JAYUYA, PUERTO RICO — The Puerto Rican government’s official tally of people who died as a result of Hurricane Maria appears to be widely undercounted.
Funeral home directors in two small, largely forgotten towns in the US territory’s interior, Jayuya and Utuado, told BuzzFeed News they have received significantly more corpses as a result of the storm, which made landfall 18 days ago, than the number the government has so far counted in a “certified” tally for those areas. Four funeral homes in San Juan said they have dozens of bodies, but two said they don’t think the deaths are storm-related.
The death toll took on increased symbolism last week when President Trump visited the island during a photo op tour to claim the recovery was “fantastic.” Sitting next to Puerto Rico Gov. Ricardo Rosselló, Trump gloated that the death toll was low when compared to Hurricane Katrina 12 years before — "Sixteen people versus in the thousands." Hours later, Rosselló increased the number of dead to 34. It’s now at 36. And there are reports it’s up to 39.
The actual death toll has also become a major point of speculation on social media. And elected officials and people are saying people have buried storm victims on their own without the government knowing. The Center for Investigative Journalism reports hospital morgues are “at capacity.”
There could be many explanations. Rosselló has said the lack of power — about 95% of the US territory, whose residents are US citizens, remain without electricity — is hampering communication with the local authorities.
It could also be that local medical and funeral home officials and residents, still wading through the storm’s aftermath, are burying the dead without being approached by the state government or without notifying the state government themselves.
On Wednesday, Rosselló, citing “rumors that turned out to be completely false,” said he commissioned a municipality-by-municipality count of the dead, which is why the toll increased from 16. He said he does “expect to have a clear picture of how many deaths occurred directly and indirectly due to the storm,” including panicked suicides and heart attacks. The public safety commissioner, Hector Pesquera, added that “I don’t think this will be the final number,” referring to 34 fatalities.
There seems to be confusion in the process for counting the dead. Pesquera told reporters that hurricane deaths, both direct and indirect, would need to be certified by the Institute of Forensic Sciences in San Juan to be included in the death toll. The funeral said, according to their understanding, they send bodies to the institute only when the death appears to be the result of an accident or a crime, not because they’re hurricane-related.
Rosselló also said he instructed his staff to communicate with hospitals and the institute to update the death toll. The funeral directors said the bodies they receive have not necessarily ever passed through a hospital — some come directly from wherever the person died. Particularly with the breakdown of transportation and communication infrastructure, reaching a hospital may not be possible for some.
Rosselló’s office didn’t immediately return a request for comment. Someone inside the Institute of Forensic Sciences on Sunday yelled through the door to contact Rosselló’s office.
Several days later, a White House official responded, saying, "Deaths and the cause of deaths are declared by local officials who then pass the information to corresponding state or commonwealth government agencies."
In the mountain municipality of Jayuya, home to around 17,000 people, the Puerto Rican government’s count includes one official death as a result of the hurricane — a man who died after a landslide wiped out his house.
BuzzFeed News spoke to staff at Jayuya’s funeral homes, who said at least 18 people there had died either during the hurricane or as a result of it in the past two weeks.
On Friday, Herman Alvarez was at Rossy funeral home, sitting in a chair by his father’s open casket. A few family and friends filtered in and out of the room, paying their respects.
His father, 78, died on Wednesday after his oxygen ventilator ran out. He had been fighting colon cancer for 10 years.
Alvarez said they spent the hurricane in a senior citizens’ home, where there was a generator — but that it wasn’t really equipped to power anything more than lights outside the building. As the storm intensified, the town’s power went out, and water started flooding into the building.
“He was anxious and worried, he was conscious the whole time,” he said, of his father.
In the following two weeks, Alvarez relied on generators to keep the machine running, but there were times that the power supply cut out.
“The other day it stopped for a few hours, in between, and during that time, I think he had a heart attack or something like that, and he had started to die,” he said.
Finally on Wednesday, the supply of oxygen to the machine ran out, and Alvarez was not able to leave his father on his own to get help. Without a working telephone (Jayuya, like 82% of the island, is still without cell phone service as of Sunday), he couldn’t call emergency services.
“We couldn't do anything,” he said. “In Jayuya there isn’t a company that supplies [the oxygen tank] to patients, for example, they have to come from Ponce, from Adjuntas, or from Arecibo, which are all pretty far away.”
Alvarez said he quit his job 10 years ago to be his father’s caretaker. He has two undergraduate degrees and a master’s degree in guidance counseling. He said he’ll now try to leave Puerto Rico and find work somewhere else, maybe Chicago where his brother lives.
“He worked the cane sugar fields. Over time he learned about that business and worked in the countryside all his life,” he said of his father. “He was a good father, he was a good father. We didn't want for anything, food or anything. He always looked after us. That’s why I looked after him to the very end.”
The administrator at Rossy funeral home, Freddy Rivera, told BuzzFeed News they had received six bodies of people who died since the hurricane because they lacked electricity, water, or supplies like oxygen.
“Three to four of them were in the hospital in [nearby] Ponce, where they didn't have light, water or oxygen and that affected them,” Rivera said. “We understand that almost all these deaths are related to what's happened because we don't have services.”
Of the 68 hospitals in Puerto Rico, 66 are open as of Sunday — 25 are operating with full electricity, according to officials. Most are running at limited capacity, with generators that require diesel, which is in short supply.
The other funeral home in town, Jayuya Memorial, said they’d received 12 bodies of people who died of direct or indirect causes from the hurricane: One was the man who is listed on the government death toll. Of the others, two had heart attacks, and one was a dialysis patient who died after the machine lost power.
“Indirectly, there were a lot of deaths,” said Misael Peris, administrator of the funeral home. “Because they didn't have water, didn't have electricity, because the gasoline shortage, because there isn't food. ... This situation creates uncertainty and anxiety that can kill you. Especially for people who already had compromised immune systems.”
A doctor at Jayuya’s Mario Canales Torresola Hospital told BuzzFeed News four patients there had died because of a lack of electricity or medicine in their homes — that included people who depended on dialysis machines and ventilators. It’s likely that the four bodies at the hospital went to the funeral homes.
The hospital is running on a diesel generator from the municipality — its own backup generator exploded during the storm. The lights are on and medical machinery has power, the doctor said, but the generator can’t power air conditioning.
The town’s coordinator of emergency medicine, Jaime Rodriguez, said his staff of six has been working 16-hour days to try to reach people whose lives are in danger as a result of the fallout of the hurricane — he said diabetics who haven’t been able to keep their insulin refrigerated, people with asthma, dialysis patients, and the elderly were particularly at risk.
“Yes, people here have died because they didn’t have electricity,” Rodriguez said. “When we get there they’re deteriorating already.”
In Utuado, a nearby municipality of around 33,000, the official government death toll counts three people — all elderly sisters who died during a landslide. The town’s streets are still full of mud and rubble, many homes and buildings are damaged.
Funeral directors there told BuzzFeed News they’d received 25 bodies of people who have died during the hurricane or afterward of related causes. The sisters are among those 25. Hospital officials wouldn’t give numbers to BuzzFeed News.
The Utuado Memorial funeral home also received the bodies of a person who died of pneumonia, three who died of septicemia — an infection of the bloodstream — and 14 people who died of heart attacks during or after the storm. They also received the three sisters the government counted.
“The septicemia could have been because of the storm, there wasn’t air conditioning, and with the infection it can get bad,” said Olga Sureda, president of the funeral home.
Of the 14 people who died of heart attacks, she said, “They would have had heart conditions and then the hurricane worsened their condition.”
The other funeral home in town that’s open after the storm, Rossy funeral home Utuado, received four bodies of people who had died of heart attacks.
“With one man, his family said there was a loud thunderclap that startled him and he had a heart attack,” said Rys Rivera, who works at Rossy in Utuado.
BuzzFeed News also visited four funeral homes in San Juan, where many cases were people who died of heart attacks after the storm.
At the Villa Nevarez funeral home in San Juan, staff said they’d received around 30 bodies of people who had died of heart attacks since the hurricane. Another four or five who were older people who died in shelters due to asthma, cancer, and diabetes, they said.
At another, Buxeda, staff said they’d received about 55 bodies since the hurricane, including people who had heart attacks, septicemia, and some who had died of cancer. They said they could not provide the exact breakdown of those numbers.
At Ehret funeral home, staff said they have received around 40 bodies since the hurricane — mostly people who were already sick and in hospitals before it hit, they said, adding they did not think the deaths were related to the hurricane.
And another funeral home, Marin, said they’ve been at capacity since the hurricane, but that they didn’t think any of those cases were directly or indirectly related to the hurricane.
Anand M. Irimpen, an associate professor of clinical medicine at Tulane Heart and Vascular Institute at Tulane University School of Medicine, and author of a study that examined a rise in heart attacks in New Orleans after Hurricane Katrina, said heart attacks in the wake of a natural disaster should be counted in the death toll because they are known to spike dramatically after traumatic events, caused by stress and physical duress.
He said that in addition to the stress factor, people in the aftermath of natural disasters tend to be more focused on trying to survive and rebuild than being diligent about taking medication and looking after their health — even when they have access to medication, which many in Puerto Rico currently may not.
“Absolutely, these numbers should be counted, because stress is a known factor for heart attacks,” he said. “There’s no way I can say definitively that that’s the cause in each case but there have been so many studies that have looked at high-stress situations in general and heart attacks and it has been shown that there is a spike in heart attacks during these events.”
His study found that in New Orleans, the rate of heart attacks tripled after Hurricane Katrina. Due to the added stress and disruption to people’s medical routines and lifestyles, this elevated rate, he said, has remained consistent ever since.