JUAN GONZÁLEZ: We begin today’s show in Puerto Rico. A stunning new report by researchers at Harvard has revealed the death toll from Hurricane Maria may be 70 times higher than the official count. The official death toll still stands at 64, but the new research says the death toll is at least 4,645, and perhaps as many as 5,740. The Harvard study was published Tuesday in The New England Journal of Medicine.

AMY GOODMAN: President Trump has so far not responded to the new study. But in October, during a visit to Puerto Rico, Trump boasted about the low official death count.

PRESIDENT DONALD TRUMP: Now, I hate to tell you, Puerto Rico, but you’ve thrown our budget a little out of whack, because we’ve spent a lot of money on Puerto Rico. And that’s fine. We’ve saved a lot of lives. If you look at the—every death is a horror, 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’s ever seen anything like this—and what is your—what is your death count as of this moment? Seventeen?

GOV. RICARDO ROSSELLÓ: Sixteen certified.

PRESIDENT DONALD TRUMP: Sixteen people certified. Sixteen people versus in the thousands. You can be very proud of all of your people, all of our people, working together. Sixteen versus literally thousands of people.

JUAN GONZÁLEZ: With a death toll of at least 4,645, Hurricane Maria would become the second-deadliest hurricane in U.S. history, behind only the Galveston Hurricane of 1900, which killed as many as 12,000 people in Texas. The Harvard study surveyed almost 3,300 randomly selected Puerto Rican households and found mortality rates leaped 62 percent from September 20th through the end of 2017, compared with the prior year. Researchers counted not just deaths directly from storm injuries such as falling debris, but also those who died due to storm-related delays in medical treatment for injuries, infections and chronic illnesses.

AMY GOODMAN: The survey found “Interruption of medical care was the primary cause of sustained high mortality rates in the months after the hurricane, a finding consistent with the widely reported disruption of health systems. Health care disruption is now a growing contributor to both morbidity and mortality in natural disasters.”

Well, for more, we go to San Juan, Puerto Rico, where we’re joined by Omaya Sosa, co-founder of Puerto Rico’s Center for Investigative Journalism, where she’s a reporter. Her latest article is headlined “Puerto Rico Government Did Not Prevent Most Hurricane María-Related Deaths.”

Welcome back to Democracy Now!, Omaya. Can you start off by talking about the significance of this Harvard study? At the time, it was said something like 60 people were dead; now this number of between 4,600 and 5,700 people.

OMAYA SOSA: Good morning, Amy. Good morning, Juan. Thanks for having me here with you again.

It’s very important. It’s significant because there’s finally a prestigious institution saying what we have been saying for eight months. Everybody is shocked. We are not shocked. We have been saying that the numbers were much higher, since the week after the hurricane, in September. And as early as the first week of December, we had already said that the first month, there was more than a thousand casualties. So, I’m really glad people are finally listening.

And, you know, things are still really bad. As you said, last week we published a story about the situation in hospitals and healthcare facilities in Puerto Rico and how they contributed to this high death toll. The situation is still bad in some places. And it’s the result of decades of neglect from the government to the healthcare system as a whole.

JUAN GONZÁLEZ: Well, Omaya, I wanted to know if you could expand on that? Because, first of all, the study only goes through December 31st of 2017. Clearly, there were many areas in Puerto Rico that didn’t even have electricity into January and February, and so the study doesn’t even cover that area. But could you talk about what has happened to the healthcare system in Puerto Rico, especially the privatization efforts that occurred in the ’90s?

OMAYA SOSA: Well, Puerto Rico used to have a public healthcare system that, let’s say, in the '70s, was a model even to the world. By the ’90s, it had many problems, but it still had a leveled, let's say, comprehensive healthcare system, where you had primary healthcare facilities that were public, then you had secondary and tertiary. And they were all over the island in an ordered, organized system. And in the '90s, because of the—they were losing a lot of money, the government was losing a lot of money with the healthcare facilities, and they had many other kinds of problems with supplies and so forth, they privatized most of the system, leaving only the San Juan hospitals, mainly, and some minor centers around the island. So, that's—most of the hospitals in Puerto Rico are private now. And this hurricane struck in a moment where that was not reorganized, let’s say. The government had no control over the hospitals in the rest of the island. And when they started trying to see how they could order the system, they had really no way. They had no plan.

So, besides this privatization thing, the government has also responsibility over the private hospitals. They license these hospitals. They regulate these hospitals. And they’re supposed to inspect these hospitals at least every two years. We found out that around 40 percent of the hospitals had not been inspected. And we found places—it’s hospitals and healthcare facilities; it’s not only hospitals. So you have 70 hospitals. And as a whole, with minor facilities and elderly homes that are also considered healthcare facilities, it’s 400. So, we found out there were some of these places that were not inspected for eight years, let’s say.

So, there’s, on one hand, the privatization of facilities that left the government without any plan to where to channel the patients in this crisis, in this emergency, and then you have the situation that the private hospitals were not being inspected as they should be. We asked for all these reports. And, no surprise, they didn’t give us access to reports, so we don’t even know which ones they inspected, what these reports said. It’s part of, as you’ve seen, a trend from this government to not give any information on this issue.

AMY GOODMAN: You’re suing for the mortality data?

OMAYA SOSA: I’m sorry? Yes, we are, actually. That was a big problem. The mortality data was one of the main problems we encountered when we started investigating this in September. And it still is. The Harvard report mentions this. Not even they got the data after December. The government has not made public any data at all since December. And we have been suing the government since February for the complete set of the mortality data, so we can know what happened after December in Puerto Rico.

JUAN GONZÁLEZ: And, Omaya, why do you feel that the—from your investigation of this tragedy, that the government has maintained this clearly false death toll of first 16, then 64, and even now, even though it’s commissioned its own study, it keeps delaying putting that study out of what the actual death toll was? Why do you think that is?

OMAYA SOSA: You know, I think, in the beginning, that it just was a matter of looking good, that they were being effective in their response, because they knew this was happening from week number two. So, you know, it’s very—it’s negligence that they have not attended the situation with the seriousness it needs. And they could have prevented many, many deaths, because if from September, first week of October, you know what’s going on and you take charge of the situation, how many deaths could have been prevented? The data we have, that goes until November only, shows that deaths were still spiking in November. So, many could have been prevented.

In the end, when nothing—they had no other choice. In December, data was so clear that the mortality had spiked so much in their own data, that the governor had to admit that their numbers were wrong, and commissioned the study. But still, I don’t think there’s a real will to find out what was going on. We’re already in the new hurricane season. We have no information. The study is still not ready—the one commissioned by the governor. And, I mean, we cannot prepare for the next season.

AMY GOODMAN: I want to turn to a clip of Jaime Plá, president of the Puerto Rico Hospital Association. The association claims the Puerto Rican government never established a special protocol to handle deaths during Hurricane Maria.

JAIME PLÁ: [translated] All deaths are clinical. In other words, if they want to make a determination like after Hurricane Maria the death count in Puerto Rico increased by 43 percent, and I make a correlation that I’m going to put that number into the Maria death toll statistics, fantastic. I don’t have a problem with that. But I need to be responsible. And from the hospital’s point of view, I can’t ask them to make a diagnostic determination that a death had to do with anything other than a clinical reason, because that’s the way we’ve always worked. In terms of specific deaths, I believe if they want to justify a series of deaths, they have to implement a protocol of how this will be done, and they have to cite a legal justification to do that.

AMY GOODMAN: Omaya Sosa, if you can respond to Jaime Plá, the president of the Puerto Rico Hospital Association? He was speaking to your Center for Investigative Journalism.

OMAYA SOSA: Yeah, I have to say he’s actually right. I mean, there’s no—the governor and the government was the one that had to take charge of this and put out an executive order ordering the hospitals and the doctors to do this in a certain way, and that they never did. They still haven’t fixed that protocol. They have admitted that the protocol is just simply wrong and it’s not working. And I have to repeat, I think there is a lack of interest from the government to really make this happen. It’s been months.

JUAN GONZÁLEZ: And, Omaya, in terms of the federal response in Washington to the hurricane, what is, from your sense, the level of aid that has actually reached Puerto Rico—not what Congress votes or what President Trump says in a press conference, but of the aid that has actually reached the people of Puerto Rico in their efforts at recovery?

OMAYA SOSA: Too little, too late. We still have about 100,000 people here without electricity, and it’s been eight months. I don’t think that would have happened in any of the states. I’m sorry, but it’s unacceptable.

AMY GOODMAN: And overall, as we wrap up, Omaya, if you can describe the condition of Puerto Rico right now?

OMAYA SOSA: It’s much better in terms of places with electricity and with, I mean, the basic services. But it’s still hanging on a thread. Many places lose electricity or lose water service weekly or biweekly, a couple of times each week. The situation—but that’s just going to basics. When you go to the situation in general, it’s far from getting back on its feet. A lot of unemployment. The streets are in very bad conditions. I mean, it’s difficult just driving around San Juan and the island. Amy, you were here, so you saw the conditions, what the infrastructure is in. Everything is just, you know, hanging in there.

AMY GOODMAN: Well, we want to thank you very much for joining us, Omaya Sosa, co-founder of Puerto Rico’s Center for Investigative Journalism. The latest report, “Puerto Rico Government Did Not Prevent Most Hurricane María-Related Deaths.”

Special thanks to WIPR public television in San Juan, which, like many PBS stations around the country, also plays Democracy Now! daily, where Omaya is broadcasting from today. And next Wednesday, we’ll have a special on Puerto Rico.

This is Democracy Now!. When we return, Glenn Greenwald joins us. Stay with us.