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Commissioned by Governor Rosselló and carried out by the Milken Institute School of Public Health at George Washington University, the study found that the death toll was considerably higher than original reports.

An estimated 2,975 excess deaths related to Hurricane Maria from September 2017 to February 2018, a number that is 22 percent higher than the number of deaths that would have been expected during that period in a year without the storm.

As a result of the study, Puerto Rican Gov. Ricardo Rosselló revised the official death count for the storm from 64 to the study's count of 2,975. The National Hurricane Center said Hurricane Maria caused an estimated $90 billion damage in Puerto Rico and the U.S. Virgin Islands, the third-costliest hurricane in U.S. history.

Financial instability and a fragile infrastructure made the Caribbean island particularly vulnerable to such weather events, Santos-Burgoa said. Residents here say they've been disappointed with the federal response following Hurricane Maria. "But if you look at a real catastrophe like Katrina, and you look at the tremendous hundreds and hundreds and hundreds of people that died, and you look at what happened here with, really, a storm that was just totally overpowering - nobody has ever seen anything like this", he said.

A Harvard University study, published in May, estimated that there were 4,645 more deaths in Puerto Rico due to the storm.

Puerto Rico's official death toll from Hurricane Maria, the most powerful storm to hit the Caribbean island in almost a century, was raised on Tuesday from 64, a number widely discounted as far too low, to nearly 3,000, based on a study ordered by the governor of the U.S. territory.

Researchers found that the risk of death was 45 percent higher for those living in impoverished communities, and that men older than 65 saw a continuous elevated risk of death. In the second phase, the researchers plan to focus on the causes of death. He told emergency responders that they should be "very proud" of the low death count in Puerto Rico. That's nearly twice the government's previous estimate. "What is your death count, as of this moment - 17?"

The disconnect between the administration's initial sanguine assessment of the situation and the enormity of the disaster was evident 12 days into the crisis when Elaine Duke, then acting United States homeland security secretary, characterized the federal response as "a really good news story" and spoke of a "limited number of deaths". The GW-led team analyzed death certificates and other mortality data for six months from September 2017 through February 2018.

The report found that "lack of communication, well established guidelines and lack of training for physicians on how to certify deaths in disasters, resulted in a limited number of deaths being identified as hurricane related".

The researchers also said the public health system needs to be strengthened, though Goldman said they don't know yet whether those weaknesses contributed to storm-related deaths.

Rossello pledged to carry out the recommendations, though there are questions about Puerto Rico's ability to do so.