Heckuva Job, Donny! Puerto Rico Edition

From New England Journal of Medicine, results of a study led by researchers at Harvard T.H. Chan School of Public Health and Beth Israel Deaconess Medical Center:

Figure 4. Estimates of Excess Deaths and Reported Causes of Death.
Panel A shows a comparison of estimates of excess deaths from official reports, press (New York Times)8 and academic (Santos–Lozada and Howard)9 reports, and from our survey. Panel B shows deaths according to the month of death and the age at death as reported in our survey, categorized according to the cause of death reported by the household member. Two persons who died of similar causes at the same age are represented by dots that are superimposed in December; thus, the 37 points shown represent 38 deaths after the hurricane.

If this is what deserves an “A+”, I wonder what a “C” looks like.

Update, 5/31 4:10PM Pacific:

Here is a press release from GWU Milken School of Public Health:

Milken Institute School of Public Health Statement on New Study to Estimate Excess Mortality in Puerto Rico Tied to Hurricane Maria

WASHINGTON, DC (May 30, 2018) — The Milken Institute School of Public Health at the George Washington University (Milken Institute SPH) issued the following statement about Harvard University’s study published Tuesday in the New England Journal of Medicine on mortality in Puerto Rico tied to Hurricane Maria:

The study led by Harvard researchers on the deaths tied to Hurricane Maria is a welcome addition to the scientific literature on the impact of the hurricane in Puerto Rico. The Harvard study used methods that are commonly used following disasters where there are few or no official records of death.

The study is based on estimates from household surveys and not on actual records of death. In that way, the Harvard study is fundamentally different from the Milken Institute SPH study commissioned by the Government of Puerto Rico.

The household survey method used by Harvard researchers in Puerto Rico gives a wide estimate of the deaths tied to Hurricane Maria. Given the design of the household survey in the reality of a difficult post-disaster environment, it is appropriate that the researchers reported the deaths with wide intervals that convey the range of uncertainty. The estimate of 4600 excess deaths reported in the popular press falls within a range of uncertainty, and that means that the number could be lower or higher than that (referred to by scientists as a 95 percent confidence interval). The study further provides insight into the circumstances surrounding deaths and the emergency context in which people were living —both will inform future research and interventions.

The epidemiological study being conducted by researchers at Milken Institute SPH will use actual data about deaths – death certificate and other mortality data from September 2017 to the end of February 2018 – in order to estimate the excess deaths related to Hurricane Maria. Estimating deaths using such mortality data is a time-consuming and difficult task, one that has rarely been done after a disaster of this magnitude. In the context of the health care and death registration systems of Puerto Rico, it is a more accurate way to assess mortality. In addition, the study will evaluate the death

certification process to understand how this process was implemented under normal conditions and how the process was affected in the aftermath of the hurricane. Finally, the Milken Institute SPH team is also assessing the Puerto Rican government’s communications with the public regarding the storm.

The Milken Institute SPH study is expected to provide a narrower range of uncertainty around the estimated excess deaths tied to Hurricane Maria. It will also offer recommendations that will help the government of Puerto Rico prepare for future natural disasters.

The Milken Institute SPH study was slated to be finished by the end of May; however, collection of the data has taken longer than expected. A final report for the Phase I of the two-part study is expected out this summer.

This release takes on heightened importance given Mr. Steven Kopits assertion that the methods used by the Harvard School of Public Health led team are “garbage”.

Rivera and Rolke (2018) did use Demographic Registry Data and concluded that 822 excess deaths occurred from September 20 through October 31 alone, with 95% CI (605, 1039). Extrapolating linearly through end-December (conforming to the NEJM article) would imply 2603 excess deaths, well within the 95% confidence interval of 793-8498.

35 thoughts on “Heckuva Job, Donny! Puerto Rico Edition

  1. pgl

    NEJM is suggesting the number of deaths may exceed 5000. This is more than 9/11 and Katrina combined. And most of these deaths are attributable to the complete incompetence and indifference of this White House.

      1. pgl

        Trump likely does not think Puerto Ricans in NYC are real Americans either. If this were Iceland with a bunch of white people, the FEMA assistance would have been substantial.

        At least George W. Bush had remorse for his failure with Katrina. Trump is proud of his disdain for those people.

      2. baffling

        it is not only mr trump who does not believe they are americans. most of his followers as well. i would imagine peaktrader and rick stryker think of those in puerto rico as spanish speaking latinos, and not americans. bad hombres crossing the border.

        1. pgl

          Roseanne Barr apparently said something really racist too and ABC fired her. I never watched her dumb show anyway.

          1. Moses Herzog

            I made a basically random comment about her and her new show in another thread, maybe 6 weeks ago?? (I can probably hunt the comment link and put it up, not that it’s amazingly “insightful”). I still think she’s a very intelligent woman—but also a nut-case who has no self-consciousness as regards the never-ending locomotions of her jawbone.

            Somewhere out there, tipping back a very large mug of beer with guaranteed contract checks still yet to be sent to him in the mail, John Goodman is going “Folks, welcome to my world”.

          2. Moses Herzog

            I’m guessing the only person who cares about this is me, but can’t resist putting it up anyway. This is my March 27 comment here about Roseanne Barr. (just barely over 2 months ago).

            A Jewish woman afraid to talk about labor unions walks straight up to the racial mud and does a bellyflop from the high diving board. Interesting in our country which topics can be broached and which ones can’t. If you’re part of Disney’s ABC TV network, apparently labor unions are a very frightening topic.

  2. Steven Kopits

    The study is almost certainly wrong.

    According to a NYT report citing the Demographic Registry of Puerto Rico — where deaths are recorded — the incidence of death over expected numbers totaled 1,052 through Oct. 31, 2017, with clear signs of the count leveling to the end of the period.

    By contrast, the study claims a total of 4,645 excess deaths during this period September 20 through December 31, 2017. Even if we allow deaths recorded at the pace seen in October, the total to year-end 2017 should not have exceeded 1,500.

    Unless the study authors are accusing the PR Demographic Registry of gross incompetence — having missed some 3,000 deaths in little more than three months — the study numbers are garbage.

      1. pgl

        People should read this link especially its title”

        Puerto Rico’s Department of Health Says It Is Not Authorized to Provide Updated 2017 Death Statistics

        There seems to be a disinformative campaign which alas your cherry picked claims are aiding.

        1. CoRev

          So, we have 3 levels of numbers, from 64 the official number, to ~1200 and finally 4600+ some from reputable sources. Some maybe not. For me the funny part is that the numbers are for different time frames. Anyone notice that in their zeal to contradict?

          Another funny example is the glee demonstrated that so many people died under the ???? administration, and the hurricane was obviously ????’s fault since he disbelieves the Climate Science ?science?.

          Maybe, since we are talking of unexpected deaths, we should compare Obama’s vs Bush’s administration re: deaths due to drone strikes. Obama had ~563 strikes compared to 57 Bush in just Pakistan, Somalia and Yemen. Any deaths other than those directly targeted are directly related to the President’s decisions. There should not be much controversy over those numbers since they are targeted events often with forensic backup to prove targeting success. The white house claimed there were between 64 and 116 civilian deaths while The Bureau of Investigative Journalism claimed there were between 380 to 801, six times higher than Obama’s claim.

          The moral is that numbers like this are difficult to accurately collect. Even when the Obama administration has insisted that drone strikes are so “exceptionally surgical and precise” that they pluck off terror suspects while not putting “innocent men, women and children in danger”, the number of unexpected deaths is imprecise even in St Obama’s surgical strike world.

          1. Menzie Chinn Post author

            CoRev: If we are going into unexpected deaths (not to mention treasure), perhaps we should mention the thousands of civilians killed in the war of choice that was Operation Iraqi Freedom (unless you are saying the GW Bush administration expected all those deaths). Not to mention the over $800 billion spent through FY2012, the over 4500 military fatalities, over 32000 wounded/injured. (and 0 WMDs found.) I’m happy to relitigate that episode of unnecessary war.

          2. CoRev

            Menzie, only if you wish to rehash those issues. I deliberately left the comparative administrations to the imagination for that very reason. It is also why I provided data. I can provide the links if you wish. If I remember correctly you were afflicted with BDS then also. Seems to be a pattern.

            If it is painful when blame is assigned to your President, then you are just playing the angry loser.

    1. pgl

      “The study is almost certainly wrong.”

      Seriously? Have you done an independent analysis with the able assistance of Kelly Anne Conway?

      1. Moses Herzog

        @ pgi
        Didn’t you hear the news?? Kellyanne Conway has now reached “expert” status on a broad range of topics:

        I’m still trying to decide if I would want to teach Kellyanne how to play clarinet with a Catwoman mask on to cover those bags under her eyes that looks like she hasn’t slept in 5 days. I think I’d still take a pass on that.

        1. pgl

          KellyAnne watches that POS Roseanne show? Figures. But this may be a good thing. The more she watches TV the less time she spends lying. I think her average of about 15 lies per minute when her mouth is running. But this could be a conservative estimate.

    2. pgl

      The 4600 + number is an estimate and it could be off but not in the way that you think. Some are now claiming that up to 8500 Puerto Ricans died as a result of Maria.

      But I’m sure you are putting together the definitive estimate as we speak. We await your very scientific study!

    3. Menzie Chinn Post author

      Steven Kopits: (1) there are confidence intervals associated with those estimates; (2) I suspect you have not been following the journalistic accounts of how the official tally was conducted. The fact that the coroner in San Juan had to do the evaluations on an island with interrupted power supply and severe infrastructure damage should give you pause for thought in asserting the estimate is garbarge.

        1. baffling

          steven, hurricane katrina was responsible for over 1800 deaths. puerto rico was hit with a stronger storm, more vulnerable population with much weaker infrastructure and resource support. you really think katrina killed more people in the modern us than a caribbean island with limited resources? elderly people in new orleans died due to loss of power and water over time, and were included in the death count. that situation was on steroids in puerto rico. why would you consider removing them from the statistics now, other than to rationalize a desired result?

          1. Steven Kopits

            Baffs –

            The approach used is take the number of observed deaths and subtract the number of deaths from the same period previous year. This gives us ‘excess deaths’ which can be plausibly attributed (correlated) to the hurricane. We have an official count through December, so that’s more than three months after the event.

            If there were bodies missing, we would expect the excess count to continue to rise. Instead, it fell by half in December, that is, there were about 650 fewer deaths in December than the 2,800 the previous year. This suggests that, in fact, there is no large reservoir of unrecovered bodies. It also suggests that elevated deaths were largely the result of power outages and principally advanced the deaths of otherwise ill and dying people by a few months. That’s the plain read.

            But I have to say, I agree with you. I would have thought the count much higher.

          2. baffling

            “But I have to say, I agree with you. I would have thought the count much higher.”
            then it is probably not fair to complain about numbers that are higher than the “official” count.

          3. Steven Kopits

            That’s fine, Baffs, but then you have to find the bodies. 4,000 is a big number.

          4. baffling

            “Instead, it fell by half in December, that is, there were about 650 fewer deaths in December than the 2,800 the previous year. This suggests that, in fact, there is no large reservoir of unrecovered bodies.”

            after such a catastrophic event, i would say it suggests normal reporting numbers were inaccurate. meaning, the conditions on the ground did not allow for accurate reporting of numbers. look, half the island still did not even have electricity in december. why would you even think normal reporting would be occurring at that time?

  3. noneconomist

    Quick way for PR to rebuild: declare war on their own country–i.e., the United States—, and hastily surrender. That way, rebuilding may proceed quickly.
    Remember: when we invaded Iraq, the idea was to conquer, then rebuild schools, hospitals, vital infrastructure. The thinking was: if it worked there, we could try it here. Why not in Puerto Rico?

  4. Not Trampis

    I do not know about anyone else but could some-one please elaborate on why the study is right and wrong please.

  5. ilsm

    Oh the humanity after all.

    I care as much for the US’ terrorist support [of insurgents called rebels] in Syria, and US direct support to bombing and starving millions in Yemen.

    Yes the US should expedite portable dialysis machines with generators to San Juan rather than guidance kits for smart bombs to Saudi princes!

    And not spend a trillion bucks to refit 15000 thermonuclear weapons and the delivery processes!

  6. Ed Hanson

    One question not asked in household survey.

    “Would you please take us to the gravesite or morgue of the deceased?”

    Dah, that might mean that the count would be so much lower, we could not possibly ask for such.

    No disrespect to the difficult situation of the many Puerto Ricans, but a lot of disrespect to the well fed, well housed, useless helpers from Harvard.


    1. Menzie Chinn Post author

      Ed Hanson: Just for your edification, the coauthors:

      From the Departments of Epidemiology (N.K., A.M., C.O.B.), Social and Behavioral
      Sciences (M.V.K.), and Biostatistics (R.A.I.) and the Center for Communicable
      Disease Dynamics (N.K., A.M., C.O.B.) and the François-Xavier Bagnoud Center
      for Health and Human Rights (A.F., J. Leaning, S.B.), Harvard T.H. Chan School of
      Public Health, Harvard University, the Department of Emergency Medicine,
      Beth Israel Deaconess Medical Center and Harvard Medical School (F.R., S.B.),
      and the Department of Biostatistics and Computational Biology, Dana–Farber
      Cancer Institute (R.A.I.) — all in Boston; the Department of Psychology, Carlos
      Albizu University (D.M., I.R.), and the Puerto Rico Science, Technology, and Research
      Trust (L.M.) — both in San Juan; Keck School of Medicine, University of
      Southern California, Los Angeles (P.E.); and the Section of Wilderness and Environmental
      Medicine at the Department of Emergency Medicine, University of Colorado
      School of Medicine, Aurora (C.S., J. Lemery).

      So, maybe we should also dismiss those useless helpers from the University of Colorado. My gosh, you are ignorant.

    1. Steven Kopits

      By the way, you will never see a more elegant disavowal than this. Whoever drafted it at Milken — probably senior staff and a senior legal counsel — are really pros. Artists, even.

  7. Steven Kopits

    Let me add this comment here also.

    I would prefer the addendum reads as follows:

    This release takes on heightened importance given Mr. Steven Kopits’ assertion that the methods used by the Harvard School of Public Health failed to reconcile survey results to observed deaths. Mr. Kopits, in an analysis entitled “Reports of Death in Puerto Rico are Wildly Exaggerated” (https://www.princetonpolicy.com/ppa-blog/2018/5/30/reports-of-death-in-puerto-rico-are-wildly-exaggerated) notes that, during the period covered by the study, Sept. 20 – Dec. 31, 2017, officially recorded deaths in Puerto Rico totaled only 654 more than during the same period in 2016. By contrast, the Harvard study estimated 4,645 excess deaths on the same basis. Thus, the Harvard survey suggests approximately 4,000 more persons died in the aftermath of Hurricane Maria than were recorded by Puerto Rican authorities.

    Kopits argues that this is a large discrepancy, and the onus falls to the Harvard team to demonstrate that these excess bodies must plausibly have existed in some form at certain locations. He maintains that the failure to reconcile survey to observed data ex-ante suggests a material lack of quality control procedures prior to the publication of the study.

    The wide range of the 95% confidence interval — 793 to 8498 excess deaths — does not mitigate this responsibility, in his view, as reported deaths came in below the 95% confidence interval. Moreover, the 4,600 central estimate was carried almost universally in the media, including through outlets like PBS, CBS, CNN, NBC, FOX, NY Times and LA Times, among many others. An op-ed in the NY Times specifically relied upon the central estimate to impugn the disaster response of the Trump administration. Therefore, Kopits contends that at issue is not only the range of estimates, but that the Harvard team’s central estimate appears to have created a materially distorted and misleading interpretation of both the situation on the ground and related US federal government responses.

    He argues that the Harvard team must either demonstrate that 4,000 bodies in Puerto Rico were not recovered through year-end 2017 or retract their central estimate of 4,600 excess deaths.

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