Hurricane Maria claimed the lives of 4,645 people in Puerto Rico past year and not the 64 long pegged by the island's government as the official death toll, according to a survey of thousands of residents by a research team led by Harvard University.
A Harvard study say Hurricane Maria likely killed thousands of Puerto Ricans more than the official estimate.
The study explained that every disaster-related death in Puerto Rico has to be confirmed by the Institute of Forensic Sciences.
Researchers surveyed some 3,299 randomly chosen households across the island to get an independent estimate of what it called "all-cause morality" after the hurricane, including information about displacement, infrastructure loss and causes of deaths.
"Our estimates are roughly according to press stories that evaluated deaths within the first month after the hurricane", it added.
The Harvard survey, however, is the most comprehensive, with over 3,000 households surveyed across the island. Respondents were also asked about deaths within a 5-minute walking distance of their homes.
Researchers said that the numbers are still not precise, and more research will be conducted.
"Statistically, it's like having interviewed the whole island", he said.
VanLandingham points out the death toll difference shouldn't necessarily indicate any intentional misdirection.
The Puerto Rican government stopped publicly disclosing its hurricane death figures in December. Researchers concluded the final death count could be as high as 8,500.
This time, they calculated that there were about 5,740 excess deaths after Hurricane Maria, though it could have been as low as 1,506 or as high as 9,889.
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Boston Medical Center psychiatrist Dr. Lisa Fortuna - a Puerto Rico native who witnessed the dire aftermath of Hurricane Maria previous year - said the new numbers come as no surprise. Harvard's independent review of the number of deaths in Puerto Rico will not be the last of its kind; in fact, George Washington University researchers were recently given the green light for a similar review.
"Both studies will help us better prepare for future natural disasters and prevent lives from being lost", Mercader said.
The situation in Puerto Rico is dire, but it is not entirely isolated.
Researchers wrote that health care disruption in the USA after Hurricane Katrina, Superstorm Sandy and hurricanes Harvey and Irma were also a major contributor to storm-related deaths.
"These difficulties pose substantial challenges for the accurate and timely estimation of official all-cause hurricane-related mortality", the report says.
One was Quintín Vidal Rolón, 89, who died in a lantern fire that relatives said occurred because of the storm; Vidal was using the lantern because he didn't have electricity.
That government figure-64-had been thought by many experts to be unrealistically low.
Natalio Rodriguez Lebron, 77, for example, died in Maunabo, Puerto Rico, in January.
If a member of the family was reported lacking however not recognized to be deceased, researchers counted them as alive.
To come up with a more realistic number, they turned to a community-based survey methodology and grouped the island's 900 barrios into eight categories based on their location and remoteness.
"We are a country used to hurricanes usually we are very prepared for that kind of situation", he said.