Puerto Rico’s Actual Death Toll

The funeral for a 58-year-old man in Utuado, P.R., who took his own life three weeks after Hurricane Maria. His family says he was mentally ill and unable to get needed medical attention in the storm’s aftermath. Credit Mario Tama/Getty Images

Early last month, President Trump visited Puerto Rico on a trip designed to signal the federal government’s recognition of the unfolding catastrophe from Hurricane Maria. When the hurricane crashed into Puerto Rico on Sept. 20, it cut off electricity to nearly all of the island’s 3.4 million residents, destroyed 80 percent of the agricultural supply, knocked out cellular phone service, blocked roads, decimated homes and left at least 1.7 million people without potable water.

Such extensive breakdowns in what engineers call “lifeline systems” would have been devastating in any American state or city. Puerto Rico, a bankrupt commonwealth where nearly half of all residents live below the poverty line and some 650,000 are age 65 or older, was especially vulnerable.

But instead of pledging support for a large-scale emergency relief plan, Mr. Trump declared that Hurricane Maria was not a “real catastrophe” and complained that the storm had “thrown our budget a little out of whack.” He announced that the official death toll from the hurricane, merely 16 at the time, was the true measure of the government’s response. “We saved a lot of lives,” he boasted, and then flew back home.

The statements were stunningly tone deaf. Morgues and funeral homes were calling for help dealing with the bodies piling up around their facilities. Scores of people who lived and died alone were sure to be discovered when roads reopened. Nearly everyone, regardless of class or status, was stranded, suffering and afraid. But federal officials, following Mr. Trump’s lead, continued to insist that the mortality level was minuscule.

Now that narrative has collapsed. On Thursday, Puerto Rican officials announced that 472 more people died there in September 2017 than in September 2016. That figure, which epidemiologists call the excess death toll, is a more reliable measure of the disaster’s human impact than the initial figure of 16 that Mr. Trump cited, because it includes cases that medical examiners could not process in the immediate aftermath of the storm.

In theory, it’s possible that the excess death toll will go down when October’s mortality statistics come in; perhaps Hurricane Maria killed mostly people who would have lived only a few weeks or months anyway. But the record from similar disasters suggests that this is unlikely. It’s far more likely that Puerto Rico experienced another spike in deaths during October, when, thanks to Mr. Trump’s refusal to support a major federal relief effort, power, water and food remained in short supply.

Counting the deaths from disasters is often politically contentious, and Mr. Trump is hardly the first public official who has been quick to underestimate the toll. In July 1995, Chicago endured a devastating heat wave. As in Puerto Rico, hundreds of bodies piled up at the morgue, and the medical examiner warned that the city would soon discover hundreds more in private homes. But rather than declare a heat emergency, Mayor Richard M. Daley questioned this scientific accounting. “Every day people die of natural causes,” he insisted. “You cannot claim that everybody who has died in the last eight or nine days dies of heat.”

Mr. Daley’s public relations strategy led to a failed public health response. Ultimately, epidemiologists confirmed that 739 people in excess of the norm died during the week of the disaster. How many lives might the city have saved had it immediately acknowledged the crisis and thrown all its resources into an urgent response? We’ll never know.

Unlike the 1995 Chicago heat wave, Hurricane Maria is a continuing disaster. At this point, it’s clear that there is nothing natural about the mounting public health crisis and that the federal government is compounding the problem through malign neglect. Puerto Rico urgently needs a sweeping infrastructure rebuilding project — not only to restore its power, water and communications systems, but also to prepare it for the next set of extreme weather events that our ever-warming world will doubtless deliver.

On his visit to Puerto Rico, Mr. Trump witnessed the physical devastation and human suffering in person. He extended his hand, not to help those in need, but rather to pat himself on the back. Every day since then, he and Congress have chosen to ignore the carnage in Puerto Rico. Some of that blood is on their hands.

Eric Klinenberg, a professor of sociology and the director of the Institute for Public Knowledge at New York University, is the author of Heat Wave: A Social Autopsy of Disaster in Chicago.

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