in Puerto Rico, that would suggest that some 2,500 people died on Puerto Rico in 2014. (The CDC did not provide specific figures to The Post by the time this article was published.)

In other words, 911 deaths in the month after the landfall would not be abnormally high at all.

We’re still left, then, with the question of where in the gray area those 911 deaths might fall. Part of the statement conveyed by Begnaud was obviously meant to tamp down speculation that the territorial government is covering up hurricane-related deaths by outlining the process by which questions get answered. The death toll is a political issue, but, then, it always is, as Trainor’s colleague Benigno Aguirre told us. Sometimes politicians want higher totals (in order to get more foreign aid, for example) and sometimes lower — as in the case of Trump and, presumably, some Puerto Rican officials.

We asked Trainor when we might have a final, accurate tally of precisely how many people died in the storm.

“The reality is,” he said, “we probably will never know.”

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