Milken Institute SPH Researchers Reflect on ‘Groundbreaking’ Hurricane Maria Study

The study identified 2,975 excess deaths in Puerto Rico in the months following the disaster and helped to bring closure to families on the island.

April 8, 2021

By Kristen Mitchell

The George Washington University Milken Institute School of Public Health’s groundbreaking study on excess deaths linked to Hurricane Maria changed the way researchers track deaths after natural disasters—providing a roadmap for uncovering the true impact of COVID-19 in communities today.

Hurricane Maria struck Puerto Rico in September 2017 as a Category 4 storm—the first hurricane of that size to hit the island in 85 years. The Puerto Rican government commissioned GW to uncover excess deaths linked to the hurricane. Researchers published an independent report in August 2018 that estimated there were 2,975 excess deaths in Puerto Rico due to Hurricane Maria between September 2017 and February 2018—a number significantly higher than what had been previously reported. In partnership with the University of Puerto Rico, GW researchers spent months completing interviews with people on the island and in-depth statistical analyses to learn about the circumstances leading up to individual deaths.

“This was an extremely important piece of work at the time to everyone in Puerto Rico who was affected by Hurricane Maria,” said Lynn R. Goldman, the Michael and Lori Milken Dean of the Milken Institute SPH. “I'm very proud of how we were able to assemble the data and the best science in short order.”

Milken SPH leaders and researchers gathered virtually on Monday to kick off National Public Health Week with a GW bicentennial event, a screening of the documentary film, "Fearless Science," about the school’s Hurricane Maria research. 

Mike Milken, a benefactor of the school, said, “The groundbreaking work of the School of Public Health at GW honors the victims of the hurricane and inspires those of us who are constantly seeking more effective ways to assist communities in need.” 

The screening was followed by a discussion with Milken Institute SPH professors Carlos Santos-Burgoa, Elizabeth Andrade and Ann Goldman. Dr. Santos-Burgoa, the principal investigator of the project and a professor of global health, said the research team chose to publish the results immediately as opposed to waiting to publish them in a peer reviewed journal—a decision that highlighted the importance of sharing results quickly so they could be translated into policy and practice. 

“A message to researchers and students: do not delay action on your results, nor save them in your computer,” Dr. Santos-Burgoa said. “Knowledge is best tested in the practice of life, real life interventions.”

The research identified gaps in the death certification and public communication processes and made recommendations that will help prepare Puerto Rico for future hurricanes and other natural disasters. The report found that while Puerto Rico was prepared for a hurricane, the government was not adequately prepared for one as strong as Hurricane Maria, and there were no guidelines on how to communicate with the public in a catastrophic context, said Dr. Andrade, an assistant professor in the Department of Prevention and Community Health.

The report brought closure to families across Puerto Rico who lost loved ones in the months following the storm, and Dr. Andrade said she felt a “personal sense of dedication” to sharing the stories of those who died. Since the report was published, Dr. Andrade has been working on follow-up research about factors that build resilience in a post-disaster environment.

“My hope is that the findings from our research will contribute to better preparedness, protection of populations moving forward, as well as better communication with the public in disaster,” she said. 

Dr. Ann Goldman, director of education programs in the Department of Epidemiology and Biostatistics’, said the Hurricane Maria study will enable researchers to develop more information on mortality and attribution, and develop tools to establish attribution in the wake of natural disasters. This issue has been at the forefront of discussions on how to count deaths related to COVID-19. 

“This is a problem across the United States and the world,” Dr. Ann Goldman said. “It's very important for our societies that we…enable families to have closure and that we understand how these deaths occurred.”