Blood on Shameless Hands

While most of the media was fixated on ABC canceling the Roseanne revival show over its star, on Tuesday, May 29, 2018, the New England Journal of Medicine released a study by Harvard and other institutions suggesting that Hurricane Maria’s ultimate fallout was over 4,600 “excess deaths” Between September 30 and December 31, 2017. This is twice the mortality of Hurricane Katrina and makes Maria the deadliest disaster on US soil for more than a century. The only other US disaster with a higher death toll was the Galveston, Texas hurricane which resulted in 6,000-12,000 people dead. Yet, the real tragedy here is that these deaths were largely due to delayed medical care as well as lack of necessities such as electricity, water, and cellphone service. Nevertheless, this new finding stands in stark contrast to the government official count of 64 which is a gross underestimate that has remained unchanged for months. But the new research validates previous analyses of mortality data and reports from the ground by journalists and other researchers who found the death count well above 1,000.

When Donald Trump visited Puerto Rico nearly 2 weeks after the storm hit on October 3, 2017, the official death count was just 16, compelling him to insist that Puerto Rico wasn’t a “real catastrophe” like Hurricane Katrina. As he said, “Everybody watching can really be very proud of what’s taken place in Puerto Rico.” But since then, multiple media outlets have found evidence of hurricane deaths not included in the official death count. These investigations prompted members of Congress to request an audit of the hurricane deaths and led social science researchers to take a closer look at the data. In December, they published an analysis of mortality data from the Puerto Rico Vital Statistics System to compare the historical death averages for September and October deaths that year. They found that the storm death rate was closer to 1,085 while a New York Times analysis of similar data found the death toll being 1,052.

The latest study shows that even these estimates were very low. This makes sense since these studies relied on the Puerto Rican government which provided an unreliable mortality picture in the months after Hurricane Maria. With George Washington University’s help, the government’s recount of the death toll is still in the works leaving the people of Puerto Rico a long way from closure from Hurricane Maria. Now they’re preparing for the 2018 hurricane season set to begin on June 1, even as thousands of Puerto Ricans are still without power. As disasterologist Samantha Motano tweeted, “We have the technology to see them coming. We know how to mitigate and prepare for disasters. The United States has the money to prevent these deaths. We are choosing not to act.”

To come up with this new estimate, the NEJM researchers surveyed some 3,300 randomly chosen Puerto Rican households in January and February. They asked each one about deaths in their family between September 30 and December 31, 2017 and factors that might’ve contributed to them. They also asked about damage to their homes, whether they were displaced, and if they had access to food, water, healthcare, electricity, and cellphones. The researchers then compared the results with the island’s official death statistics from 2016 and found a 62% increase in the mortality rate in 2017, which added up to an estimated 4,645 deaths linked to Hurricane Maria (ranging from 793 to 8,498 deaths). About 1/3 of these deaths were attributed to delays or interruptions of healthcare, which in many cases was due to widespread power outages across the island for weeks and months after the storm knocked out 80% of the island’s power grid. And they wrote that the total death estimate “is likely to be conservative since subsequent adjustments for survivor bias and household-size distributions increase this estimate to more than 5,000.”

Obviously, a survey like this has its limitations. There’s always some inherent bias in who volunteers to participate and who doesn’t. Not to mention, we have possible bias in people’s memories of events. But it’s certainly the most exhaustive attempts so far to quantify Hurricane Maria’s death toll. And according to Puerto Rican demographer Alexis Santos, the study’s methodology was consistent with how other scholars have tried to measure the death counts as he told Vox, “Under the level of devastation experienced following Hurricane Maria it is very difficult to separate deaths from the environmental or contextual conditions, one may even say that Hurricane Maria impacted all of the deaths that occurred during that period. That is why approaching it through the perspective of excess deaths provides a figure that excludes the deaths that would have happened under normal conditions.”

Puerto Rico’s government has stopped sharing mortality data with the public in December 2017 and refused to provide it to researchers who conducted the study without its help. But the lack of transparency is no surprise since it’s been a key factor in the inaccuracies surrounding Hurricane Maria’s deadly impact. At the same time, Governor Ricardo Rossello ordered a death recount which public health researchers at George Washington University are doing right now and is still underway. But his office did respond to the NEJM report with this statement: “As the world knows, the magnitude of this tragic disaster caused by Hurricane Maria resulted in many fatalities. We have always expected the number to be higher than what was previously reported. That is why we commissioned The George Washington University (GWU) to carry out a thorough study on the number of fatalities caused by Hurricane Maria which will be released soon. Both studies will help us better prepare for future natural disasters and prevent lives from being lost.”

Of course, suspicion will remain for years between Donald Trump’s habit of weaponizing anti-Latino hysteria as his political centerpiece and the unfolding of an essentially unprecedented human tragedy in a Spanish-speaking US territory. Sure we can’t dismiss that Trump and his team simply don’t know what they’re doing. But Hurricane Maria’s impact on Puerto Rico is the only real crisis we’ve had to see Trump wrestle with which has been a total fiasco with a high human cost.

Puerto Rico’s catastrophe has a 3-fold origin. First, the situation is objectively difficult since Hurricane. Maria was a large storm. But before then, Puerto Rico’s infrastructure was shitty and its economic conditions were unfavorable. Second, under Donald Trump’s “leadership,” the federal government wasn’t prepared for the hurricane and failed to properly place supplies and provide full use of military assets. And last, Trump was never willing to admit that the initial response went poorly and try to improve. Being the narcissistic sociopath he is, admitting wrongdoing and taking responsibility isn’t part of who Trump is. Because as far as he’s concerned, such actions are for losers. So instead, he resorted to defensiveness and counterpunching. Last fall, he wasted no time turning a disaster response into a culture war pitting heroic first responders against indolent Puerto Rican officials. On September 30, 2017, he tweeted: “The Mayor of San Juan, who was very complimentary only a few days ago, has now been told by the Democrats that you must be nasty to Trump. …Such poor leadership ability by the Mayor of San Juan, and others in Puerto Rico, who are not able to get their workers to help. They…. …want everything to be done for them when it should be a community effort. 10,000 Federal workers now on Island doing a fantastic job.”

Obviously, this didn’t convince any skeptic that Donald Trump was handling the disaster well. More like far from it, in fact. But it did accomplish what Trump is good at while cornered: driving politics back to the baseline question of how you feel about the guy overall. Soon enough, the news cycle moves on. However, this made no difference and is the wrong way to respond to a natural disaster crisis. The recovery itself didn’t move particularly quickly either. On average, Puerto Ricans went 84 days without electricity, 68 days without water, and 41 days without cellphone coverage after Maria. That long-term persistence of lethal conditions is how we ended up with thousands dead from a storm that, by the official count, killed “only” 64 people through direct damage. But that wasn’t on the TV news, so Trump didn’t care. As the study’s authors wrote on the revised death toll, “These numbers will serve as an important independent comparison to official statistics from death-registry data, which are currently being reevaluated and underscore the inattention of the U.S. government to the frail infrastructure of Puerto Rico.”

While Donald Trump and his administration aren’t entirely responsible for the Hurricane Maria disaster. But it will be difficult, perhaps impossible, to assess how much it had to do with the federal government’s indifference or ineffectiveness, how much it was the current Puerto Rican officials’ fault, and how much was the effects of long-term Puerto Rican poverty and structural conditions. In any case, Caribbean assistance and recovery weren’t going to be easy since Maria would’ve been devastating under the best of circumstances. Even so, Trump’s reaction was terrible. He picked fights with local government. And he focused more on congratulating himself than doing something worth bragging about while visiting the island. Worse, he didn’t follow up. Puerto Rico and the Virgin Islands simply vanished from his public statements and there’s no reporting to indicate anything was different behind closed doors. There’s no record of FEMA officials or anyone else being summoned to the White House and urged to do more. No evidence of high-level White House coordination of efforts from various agencies involved such as they were. In fact, even the best reporting on the government response shows it was botched from the beginning. As the government went all out to assist Houston, not Puerto Rico.

Donald Trump’s failure to act is extremely important because without presidential involvement, executive branch departments and agencies aren’t likely to mobilize despite that many people involved are professionals who care deeply about doing their jobs well. We’ve seen other times the effects on agencies when they know they have to answer to the president. If a Homeland Security secretary knows she’ll have to make a daily report to the president on what he department did about any acute problem, she’ll make sure she has an answer. And that’s exactly when bureaucrats find solutions for intractable problems. When a president declares something mission accomplished and moved on, then even a disastrous continuing situation slides down the list of priorities. This is especially true for the Puerto Rican people’s urgent needs who don’t have their own congressional representatives to put pressure on those agencies. If the impetus doesn’t come from the president, it’s not going to happen. Thus, the best long-term solution for the island probably is statehood, but that won’t help Puerto Rico right now. Though it would be a fitting consequence of the failure to help these citizens when they needed it the most.

Unlike Barack Obama, Donald Trump was lucky to inherit a stable and improving an economic system thanks to a competent, conventional Federal Reserve policymaking. There have been no domestic terrorist attack or major wars. So we should be grateful for the baseline conditions of peace and prosperity. But where Trump’s tested, he’s failed bigly. In the diplomatic crisis between Qatar and the United Arab Emirates, Donald Trump’s decision making is largely driven by his various corrupt associates’ personal financial interests. He’s left the US isolated on Iran while gaining nothing. He’s focused on the atmospherics of a potential summit with Kim Jong Un on Korea while leaving US allies baffled on who’s making decisions and why. The opioid crisis has apparently gotten worse in 2017 and shows no sign of abating.

The carnage in Puerto Rico illustrates the most severe manifestation of Donald Trump’s presidential unfitness despite being far from the only one. Yet, the media focus on Donald Trump’s various antics has the unfortunate tendency to detract from the basic reality that he doesn’t put in the time or the work to solve problems when that’s really the issue’s core. Put a telegenic demagogue in office, you’ll get some memorable demagogic moments that’ll boost news ratings. But you won’t get an adequate hurricane response, meaning a sky-high death toll as a result. For some Americans, Trump’s constant stream of invective and controversy is just another form of reality television. Except that it’s not unless you’re making comparisons to the Hunger Games, which involved people actually killing each other in a post-apocalyptic hellscape. However, frighteningly so, Trump isn’t a reality TV star anymore but an elected official with real and important responsibilities that he shirks on a regular basis. What he does or doesn’t do has huge practical consequences for all Americans, which will be negative for most of us. And sometimes those consequences are the difference between life and death as what went on with Puerto Rico in the wake of Hurricane Maria. To hear about the deaths of 4645 people in any disaster would be heartwrenching enough for any president to hear. But Trump doesn’t care and as long as he’s in office our country’s problems won’t get better and more likely exacerbate in the years to come.

The Catastrophe in Puerto Rico


On Wednesday, September 20, 2017, the powerful Category 4 Hurricane Maria made direct landfall on Puerto Rico, ravaging the entire island with its 150 mph winds and drenching it in a few feet of rain. Save for generators powering only the highest priority buildings like hospitals. In many places there’s no fresh water you can drink, bathe, or use to flush toilets. Food, fuel, and cell service is limited. Reaching remote towns and villages takes several days for reporters and rescue workers. Due to strained communications and severe road damage, the extent of Maria’s damage on the island isn’t yet known. Though photos show who communities flooded streets, houses with torn roofs and second floors ripped apart, people waiting in long lines for clean water and fuel, and a severely crippled infrastructure. Even for Puerto Ricans living in intact houses, survival will be difficult in the weeks and months ahead. Thus, the aftermath of Hurricane Maria has been a humanitarian catastrophe. for the 3.4 million people on Puerto Rico.


The 2017 hurricane season has been punishing for the island. Hurricane Irma had ravaged several Caribbean islands and left 1 million Puerto Ricans without power. 60,000 on the island were still without electricity when Maria hit 20 days later. Though Maria was a slightly smaller storm, it was far more devastating charted a course directly across Puerto Rico where it hit near peak intensity and passed around 25 miles from its capital San Juan. No landmass could suffer such a direct hit without at least some damage. According to the record books, Maria was the 5th strongest storm to ever hit the US and the strongest to hit the island in 80 years.


This disaster deserves more coverage and a swifter response. But so far, federal government recovery efforts have been inadequate at best. In some ways this is understandable since few major news organizations have a full-time regular presence on the island. Also lack of wi-fi and cellphone service have hurt local journalists’ ability to report the news from there. But even a communications blackout is no excuse for Puerto Rico’s virtual absence from news coverage in favor of protesting football players and Donald Trump’s latest incendiary Twitter tantrums. Nonetheless, if this kind of devastation happened in mainland United States, you’d see round the clock news coverage from all the cable news channels for days. You’d see the affected states’ congressional delegation appear on major news networks making sure the American public knows and pressuring the president, House, and Senate leaders to take immediate action.



As a US territory, Puerto Rico doesn’t get electoral votes in general presidential elections or representation in Congress. But Puerto Ricans have been US citizens since President Woodrow Wilson signed the Jones-Shafroth Act in 1917. They can travel to the continental United States without a passport and vote in presidential primaries. They’re also protected by the same Bill of Rights as anyone else in the United States. But more importantly in Maria’s wake, Puerto Ricans are entitled to the same federal government response as state residents should a natural disaster like Hurricane Maria arise on their soil. However, though the US has long benefitted from its island territories’ geographical reach, it has taken them for granted and denied their residents full political representation. Hurricane Maria illustrates that this two-tiered system of American citizenship is neither democratic nor tenable to territorial residents. And to make matters worse a survey from the New York Times reports that only 54% of Americans know Puerto Ricans are US citizens.


Though powerful storms often devastate communities, the true catastrophe was long in the making. Puerto Rico was no different regarding Hurricane Maria. Despite a $103 billion economy, we all knew that Puerto Rico’s government is broke and can’t borrow money to fix it. In fact, the island declared bankruptcy in May and has been trying to restructure more than $70 billion in debt. Thus, even on a good day, its infrastructure is aging and in disrepair. Certain US policies have also contributed to Puerto Rico’s economic deterioration. One is the antiquated Jones Act forcing Puerto Ricans to pay nearly double for US goods through various tariffs, fees, and taxes. The act stipulates that any goods shipped from one American port to another must be on American made and operated ships. Thus, thanks to little competition among freighters, shipping to Puerto Rico is costlier. As former New York State Assembly member Nelson A. Denis noted in The New York Times, “a shakedown, a mob protection racket, with Puerto Rico a captive market.” Economic woes have also contributed to over 8% population loss from 2010. However, since the island’s per capita income is $18,000 (which is half of Mississippi’s), its cost of living is 13% higher than 325 urban areas elsewhere in the US, it’s not much of a surprise. The population drain makes it harder for Puerto Rico’s economy to recover. And as people will likely migrate due to the storm, recovery will be more difficult.


As Puerto Rico is an island, recovery efforts are more complicated since supplies has to be flown in or shipped over. Residents can’t drive to nearby states or cities for shelter to wait out the worst of it. Here’s a rundown on some of the major problems on the island.


Electricity: The island’s electric company PREPA has a massive $9 billion in debt and defaulted on an interest payment in July. So it doesn’t have the money to modernize its electrical systems. Even without hurricanes power outages are common. To make matters worse, there aren’t enough workers on the island to fix the infrastructure. Mostly because young people have been leaving in droves since the economy tightened while older workers have retired en masse to secure their pensions.

Hurricane Maria has knocked out 80% of the island’s power transmission lines and as of yesterday, 1.57 Puerto Ricans were still without power. Though generators are being distributed most of them are prioritized to hospitals while most homes and businesses are dark. It could be 4-6 months before power is fully restored on the island. So you have Puerto Rico’s 3.4 million residents relying on generators for half a year. That means half a year that electrical pumps can’t bring running water to people’s homes. Half a year people will have to make do without air conditioning in a tropical climate. Without power, even the most basic tasks of modern life become difficult.

Taken these factors together, rebuilding Puerto Rico’s power system will be a long and difficult process. According to the New York Times, getting power back on the island “will be daunting and expensive” for “Transformers, poles and power lines snake from coastal areas across hard-to-access mountains. In some cases, the poles have to be maneuvered in place with helicopters.”


In a disaster situation, health hinges on electrical power and it’s extremely important to get it going to suppress chances of illness. Dialysis, refrigeration for insulin and other medicine, and nebulizers for people with asthma all need electricity to be useful. But electricity also provides for sanitation that prevents many illnesses like typhoid from spreading in the first place. Puerto Ricans need power to run their air conditioning systems and get clean water from the faucet. Without it, people could get sick from dirty water, can’t dispose waste, and suffer from heatstroke. Mental health can also suffer those without access to rapid opportunities for recovery with residents suffering from depression and post traumatic stress disorder.


Water: No electricity means no power to pump water into homes and no water to bathe, drink, or flush toilets. According to FEMA, 42% of Puerto Ricans are without potable water. One town’s only source of fresh water was a single fire hydrant. Though rescue workers have been distributing bottled water, it’s safe to say that many people haven’t received any yet.

Fuel: Without a working electrical grid, Puerto Ricans must turn to gas-powered electric generators for energy. But it’s so difficult getting fuel on the island that people could wait over 6 hours for gas if they’re lucky. Other stations are completely out of fuel and have been for days. According to NPR, while authorities don’t believe there’s a gas shortage on the island, they’ve claimed Hurricane Maria has disrupted distributing it. But when fuel runs low, lives are endangered. In the central eastern town of Juncos, the Washington Post reported on a diabetic woman afraid that the refrigeration keeping her insulin preserved will soon run out and there won’t be fuel to restart the generator.


Cellphone Reception: Hurricane Maria knocked out 1,360 out of the island’s 1,600 cellphone towers, isolating many communities from the outside world for days and relying only on radios for news. National Guard members told the Daily Beast they struggled communicating on the ground, which has made their ability to respond to the disaster exceptionally hard. The cellular outage also means that a mainland or abroad Puerto Rican family can’t get in touch with those on the island to find out if they’re safe.
Weather Radar: On Monday, September 25, the National Weather Service reported that its Doppler radar station on Puerto Rico was destroyed. If you don’t know, that’s the radar that helps meteorologists see where thunderstorms and other weather systems move in real time. Without it makes future storms more hazardous.

Mountain Top Mayday

Hospitals: According to FEMA, 59 out of 69 Puerto Rican hospitals are “operational with unknown status.” Many now run on generators but there are serious issues with distributing fuel so access to X-ray machines and other diagnostic equipment remains limited. There are few open operating rooms despite an unsurprising influx of patients with storm-related injuries. San Juan’s mayor reported that two people died due to lack of diesel in the hospital they were. And San Juan is among the better places to be in Puerto Rico right now. Still, if power isn’t restored, Puerto’s health crisis will get worse. After all, electricity is involved with almost every interaction with the health system. For you need power to call a hospital, access electronic records, and running lifesaving equipment like hemodialysis and ventilators.

Farms: Agriculture only contributes 0.8% of Puerto Rico’s GDP and employs 1.6% of its labor force. But within hours Hurricane Maria wiped out 80% of its crop value which amounts to a loss of $780 million. Though the island imports 85% of its food, its agriculture sector’s destruction will increase prices and exacerbate the scary prospect of continued food shortages.

Airports: Puerto Ricans have had a difficult time getting off the island. Though San Juan’s Luis Munoz Marin International Airport reopened to commercial flights on Sunday, September 24, they can expect to wait a long time in uncomfortable conditions if they want a flight. There’s no air conditioning. Ticketing computers are out. And due to FAA radar damage, only a limited number of planes take off from San Juan each day while hundreds of flights have been canceled.


Though Puerto Rico has received government relief, response is still badly inadequate especially as relief supplies wait on the island’s shipping docks. Even as we speak, millions remain without food, water, electricity. And they have no means of getting help. However, instead of doing everything he could to help Puerto Rico, Donald Trump goes golfing in New Jersey. Only to take a tweeting break to attack San Juan Mayor Carmen Yulín Cruz on Twitter just for speaking out for her people and calling out FEMA for patting itself on the back while the island was still ravaged when Hurricane Maria hit. Disease outbreaks have begun due to murky water and packed shelters. Residents have shown signs of Zika, Dengue, conjunctivitis, cholera, hepatitis A, meningitis, and salmonella. Now Trump says that Puerto Ricans are lazy and want everything done for them. Like they should help themselves instead of asking for a handout. Local officials in Puerto Rico are doing everything they possibly can with the limited help they have. Far from showing “poor leadership” Mayor Cruz has been there for her city almost 24/7 with little to no rest, doing whatever she could. But she knows she doesn’t’ have the resources like the federal government has like FEMA under her thumb. She shouldn’t have to beg for that response for it should’ve arrived already. It’s a shame that she has to beg a man for help who is more likely to step on your hand and leave you to drown when you’re reaching to him to lift you into his yacht. Or at least give you a lifesaver to hold. Of all the things Trump has said and done, letting millions of people suffer for days without adequate response just breaks me. Mayor Cruz wasn’t asking for a handout like the welfare recipients conservatives constantly unfairly demonize. She was asking for a lifesaver because people are dying and Puerto Rico is drowning. The island’s residents are utterly helpless and without help soon, many will die if they haven’t already. But up golfing in New Jersey, Trump tells Puerto Ricans to eat cake without any second thought to their dire suffering. Even George W. Bush’s response to Katrina was better than this.


It breaks me more that people in my own family, neighborhood, and community will find some way to defend and support this unrespectable man no matter what he does which I feel is so morally indefensible as a Catholic, liberal, and American in that order. I have no capacity to respect Donald Trump as neither a person nor as an authority figure. To have him as president of the United States is absolutely humiliating for I’m deeply convinced that Trump is a narcissistic sociopath doesn’t believe in America, the Constitution, or in any concept of democracy. He is a total failure as a human being, let alone a president which doesn’t surprise me. But I find his cruelty utterly gut wrenching to the point of inhumanity. Hurricane Maria devastated Puerto Rico but Trump’s lack of interest in the island’s plight has resulted in very serious consequences. The people of Puerto Rico deserve better than what they’re receiving. So you’re Donald Trump and you’re reading this, then to quote Lin Manuel Miranda, “You’re going straight to hell.”