Puerto Rico's efforts to record how many people died as a result of Hurricane Maria have slowed to a crawl because a lack of power has forced officials to rely on written records collected from 53 medical offices, rather than using electronic files.
"We have to go piece of paper by piece of paper," Hector Pesquera, secretary of public safety, said Saturday at the government's San Juan command center. "Energy. That's the crux of all this thing. That's why the governor is taking such an aggressive approach. So much depends on energy."
President Donald Trump has cited the low reported death toll in lauding his administration's response to the storm, comparing it favorably to "a real catastrophe like Katrina" during a visit to the island.
The count rose to 48 Saturday when hospitals sent three bodies to the medical examiner. One of those people died from not receiving dialysis.
Bodies are being sent to medical examiners while hospital reports and permits needed for burials are reviewed. "We are now crisscrossing those so that we don't miss any," Pesquera said. That should account for most of the death toll, but, "if there is an urgency to bury and they died of natural causes we will never get it."
Puerto Rico reported 35 deaths so far in October compared with a normal rate of about 2,000 a month for any cause, he said.
Gov. Ricardo Rossello announced what he called an aggressive plan to restore 95 percent of the electricity grid by late December, accelerating the timeline from previous estimates of six months to a year. The island's network was at 15 percent on Saturday, more than three weeks after the storm struck.
The government is refueling backup generators at all public and private hospitals on the island. Intensive care and surgical trauma units have double backups to maintain electricity supplies, Pesquera said. Patients being treated in some hospitals may not have air conditioning.
"We are still saving lives, we have to make sure we are taking care of patients in the hospital; it is a never-ending cycle because they are still on alternative power," Pesquera said.
