More than 4,500 people are believed to have been killed in Puerto Rico as a result of Hurricane Maria last year, more than 70 times the official death count of 64, the prestigious New England Journal of Medicine reported Tuesday. That estimate would make the hurricane far deadlier than Hurricane Katrina in 2005, when 1,833 people died. Deaths that count towards a total death toll include directly related events, like "flying debris," as well as deaths "caused by unsafe or unhealthy conditions resulting in injury, illness, or loss of necessary medical services." Puerto Rican deaths went underreported because hurricane-related casualties are required to be confirmed by the island's Institute of Forensic Sciences, and indirect deaths often aren't properly represented on official death certificates.

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