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GWU Study: 64 Direct Deaths in Puerto Rico Hurricane; not 2,975

Posted by FactReal on September 20, 2018

GWU STUDY DOESN’T SAY 3,000 PEOPLE DIED DUE TO HURRICANE MARIA IN PUERTO RICO

If you read the study done by the George Washington University (GWU) carefully, you’d find that:
1. There were 64 DIRECT DEATHS and not 2,975 deaths due to Hurricane Maria in Puerto Rico.
2. The 3,000 figure is an ESTIMATE based on a PREDICTION; not actual deaths.
3. The GWU uses “excess mortality” which is not the standard used for hurricanes.
4. The GWU mortality data is for 6 months – a much longer period than usual.
5. Did the GWU mortality estimate include the whole month of September 2017? (Remember, Hurricane Maria made landfall in Puerto Rico on Sept. 20, 2018)
6. Their GWU migration calculation of Puerto Ricans leaving their island was based on surveys…not actual records.
7. Why GWU did not publish their methodology? But they want us to trust them, because they say their study is “independent,” “rigorous,” and “sophisticated.”
8. Is GWU truly independent or unbiased? We know they proudly promote events with left-wing politicians (i.e., San Juan Mayor Cruz, Bill Clinton) [See photos below]
9. The GWU study found Puerto Rican forensic staff were doing things right with death certifications.
10. GWU recommends more financial resources ($$$$).

SUMMARY

After a hurricane, the standard has been to count DIRECT DEATHS, that is, deaths directly attributable to the hurricane. This standard is used by the National Weather Service and National Hurricane Center.

The Puerto Rico government and forensic teams were following that standard. Therefore, they reported 64 direct deaths after Hurricane Maria.

But, then came GWU researchers who wanted to go beyond DIRECT DEATHS and stretched the number of deaths by using “excess deaths,” “predicted mortality,” and by extending the period to six months after the hurricane landfall.

The GWU used estimates and predictions instead of actual death certificates.

[Point-by-point analysis below]


ERRORS & ISSUES WITH THE GWU STUDY

1. THE GWU STUDY ACCEPTS THERE WERE 64 DIRECT DEATHS ATTRIBUTABLE TO HURRICANE MARIA
64 deaths was the official number published by the Puerto Rican government…before the GWU study.

Here GWU study acknowledges there were 64 direct deaths due to the hurricane (page 11):[1]

The official government estimate of 64 deaths from the hurricane is low primarily because the conventions used for causal attribution only allowed for classification of deaths attributable directly to the storm, e.g., those caused by structural collapse, flying debris, floods and drownings..

Counting DIRECT DEATHS has been the standard:
NBC-Miami Meteorologist John Morales (who was raised in Puerto Rico and his mother is Puerto Rican) explained:[2]

The National Weather Service and National Hurricane Center count only direct deaths – those that can be attributed to the effects of the weather like flood drownings or flying debris… Emergency management agencies follow the same model, and their officials are normally the ones briefing the politicians. So the politicians are used to counting deaths just like the National Weather Service does.

2. THE 3,000 FIGURE IS JUST AN ESTIMATE AND NOT ACTUAL DEATHS attributed to Hurricane Maria
When the study and the media say “3,000 excess deaths”, people think that there were actually 3,000 people who died in Puerto Rico because of Maria. But that is misleading.

Three important words in the GWU study: ESTIMATE, EXCESS DEATHS, PREDICTED MORTALITY

a) Estimate: The title of the GWU study states it is an ESTIMATE: “Ascertainment of the Estimated Excess Mortality from Hurricane Maria in Puerto Rico.” The GWU used estimates instead of actual death certificates.

b) Excess Deaths and c) Predicted Mortality:
GWU calculated “excess” deaths (page i):[1]
“Our excess mortality study analyzed past mortality patterns (mortality registration and population census data from 2010 to 2017) in order to predict
the expected mortality if Hurricane María had not occurred (predicted mortality) and compare this figure to the actual deaths that occurred (observed mortality).The difference between those two numbers is the estimate of excess mortality due to the hurricane.”

The GWU study estimated “excess deaths” as 1,271 for the first two months, 2,098 for four months, and 2,975 deaths for six months after the storm. (page 9)[1]
Of course, the media did not report the 1,271 figure…they decided to report the most alarmist figure: 2,975 excess deaths.

“Results from the preferred statistical model, shown below, estimate that excess mortality due to Hurricane María using the displacement scenario is estimated at 1,271 excess deaths in September and October…, 2,098 excess deaths from September to December …, and, 2,975… excess deaths for the total study period of September 2017 through February 2018. Table 1 shows observed, predicted and excess mortality by month for the study period as well as the total study period.”

[tableOnly]GeorgeWashingtonUniversity-PuertoRicoDeathTollEstimate

The GWU study used “excess deaths” and not direct deaths. These are not actual deaths. These are just estimates of excess mortality and predicted mortality.

Why use estimates and predictions of expected mortalities when they had tangible proof: The death certificates and records of people who died?

About death certification, the GWU press release stated:[3]
“The team found error rates in death certificates that were within the norms. In fact, similar error rates in death certificates are found throughout the United States.”

In other sections of the study, the GWU attacks the people preparing death certificates in Puerto Rico. Do you think that after all these decades professionals in Puerto Rico (physicians, forensic personnel) do not know how to complete death certificates? Maybe the GWU wants to change the standards here too. [See points #3 and #10 below for more.]

3. WHY DID GWU USE “EXCESS MORTALITY” WHICH IS NOT THE STANDARD USED FOR HURRICANES
By using “excess deaths”, GWU added uncertainty to the mortality calculation.

Meteorologist John Morales explains “excess mortality” is not the standard:[2]

“Excess mortality studies are *not* done for all disasters, much less all hurricanes.”

“Excess mortality requires that the investigators look at deaths that are ‘possibly attributable to hurricanes’, as stated in the GW study.”

“Because excess mortality studies are not available for most hurricane disasters, there’s no way for us to compare what happened in regards to excess deaths in Puerto Rico to any other past disaster. It can’t be compared to other American landfalling hurricanes either because deaths in those were counted based on the customary methods used by the National Hurricane Center…” [i.e., direct deaths.]

GWU defined “excess mortality” (page 3):[1]

Excess deaths are deaths that exceed the regular death rate predicted for a given population (WHO 2018) had there not been a natural disaster or other unexpected or calamitous event, such as an epidemic or industrial accident (Geronimus et al 2004; Haentjens et al. 2010). [WHO = World Health Organization]

To estimate excess mortality associated with Hurricane María, it was necessary to develop counterfactual mortality estimates, or estimates of what mortality would have been expected to be had the disaster not occurred.

4. THE GWU MORTALITY DATA IS FOR 6 MONTHS AFTER THE HURRICANE – a much longer period than usual
On their press release dated Aug. 28, 2018[3], GWU stated their estimate of “mortality data [was] for six months from September 2017 through February 2018.”

Is that a new protocol when calculating deaths due to a hurricane?
Is that how loss of life (or property) from past storms have been calculated (6 months after the event)?

The Telegraph tries to provide a pretext:[4]

Researchers with George Washington said they counted deaths over the span of six months – a much longer period than usual – because so many people were without power during that time.

However, Puerto Rico had power problems long before the 2017 hurricanes. The local leaders, more than the federal government, failed to the Puerto Rican citizens. [Read the reports.]

If GWU used a different standard than what is customary (i.e., National Hurricane Center) then we cannot compare their findings with previous disasters. The GWU study and the media must make that distinction.

5. DOES THE GWU ESTIMATE INCLUDE THE WHOLE MONTH OF SEPTEMBER?
Hurricane Maria hit Puerto Rico on September 20, 2017. Did the university include into their estimate the deaths that occurred the first weeks of September 2017?

The GWU study is titled “Ascertainment of the Estimated Excess Mortality from Hurricane Maria in Puerto Rico.” It should include only the deaths due to Maria and not Irma.

Why did they use an arbitrary end date of February 2018 for their study? Did the deaths suddenly stop in Feb. 2018? Why not July or September 2018? And, why not Oct. 2018?

6. THEIR MIGRATION DATA IS BASED ON SURVEYS…NOT ACTUAL RECORDS
GWU indicated that they factored the migration data (of people leaving Puerto Rico due to the hurricane) into their calculations. However, their migration data is based on airline surveys from a Puerto Rico institute and not actual travel data.

GWU study, page 4:[1]

Cumulative monthly population displacement after the storm in each month was estimated using Bureau of Transportation Statistics (BTS) data on monthly net domestic migration provided by the Puerto Rico Institute of Statistics and a survey of airline travelers provided by the Puerto Rico Planning Board (Planning Board 2018).

The GWU team did not trust the Puerto Rican professionals handling the death certificates, but suddenly they trust airline surveys coming from other Puerto Rican institution.

7. GWU DID NOT PUBLISH THEIR METHODOLOGY BUT THEY WANT US TO TRUST THEM
We have to trust them because they say their study is “independent,” “rigorous,” and “sophisticated.”

They try to legitimize their report by using suggestive adjectives: “independent study,” “sophisticated mathematical model,” or “the most rigorous study of excess mortality due to the hurricane done to date.”

But where are the data? Where is the methodology?

Telegraph also wanted to know:[4]

For the study, the researchers reviewed mortality data from July 2010 to February 2018. They also took into account an 8 percent drop in Puerto Rico’s population in the six months after the storm, when tens of thousands fled because of the damage.

However, they did not share details of their methodology, saying those will be released if the study is published in a scientific journal.

“We did not cherry-pick, I can promise you,” Goldman [dean of the Milken institute] said. “We used very rigorous methodology.”

Data are not listed on their website as promised in their study (page 2):[1]
“For more details on the methodology,data and programs used in the excess mortality calculations,these will be made available online at: http:// prstudy.publichealth.gwu.edu/”

8. IS GWU INDEPENDENT AND UNBIASED?
We know they celebrate and proudly promote events with left-wing politicians like Bill Clinton[5] or San Juan Mayor Carmen Yulin Cruz[6] (the new darling of the Left.)

PUERTORICO-YULIN-andGeorgeWashingtonUniversity

George Washington University proudly hosted socialist San Juan Mayor Carmen Yulin Cruz in November 2017. The topic: “Importance of Honesty in Public Communications.”

CLINTONandGeorgeWashingtonUniv - Edited

George Washington University – Milken Institute SPH proudly hosts yearly events with liberal Bill Clinton.

9. GWU STUDY ACCEPTS PUERTO RICAN FORENSIC STAFF WERE DOING THINGS RIGHT
In some parts, the GWU researchers criticize the forensic teams in Puerto Rico but in other areas they acknowledge death certification errors were low.

Death certificates errors within the norms, indicated GWU press release of Aug. 28, 2018:[6]

The team found error rates in death certificates that were within the norms. In fact, similar error rates in death certificates are found throughout the United States.

GW study, page iii:[1]

Quality & Completeness of Death Certification:

“The [Puerto Rico Vital Statistics System ] PRVSR offices sustained damage and did not have power to operate for some time after the hurricane, and death registration was delayed. Nevertheless, based on our findings in the assessment of death certification quality, the disaster does not appear to have affected the completeness of the certificates.“

Timeliness 5 days from normal time:

“On timeliness, there was a statistically significant delay in the number of days between date of death and date of death registration, with an average of 17 days in the period after the hurricane compared to 12 days in the prior year.“

Garbage codes were low:
“Garbage codes refer to diagnoses that should not be considered as an underlying cause of death or assigning deaths to causes that are not useful,” indicates the GWU study, page 6.

Overall, there was a low percentage of garbage codes as the underlying cause of death and there appears to be no impact from the event on the percentage of codes that were mis-assigned. With respect to internal consistency, less than 1% of death certificates had medically inconsistent diagnoses in the underlying cause of death.

10. GWU RECOMMENDS MORE FINANCIAL RESOURCES($$$$) (Page 18):[1]

The federal government should support the implementation of this agenda and its financing. An executive order should be issued for an expansion of the regular operating budget to all organizations and especially the DoH, BFS, PRVSR.

SOURCES:
[1] Study by George Washington University (GWU) – Milken Institute School of Public Health titled,
“Ascertainment of the Estimated Excess Mortality from Hurricane Maria in Puerto Rico,”(PDF) (August 28, 2018)
#https://publichealth.gwu.edu/sites/default/files/downloads/projects/PRstudy/Acertainment%20of%20the%20Estimated%
20Excess%20Mortality%20from%20Hurricane%20Maria%20in%20Puerto%20Rico.pdf

[2] John Morales: Many Are Misreporting Hurricane Maria’s Death Toll. Here’s the Messy Reality (August 28, 2018)
#https://www.nbcmiami.com/news/local/On-the-Reported-Death-Toll-of-Hurricane-Maria-in-Puerto-Rico-491951441.html

[3] GWU press release (August 28, 2018)
#https://publichealth.gwu.edu/content/gw-report-delivers-recommendations-aimed-preparing-puerto-rico-hurricane-season

[4] UK Telegraph: Puerto Rico revises Hurricane Maria death toll from 64 to almost 3,000 (Aug. 29, 2018)
#https://www.telegraph.co.uk/news/2018/08/29/puerto-rico-revises-hurricane-maria-death-toll-64-almost-3000/

[5] QuickNewsVault: Bill Clinton promoted by George Washington University
https://quicknewsvault.wordpress.com/2018/08/23/bill-clinton-promoted-by-george-washington-university/

[6] QuickNewsVault: PR Mayor Carmen Yulin Cruz at George Washington University – Nov. 2017
https://quicknewsvault.wordpress.com/2018/05/07/pr-mayor-carmen-yulin-cruz-at-george-washington-university-nov-2017/

[7] Home page for the GWU study, press releases:
George Washington University Milken Institute School of Public Health (GW Milken Institute SPH)
#https://prstudy.publichealth.gwu.edu/

[8] LIST: Puerto Rico was a Disaster long before Hurricane Maria (Liberal Media Sources)

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