According to the Trump administration, Hurricane Maria killed 64 people; according to a careful, peer-reviewed study in the New England Journal of Medicine, the death toll was 4645.
The researchers used "a representative, stratified sample" of 3299 Puerto Rican households to estimate the likelihood of a death occurring in the absence of Maria and then used the actual deaths that occurred to compute the excess mortality.
The Trump administration arrived at its estimate by distributing paper towel rolls, guessing at how many would be needed to clean up after a tragic death, and then counting how many rolls were actually used.
Our results indicate that the official death count of 64 is a substantial underestimate of the true burden of mortality after Hurricane Maria. Our estimate of 4645 excess deaths from September 20 through December 31, 2017, is likely to be conservative since subsequent adjustments for survivor bias and household-size distributions increase this estimate to more than 5000. These adjustments represent one simple way to account for biases, but we have made our data publicly available for additional analyses. Our estimates are roughly consistent with press reports that evaluated deaths in the first month after the hurricane.8,29-33 Our estimates also indicate that mortality rates stayed high throughout the rest of the year. These numbers will serve as an important independent comparison to official statistics from death-registry data, which are currently being reevaluated,13,34 and underscore the inattention of the U.S. government to the frail infrastructure of Puerto Rico.
Mortality in Puerto Rico after Hurricane Maria [Nishant Kishore, M.P.H., Domingo Marqués, Ph.D., Ayesha Mahmud, Ph.D., Mathew V. Kiang, M.P.H., Irmary Rodriguez, B.A., Arlan Fuller, J.D., M.A., Peggy Ebner, B.A., Cecilia Sorensen, M.D., Fabio Racy, M.D., Jay Lemery, M.D., Leslie Maas, M.H.S., Jennifer Leaning, M.D., S.M.H., Rafael A. Irizarry, Ph.D., Satchit Balsari, M.D., M.P.H., and Caroline O. Buckee, D.Phil. et al/New England Journal of Medicine]
(Image: Mosaic 36, CC-BY)