What Donald Trump Is Ignoring About the Hurricane Maria Death Toll

According to the Trump administration, a small number of people died in Hurricane Maria. But experts disagree with the president. The Washington Post reports that in an apparent effort to cast doubt on a George Washington University study that concluded there were nearly 3,000 excess deaths on the island in the months after the storm, Donald Trump denied large-scale casualties from Hurricane Maria.

Trump tweeted that “3000 people did not die in the two hurricanes that hit Puerto Rico. When I left the Island, AFTER the storm had hit, they had anywhere from 6 to 18 deaths.” He also claimed that “if a person died for any reason, like old age,” the researchers would “just add them onto the list.” FEMA administrator Brock Long, similarly, said Hurricane Maria death toll numbers are “all over the place.” Long added, “It’s hard to tell what’s accurate and what’s not.”

But experts — even though they concede that the death toll is only an estimate — don’t seem to think it’s that difficult to tell. Here’s what we know about the Hurricane Maria death toll, and what the Trump administration is ignoring.

Puerto Rico’s official count is 2,975 deaths from Hurricane Maria

Donald Trump and Melania Trump arrive at the Muniz Air National Guard Base after Hurricane Maria hit the island. | Joe Raedle/ Getty Images

Vox reports that Puerto Rico’s official count of 2,975 deaths in Hurricane Maria “was calculated after months of painstaking analysis of death records and expected mortality rates by researchers at George Washington University at the behest of the governor of Puerto Rico, Ricardo Rosselló.” Trump falsely claimed that “this method was never done with previous hurricanes because other jurisdictions know how many people were killed.” To the contrary, Vox reports that this is the accepted method for determining the death toll:

The ideal way to calculate the death toll from a hurricane, disaster researchers say, generally, is to count all the deaths in the time since the event, and then compare that number to the average number of deaths in the same time period from previous years. Subtract the average number from the current number and that’s the death toll.

Trump seems to object to the updated number in part because the official death toll began at 16 and then went up to 64, where it remained for months. But people on the ground knew the figure was an order of magnitude too low, Vox reports. Which is why — in the absence of a reliable figure from the government — researchers and journalists attempted to calculate the “excess mortality” of Hurricane Maria. Rosselló commissioned the GWU study to enable the government to put out a more accurate death toll. But Trump now refuses to accept the official count because it exposes what The Atlantic characterizes as “the collapse of official systems and the disastrous response by multiple levels of government.”

Trump is ignoring the real impact of the disaster

As The New York Times reports, Donald Trump’s tweets betray his opinion that a disaster is “an event in a specific moment. If you died later because of the long-term effects of a hurricane, for instance, then to his way of thinking, your death should not be counted in the toll,” The Times explains. But that’s not how unbiased researchers approach the task of calculating a death toll from a disaster like Hurricane Maria.

Time reports that the number — 2,975 — highlighted in the GWU report represents deaths “in excess of what would have been predicted if there had not been a hurricane,” whether the physician filling out a death certificate says it was related or not.  That could include deaths caused by dangerous conditions encountered while evacuating, for example, or by disruptions to medical care caused by widespread and long-lasting power outages in Puerto Rico. (Such as kidney patients who couldn’t get treatment because their dialysis center didn’t have generator fuel or fresh water, as federal and local emergency plans classified dialysis facilities as a relatively low priority for emergency supplies.)

Guidelines by the Centers for Disease Control and Prevention (CDC) say that these deaths should be included in disaster totals. But the GWU researchers found that most physicians don’t have formal training in completing a death certificate and weren’t aware of the CDC’s recommendation. So by the researchers’ estimate, some 2,911 deaths (2,975 minus 64) should have been counted as storm-related, but initially were not.

Deaths weren’t just caused by winds or flooding

Time reports that an earlier study of Hurricane Maria deaths by researchers at Harvard University attributed thousands of deaths to “delayed or interrupted health care.” As Vox notes, Hurricane Maria knocked out 80% of the island’s power transmission lines, vulnerable due to years of neglect and fiscal crisis, in what would become the United States’ longest-ever blackout. As the response from FEMA “progressed painfully slowly, thousands of people went without power, adequate safe water, or medical care for months.

The Associated Press reports that thousands of people who died in Puerto Rico “could have been saved with standard medical treatment.” Disabled and elderly patients were discharged from overwhelmed hospitals with bedsores that led to fatal infections. People developed lung infections in the heat of nursing homes and state facilities. Others died of diseases transmitted by contaminated water, or when medical equipment failed, or due to complications from heart disease or diabetes. It doesn’t help that Puerto Rico’s health care system was in financial crisis going into the storm, and receives far less help from the federal government than it would if Puerto Rico were a state instead of a territory.

The AP explains, “This was a slow-motion, months-long disaster that kept Puerto Ricans from getting the care they needed for treatable ailments, even as President Donald Trump lauded his administration’s response.” The publication adds, “Along with post-storm conditions, each death has a complex mix of causes that can include serious pre-existing conditions and individual decisions by patients, caregivers, and doctors, making it difficult to definitively apportion blame in every case. But critics say many could have been saved by better preparation and emergency response.”

Hurricane Maria’s death toll isn’t the most important fact

Time also notes that death tolls aren’t the most meaningful piece of information about a disaster. That’s especially true if, like the Trump administration, you look at a disaster as a single, isolated event to downplay its impact. The New York Times reports that “We will never understand why some people are vulnerable and others aren’t if the focus is only on a disaster as an event. Nor will we comprehend why some communities recover quickly while others languish.”

Though the Trump administration doesn’t want to take responsibility for its response to the natural disaster, The Conversation reports that Hurricane Maria was “partly a human-made disaster.” Most of Maria’s fatalities were caused by the failure of the U.S. disaster response system. And as The Conversation notes, “Disasters can be particularly devastating for those with poor access to government services, lower incomes, or living further from population centers. Many Puerto Ricans fit all three conditions, and most fit at least one or two.”

Even accurate fatality counts don’t capture the true extent of the disaster, which is still unfolding in Puerto Rico and will affect many survivors for the rest of their lives. Increased levels of disability, higher incidences of malnutrition, homelessness, lower school participation, mental health consequences, and other effects “leave both the individuals and their communities worse off,” The Conversation reports. Trump accounts for none of that.

Read more: These Photos Show How Much Damage Hurricanes Leave Behind

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