The NEJM study offers one thoughtful, evidenced-based answer to a question that has lingered like subtext since last September: How many people in Puerto Rico died as the result of Hurricane Maria? Researchers then compared the post-Maria death rate to that of the previous year and found that the mortality rate was 14.3 deaths per 1,000 residents from September 20 through December 31, 2017, a 62 percent increase compared with 2016, or 4,645 "excess deaths". The post-hurricane deaths within these households were compared with the mortality rate of the same period of time in 2016.
Researchers at the Harvard T.H. Chan School of Public Health, however, surveyed more than 3,000 households on the battered island.
If a member of the family was reported lacking however not recognized to be deceased, researchers counted them as alive.
Cobra in October 2017 received a 120-day, $200 million contract to begin emergency work in Puerto Rico to help restore power following Hurricane Maria.
The official death toll in Puerto Rico related to Hurricane Maria has always been a controversial topic.
The study found that the delay or interruption of medical care in the months after the hurricane was the No. 1 cause of death.
Some in St. Maarten too wondered openly whether the low casualty count from Hurricane Irma two weeks earlier hadn't been rather unrealistic. It captures the number of deaths the medical examiner attributed directly to the storm - the high water and howling winds in the worst natural disaster on record for the US territory.
Gathering data on Puerto Rico's death counts has been a contentious and hard task.
Now, as residents along the Atlantic are gearing up for another season that the National Oceanic and Atmospheric Administration predicted last week to most likely be near-normal or above-normal, the Puerto Rican government says it's better prepared to confront upcoming storms.
The researchers said the number was conservative and that the death toll likely exceeded 5,000.
Both key services were only gradually restored and some parts of the island still don't have electricity months later.
HARRIS: She says it complements the official method, which usually relies on medical examiners who view bodies and determine the cause of death.
Such mortality would far outstrip the 1,833 who died in Hurricane Katrina in 2005, belying President Donald Trump's boasts about the low death toll of the storm that occurred on his watch. Once again, thousands of people lost their lives because of it.
The research was published online in the New England Journal of Medicine. A proper and timely count of deaths should make it easier to get aid to survivors - and perhaps prevent secondary deaths owing to a lack of doctors, hospitals and medicines.