Hurricane Maria was a lot more deadly than people were led to believe. Only 64 deaths are officially attributed to this Category 4 storm when it ripped though Puerto Rico in September 2017. A closer look has revealed that the real number is closer to 5740. That’s 90 times the official number published by Puerto Rico’s government.
Reported last week in the New England Journal of Medicine (NEJM), the researchers surveyed 3299 randomly selected households in 104 barrios across the main island, and a couple more from Vieques and Culebra—the small islands off the NE coast.
Analyzing the survey data, the team estimated a mean mortality rate of 14.3 deaths per 1000 persons from 20 September 2017 (when the hurricane hit) through to the end of 2017. The mortality rate remained high even at the end of that period.
Loss of service
The more remote communities were, the more they suffered—not during but after the hurricane. On average, households went 84 days without electricity, 68 days without water and 41 days with cell phone service during the period though to the end of 2017. But in the more remote regions, families were without electricity for closer to 100 days. They averaged about 80 days without cell phone service and well over a month without water.
The loss of these critical services had a fatal impact on people who were elderly or chronically ill. Approximately one third of post-hurricane deaths were reported by household members as being caused by delayed or prevented access to medical care. This is three times the number of deaths caused directly by the hurricane itself. The type of disruption of medical services reported by the household members (in descending frequency) included:
- Unable to get medicines
- Unable to use respiration equipment
- Roads damaged
- Facility closed
- Doctors unavailable
- Unable to afford care
- Transport issues
- No 911 service
- Unable to have dialysis
The NEJM report concludes by stating that “health care disruption is now a growing contributor to both morbidity and mortality in natural disasters.”
Ready or not?
In light of this conclusion, it’s instructive to look at how Puerto Rico is preparing for this year’s hurricane season. According to Governor Ricardo Rossello , the island is well prepared. FEMA has stocked millions of meals and bottles of water on the island. Officials say they have installed satellite and radio towers across the island in case communications fail. Fiber optic cables have been buried to protect them from the wind. Hundreds of generators and water pumps have been located at hospitals. 
So clearly preparations have been made.
But according to the same report, there are still people whose damaged roofs have not been repaired—they live with “gaping holes in their homes.” There are families living in flood prone areas, and there are still almost 14,000 people who still have no electricity more than eight months after the storm.
Hooking up diesel generators is certainly one way to try and keep the lights on—and essential health services running. But how reliable are they?
When Hurricane Sandy hit the east coast of the US in 2012, electricity service was disrupted in many cities for days—in some cases weeks. Without electricity, emergency shelters often depend on diesel-powered backup generators to supply power. But after Sandy had passed, fuel for the diesel generators and emergency vehicles was in short supply, and floodwaters often made it difficult to get fuel to where it was needed. In many cases, diesel generators were themselves flooded out.
However, Midtown Community School in Bayonne, New Jersey, was different. It had a constant supply of electricity throughout the storm and afterwards thanks to a hybrid solar-diesel generating system installed in 2004. The school served as a community shelter during the storm because of the reliability of this power system .
In the case of this school, the 292 kW photovoltaic system was installed in order to substantially reduce diesel fuel costs—but the success of this system in maintaining power during a devastating storm shows the importance of installing solar photovoltaic systems on critical infrastructure that must absolutely keep functioning during and after an extreme weather event.
Installing diesel generators in hospitals can be a useful stop-gap measure because it’s quick, and generators can be found off-the-shelf and quickly patched in. But large areas of Puerto Rico were flooded by hurricane Maria; roads were impassable, and it was very difficult if not impossible to find enough diesel fuel.
Tesla has demonstrated just how quickly a large PV system can be installed and operationalized. In October 2017, the company installed a PV system adjacent to San Juan’s Hospital del Nino. It took just three weeks to get the system up and running. Tesla has also set up photovoltaic minigrid power systems on the islands of Vieques and Culebra.
Keeping key medical faculties operational during and after a hurricane is clearly an absolute priority. But many critically ill people dependent on medical services will be trapped in their homes without electricity, and in areas where the cell phone service has crashed because of the storm.
So what the Governor Rossello is proposing for preparing Puerto Rico for the hurricane season is not enough. School buildings doubling as emergency shelters with photovoltaic power and energy storage systems are the key to community protection. Cell phone towers must be able to resist hurricane force windspeeds and function independently of the grid. That means batteries must be installed. Often forgotten are the sewage treatment plants—if they fail because the grid has crashed this is potentially a major health hazard.
Government agencies in Haiti (and the other Caribbean nations) should be paying close attention. With a population three times that of Puerto Rico and an electricity distribution system just as fragile and decrepit, Haiti is hugely vulnerable to hurricanes. The country came through the 2017 season relatively unscathed, but there is no guarantee that the island will be so lucky this year. Digicel must ensure that all its cell phone towers can resist a major storm. The working assumption for disaster preparedness is always that the grid will crash and low-lying coastal areas will be inundated.
For disaster preparedness planning, that’s the point of departure.
 See: Puerto Rico Governor outlines island’s hurricane preparedness plans. At: https://www.npr.org/2018/29/615263459/puerto-rico-governor-outlines-islands-hurricane-preparedness-plans
Also check out the previous blog here which talks about this year’s Caribbean hurricane season