Milken Institute School of Public Health Launches New Study of Deaths in Puerto Rico Due to Hurricane Maria

WASHINGTON, D.C. (Sept. 9, 2020) — The Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University (GW) today announced receiving nearly $1 million in a contract award from the National Institute of Standards and Technology (NIST) to identify deaths in Puerto Rico directly and indirectly tied to Hurricane Maria – especially those associated with building failures.

In 2018, Milken Institute SPH researchers published a report finding an estimated 2,975 excess deaths in Puerto Rico due to Hurricane Maria. The new project, which is part of a National Construction Safety Team (NCST) investigation, aims to cast light on how damaged buildings and infrastructure played a role in the injuries and deaths associated with Hurricane Maria, a category four storm that hit the island on September 20, 2017.

The goal of the Hurricane Maria NCST investigation is to make recommendations to improve building codes, standards and practices to make communities across the United States more resilient to hurricanes and other disasters. This specific project seeks to improve death certification and surveillance performance during disasters and improve building standards to minimize casualties in future events.

“This in-depth and detailed analysis goes beyond our 2018 study and will provide insight that could be used to accurately and rapidly identify deaths associated with hurricanes and natural disasters,” said Carlos Santos-Burgoa, MD, MPH, PhD, the principal investigator for the project and a professor of global health at Milken Institute SPH. The new project will focus on identifying specific causes of death, including indirect deaths that might have been missed in the past. “We hope the findings will pave the way toward solutions, including improved building codes and standards aimed at keeping communities safe.”

This project is a collaboration between teams at the Milken Institute SPH, the University of Puerto Rico-Graduate School of Public Health, the Institute for Health Metrics and Evaluation at the University of Washington, and NIST.

The project aims to:

  • Identify all direct deaths and other deaths associated with building failures during the first two weeks after the hurricane.
  • Find clusters of deaths associated with building systems failures of critical facilities (e.g., hospitals and schools).
  • Identify factors associated with both direct and indirect deaths in the two weeks following Hurricane Maria.

The team will create an integrated database of existing administrative records from the government of Puerto Rico, hospitals and others to identify and classify deaths related to Hurricane Maria.

The project hopes to improve the process of counting deaths after a natural disaster, Santos-Burgoa said. Death tolls help the public understand the scope of such disasters and they can influence the resources allocated to help communities heal and re-build, he said.

Disaster deaths are counted as direct, which are easily counted, and indirect, which can seem unconnected to the disaster and thus are often misclassified. For example, indirect deaths can be caused by disaster-related conditions like the widespread power outages after Hurricane Maria.

By all accounts, Hurricane Maria damaged buildings that people rely on for safety, communications or health care. This project’s findings could lead to recommendations that would help improve building standards and practices to make communities more resilient in the face of extreme weather, Santos-Burgoa said.

In addition to Santos-Burgoa, the team of contractors includes scientists from the Departments of Global Health and Epidemiology, Diane Uschner at the GW Biostatistics Center; Pablo Méndez-Lázaro from the University of Puerto Rico-Graduate School of Public Health as well as Bernardo Hernández Prado and Abraham Flaxman from the Institute for Health Metrics and Evaluation at the University of Washington.

NIST, which is part of the U.S. Department of Commerce, is leading the NCST investigation and funding this work.