Hurricane Maria killed at least 4,645 people in Puerto Rico, a study estimates

Hurricane Maria and its chaotic aftermath in Puerto Rico led to at least 4,645 deaths, according to a new estimate based on household surveys. That’s thousands more than the 64 official storm-related deaths counted from death certificates.

The Category 5 storm hit the U.S. Caribbean territory on September 20, 2017, bringing down trees, houses and the electricity system. From then until December 31, the death rate rose 62 percent compared with the same time period in 2016, researchers report online May 29 in the New England Journal of Medicine.

A third of those deaths resulted from delayed or interrupted medical care, the researchers found. Residents most commonly reported that they weren’t able to get medications. Damaged roads and closed medical facilities also disrupted health care, as did the loss of power, which shut down respiratory equipment and dialysis machines.

Puerto Rican officials tallied 64 deaths from the storm, relying on medical examiners to attribute cause of death. But investigations by other researchers and some media organizations had estimated that there were more than 1,000 hurricane-related deaths. The new study took a community-based approach, querying 3,299 randomly selected households from January 17 to February 24 about deaths and medical care delays as well as disruptions to water, electricity and cell phone services.

With the Atlantic hurricane season beginning again in June, “it will be critical to review how disaster-related deaths will be counted, in order to mobilize an appropriate response operation and account for the fate of those affected,” the researchers say.