Puerto Rico’s morgues full of uncounted bodies as hurricane death toll continues to riseBMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4648 (Published 06 October 2017) Cite this as: BMJ 2017;359:j4648
Only a small fraction of the people who have died in Puerto Rico as a result of Hurricane Maria, which struck the island on 20 September, have been included in official statistics, reports indicate.
The category 4 storm forced 51 of the island’s 69 hospitals temporarily to close their doors to new patients. Sixty four hospitals are now at least partly operating, though only 17 have grid power and the rest are using generators. The 1000 bed US navy hospital ship Comfort arrived in San Juan harbour on 4 October to help with the relief effort.
With roads closed and phone services down, however, transfer and triage of patients at the most overcrowded emergency rooms is a major challenge. “We can’t communicate with anybody,” said Carlos Gomez Marcial, emergency medical director at the Centro Medico de Puerto Rico, the island’s tertiary trauma centre, during a meeting with medical officers from USS Comfort.
The official number of dead doubled on 3 October to 32, but officials told local journalists that hospital morgues were full and that only hurricane victims with death certificates issued have been added to the official count.
Morgues normally do not release bodies until a death certificate has been issued, and only half of the 42 offices of the island’s Demographic Registrar are open, with some employees who would normally certify deaths themselves still unaccounted for.
Puerto Rico’s Centro de Periodismo Investigativo (Centre for Investigative Journalism) collected reports from nine hospitals, local police, and mayors and concluded that Hurricane Maria’s victims numbered several dozen at the least and possibly hundreds.1
Rafael Rodríguez Mercado, the health secretary, and Hector Pesquera, the public security secretary, did not dispute the findings but said that they themselves lacked details.
“I understand that there are more dead people here,” Pesquera told the centre. “But what I do not have is reports that tell me [for example] in Mayagüez eight died because they had no oxygen, four died in San Pablo because they did not receive dialysis.”
He said that 10 mobile morgue vehicles from the US mainland would be brought in to more than double the 295 cadaver capacity of the Forensic Science Institute.
Mercado told the Centro de Periodismo Investigativo that he heard from three hospitals in the west of the island of seven more victims who were still unaccounted for. In addition, many people in the unreachable parts of the interior had buried relatives without death certificates, he said.
CNN was able to confirm that two patients died in a San Juan intensive care unit after diesel fuel ran out.2 But a much retweeted claim that “everyone” in one intensive care unit had died (https://twitter.com/NelsonMRosario/status/914220569402281985) could not be confirmed.
Orlando López de Victoria, the only cardiothoracic surgeon still on the island, told USA Today that patients were arriving sicker than usual, citing one who had presented with a severely infected wound from showering in dirty water and another who had died during cardiac surgery because of a delay in moving her.
Rumours abound of cholera outbreaks, although these were firmly denied by the new US surgeon general, Jerome Adams, who visited the island on 3 October.
Isolated elderly people with chronic disease are also a concern, especially the island’s 5000 or so patients needing dialysis, and residents of small nursing homes, many of which are short of oxygen and water as well as electricity.
The final death count will not be known for months, said Pesquera. Most deaths occurred soon after the storm, from causes such as heart failure while people cleared debris or carbon monoxide poisoning from indoor generators.
On the US mainland the Food and Drug Administration’s commissioner, Scott Gottlieb, warned that disruption to the island’s 80 pharmaceutical plants could endanger US supplies of key drugs such as methotrexate, already in short supply. Puerto Rico’s factories make many bestselling drugs such as the rheumatoid arthritis treatment adalimumab (Humira) and the anticoagulant rivaroxaban (Xarelto).