UTopiAH. 64 or 2,975? This is Part 25 of a series for comparing census based life expectancy and death rate tables, ranking states by how long we live. Included are medical conditions rating Utah’s #1 health rankings. Where should a memorial be built listing names from the Hurricane? Does over or understating death rates matter in Puerto Rico or anywhere?

Part Twenty Five. Why is Puerto Rico’s death toll from 2017’s Hurricanes a metric of economic development? 64 with death certificates, 2975 without?  Hurricane Maria September 20, 2017. NASA’s Terra satellite provided this visible image as Hurricane Maria was moving over Puerto Rico. The eye had become obscured by clouds. Credit: NASA Goddard MODIS Rapid Response Team

Read more at: https://phys.org/news/2017-09-nasa-hurricane-maria-torrential-rainfall.html#jCp

How about a memorial listing the names of all Puerto Ricans who died in the Maria Hurricane of September 20, 2017? Such lists on name memorials are familiar, in Gloucester, Arlington, Pearl Harbor, New Haven, San Antonio, Oklahoma City, and Washington District of Columbia. [i] Online are the Million grave project and Billion grave project which collects photographs of grave or head stones, identifies the names, and, where available, includes family history.

   Alamo centograph Memorial, San Antonio, Texas

A list of names from 2017 has not been published. Which absence is the subject of this column. How, when and why did the Puerto Rican Hurricane death rate make such head lines?

Death counts reflect economic development

As quoted in the media, deaths have broad implications.

‘’ The death toll can be a metric of economic development: Poorer localities tend to have more deaths and fewer economic losses after disasters than wealthier places, according to John Mutter, a professor at Columbia University.

Deaths can politicize issues, such as ‘man made’ climate disasters.

‘’Getting the death toll right is important for disaster planning, according to Alexis Santos, ** Penn State University. “This is not a vanity exercise ** Effective assessment of climate disasters is the only way we can prevent loss of life in future events.”            Mutter continued, ‘’[Death toll is] a measure of how well you protected your people.’’

So, what do we know about Puerto Rico’s death toll? In 2015, Puerto Rico had 28,085 total deaths, about a fifth from cancer and a fifth from heart disease. That is an actual count from death certificates, each with a date, place, name, and cause of death. These same death certificates are recorded throughout the United States.[ii] As for the 2017 hurricane, the death certificate death toll was over 5 dozen.  Gloucester Fisherman’s Cenotaph Memorial ‘Man at the Wheel, 1923.

What is a Storm death?

According to media reports-

In a U.S. storm, one might assume that deaths are from those who drown in floodwaters, or are hit by flying debris. ‘’** death certificates are the primary source of mortality statistics, and ** death can be attributed to disasters only by medical examiners.’’

But not in the revised 2017-2018 death toll. Puerto Rico’s storm death rate is broader, such as suicides, dependence on dialysis or respirators, sepsis, a severe infection that can be tied to delayed medical care, a heart attack brought on by stress from the hurricane, or a fatal heart attack because an ambulance could not get through debris-blocked streets, or loss of necessary medical service.

Problems with storm death calculations?

According to media –

‘’indirect [storm] deaths resulting from worsening of chronic conditions or from delayed medical treatments may not be captured on death certificates.’’

Washington DC, USA – June 18, 2016: The Memorial Wall of the Vietnam Veterans Memorial in Washington DC at dawn.

‘’Records from hospitals, ** will not include [storm] deaths that may have occurred outside health care facilities.’’

‘’surveys can provide an independent estimate of mortality that does not rely on death-certificate data.’’

‘’[survey]inherent limitations associated with the nature of participant-reported data, recall bias, nonresponsive bias, and survivor bias.’’

‘’ Lack of consensus on a definition and time frame for attributing indirect mortality following a disaster.’’

‘’ Lack of consensus on a definition and time frame for attributing indirect mortality following a disaster that integrates verbal and social autopsies.’’

‘’ gaps in information and the dissemination of inconsistent information’’‘’ gaps in the information provided by the Government of Puerto Rico, including limited explanation of the death certification process, distinguishing between direct and indirect deaths, or explanations of barriers to timely mortality reporting.’

War of the Revolution, Woolsey Hall, Yale New Haven Connecticut, 1915

Time Line for Increasing Death Toll

Sept. 20, 2017 – Hurricane Maria made landfall on Puerto Rico.

Sept. 29, 2017 – ‘’Puerto Rico’s government insisted that its count of the dead was accurate and not significantly low.’’

About Oct. 3, 2017 – ‘’President Trump visited the island and remarked that the death toll — which officially stood at 16 at the time — was much lower than the 1,833 people who died in 2005 because of Hurricane Katrina.’’

Oct. 4th, Harry Figueroa, a 58-year-old teacher, died in Caguas on Oct. 4 from pneumonia, and his family blamed the power outage for his death.’’

About Sept. to October 2017, ‘’Puerto Rico authorized 911 cremations of people whose deaths were attributed to natural causes.’’

Yale College Woolsey Hall inscription.

Nov. 20, 2017, ‘’half the island’s funeral homes ** directors believed that 499 more deaths than the official count were tied to the hurricane.’’

About Dec. 4th 2017 ‘’Pressure mounted [on the Governor of Puerto Rico] *** when two Democratic members of Congress, Nydia M. Velazquez of New York and Bennie Thompson of Mississippi, asked the Government Accountability Office to review the hurricane death toll in  Puerto Rico.’’

Dec. 8th ‘’The New York Times, conducted independent analyses and found that the number of deaths traceable to the storm was probably far higher than the official count of 64.’

About Dec. 13th, 2017, ‘’ the Governor said he welcomed the published reviews of the death toll, but he cautioned that the government could not adjust its official mortality count based on “statistical analysis.”

Pentagon Memorial, 9/11 2001 attack.

Dec. 18th ‘’Parts of the island are still without power almost three months later, and the power grid is operating at only 70 percent of capacity.’’

February 27, 2018 the George Washington University was selected to conduct a review of fatalities from Hurricane Maria funded by $305,000.

Spring 2018.

May 29, 2018. ‘’ deaths caused by last year’s devastating Hurricane Maria in Puerto Rico. The latest estimate: roughly 4,600, many of them from delayed medical care.’’

July 12 2018. A survey of 3299 households increased the mortality rate to 14.3 per 1000 for 4,645 excess deaths.

184 Named Benches Pentagon 9/11 Memorial.

September 2018. Puerto Rico government raises Hurricane deaths from 64 to 2,975.

Take Away – access to Medical care or Health Provider Shortage

Take away? Media reports –

‘’ In Hurricane Katrina, they had to evacuate people from critical care by boat ** to other medical facilities far away. ** their medical records have to go with them because people on the receiving end didn’t understand a lot about their medical histories. This led to a change in process that is used by emergency management folks and now they have to bring the records with them.

168 named chairs for Oklahoma City Bombing April 19, 1995.

In Hurricane Sandy, we learned that a lot of people at home are medically dependent on electricity,’’ such as oxygen. Public health should Identify them in advance for loss of electricity. Medical care facilities can be vulnerable.

Puerto Rico and Hurricane Maria –‘’one third of post-hurricane deaths were reported by household members as being caused by delayed or prevented access to medical care’’ specifically –

‘’**inability to access medications (14.4% of households), respiratory equipment requiring electricity (9.5%), ** closed medical facilities (8.6%), absent doctors (6.1%). ** unable to reach 911 services by telephone (8.8%).’’

‘’ In [ the Puerto Rico Hurricane Maria spring 2018 New England] survey, interruption of medical care was the primary cause of sustained high mortality rates in the months after the hurricane, a finding consistent with the widely reported disruption of health systems.37  Health care disruption is now a growing contributor to both morbidity and mortality in natural disasters.’’

‘’ nursing home residents and those dependent on life-sustaining equipment were disproportionately affected.’’

‘’ chronic diseases and [those who] use sophisticated pharmaceutical and mechanical support that is dependent on electricity. Chronically ill patients ** these patients, their communities, and their providers [need] to have contingency plans during and after disasters.’’

‘’ emotional closure, qualifies [surviving families] for disaster-related aid, and promotes resiliency.‘’

USS Arizona Pearl Harbor Hawaii, wall listing the name of each of the 1,177 Navy sailors and Marines who went down with the ship.

[1] At the Pentagon Arlington Virginia, the 200 killed on 9/11 2001, have benches arranged by year of birth; in Gloucester Massachusetts, a stone memorial lists sailors lost at sea going back to the 1623-1923’s including the name of Ephraim Choate drowned 1784 Oct 1;

https://gloucester-ma.gov/DocumentCenter/Home/View/404

in Woolsey’s Memorial Hall, Yale University, New Haven Connecticut chiseled into the marble walls are the Yalies killed in wars from French and Indian to the 21st century – established about 1915, it lists the rank, Yale Class, Degree, and home state, many from the Civil War; which memorial was a partial inspiration for black marble of the Vietnam Memorial in Washington D.C. with 55,000 names from the 1960s to 1970s; a park in downtown Oklahoma City with chairs for names of those who died in the bombing of April 1995; the Alamo in San Antonio lists the names of the defenders from the 1836 battle (with Lieutenant Cleveland Kinloch Simmons); memorial at Pearl Harbor lists names who died from the attack of December 7, 1941; and so it goes.

[1] The Department of Health and Human Services Center for Disease Control published the National Vital Statistics Reports (Vol. 66, No. 6, November 27, 2017). Tale 12, for 2015, lists Puerto Rico deaths from All causes of 28,085, at death rate of 808.4 per 100,000; malignant neoplasms (C00-C97) number 5,158 and rate *; Disease of Heart Number 4,972 and rate of 143.1 (I00-I09, I11,I13,I20-I51) ; Accidents (V01-X59, Y85-Y86) number 911 and rate of 26.2; Motor vehicle accidents number 328 at a death rate of 9.4 per 100,000; Accidental poisoning and exposure to noxious substances (X40-X49) number 28, at a death rate of 0.8; Intentional self harm (suicide) (U03,X60-X84,Y87.0) number 226, at a death rate of 6.5; Assault Homicide (U01-U02,X85-Y09,Y87.1) number 588, at a rate of 16.9.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics National Vital Statistics System

Baby deaths. Table 15. Number of infant deaths and mortality rates, Puerto Rico’s total 218, Hispanic number 217, and non-Hispanic Black one (1); at a rate of 7.0. The United States total infant deaths total was 23,455, 13,008 male, and 10,447 female, of which 4,805 total were Hispanic, rate 5.2; 2,819 male, and 2,186 female.

Estimated 2015 population (Table IV) for United States was 321,418,820; for Puerto Rico 3,474,182; for Utah 2,995,919. U.S. census Bureau. Available from: https://factfinder.census. gov/faces/tableservices/jsf/pages/productview.xhtml?pid=PEP_ 2015_PEPANNRES&src=pt.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics National Vital Statistics System.

Conclusion.  If  the lack of medical services was the cause of 2,911 deaths, then open more medical schools, train more doctors.  There won’t be a centograph because there are no names nor death certificates.

Disclaimer: The author of each article published on this web site owns his or her own words. The opinions, beliefs and viewpoints expressed by the various authors and forum participants on this site do not necessarily reflect the opinions, beliefs and viewpoints of Utah Standard News or official policies of the USN and may actually reflect positions that USN actively opposes. No claim in public domain or fair use.   © Edmunds Tucker.

 

 

 

 

[i] At the Pentagon Arlington Virginia, the 200 killed on 9/11 2001, have benches arranged by year of birth; in Gloucester Massachusetts, a stone memorial lists sailors lost at sea going back to the 1623-1923’s including the name of Ephraim Choate drowned 1784 Oct 1;

https://gloucester-ma.gov/DocumentCenter/Home/View/404

in Woolsey’s Memorial Hall, Yale University, New Haven Connecticut chiseled into the marble walls are the Yalies killed in wars from French and Indian to the 21st century – established about 1915, it lists the rank, Yale Class, Degree, and home state, many from the Civil War; which memorial was a partial inspiration for black marble of the Vietnam Memorial in Washington D.C. with 55,000 names from the 1960s to 1970s; a park in downtown Oklahoma City with chairs for names of those who died in the bombing of April 1995; the Alamo in San Antonio lists the names of the defenders from the 1836 battle (with Lieutenant Cleveland Kinloch Simmons); memorial at Pearl Harbor lists names who died from the attack of December 7, 1941; and so it goes.

[ii] The Department of Health and Human Services Center for Disease Control published the National Vital Statistics Reports (Vol. 66, No. 6, November 27, 2017). Tale 12, for 2015, lists Puerto Rico deaths from All causes of 28,085, at death rate of 808.4 per 100,000; malignant neoplasms (C00-C97) number 5,158 and rate *; Disease of Heart Number 4,972 and rate of 143.1 (I00-I09, I11,I13,I20-I51) ; Accidents (V01-X59, Y85-Y86) number 911 and rate of 26.2; Motor vehicle accidents number 328 at a death rate of 9.4 per 100,000; Accidental poisoning and exposure to noxious substances (X40-X49) number 28, at a death rate of 0.8; Intentional self harm (suicide) (U03,X60-X84,Y87.0) number 226, at a death rate of 6.5; Assault Homicide (U01-U02,X85-Y09,Y87.1) number 588, at a rate of 16.9.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics National Vital Statistics System

 

Baby deaths. Table 15. Number of infant deaths and mortality rates, Puerto Rico’s total 218, Hispanic number 217, and non-Hispanic Black one (1); at a rate of 7.0. The United States total infant deaths total was 23,455, 13,008 male, and 10,447 female, of which 4,805 total were Hispanic, rate 5.2; 2,819 male, and 2,186 female.

Estimated 2015 population (Table IV) for United States was 321,418,820; for Puerto Rico 3,474,182; for Utah 2,995,919. U.S. census Bureau. Available from: https://factfinder.census. gov/faces/tableservices/jsf/pages/productview.xhtml?pid=PEP_ 2015_PEPANNRES&src=pt.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics National Vital Statistics System

 

Centotaph in Alamo Plaza, 1936-1940.

Lost at Sea Register for

Gloucester Fisherman’s cenotaph Memorial ‘’Man at the wheel’’ 1923.

 

Washington DC, USA – June 18, 2016: The Memorial Wall of the Vietnam Veterans Memorial in Washington DC at dawn.

 

 

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War of the Revolution, Woolsey Hall, Yale New Haven Connecticut, 1915

 

 

Yale College Woolsey Hall inscription.

 

Pentagon Memorial, 9/11 2001 attack.

 

184 Benches Pentagon 9/11 Memorial.

168 chairs for Oklahoma City Bombing April 19, 1995.

 

USS Arizona Pearl Harbor Hawaii, wall listing the name of each of the 1,177 Navy sailors and Marines who went down with the ship.