Horrific numbers from a Harvard Study, detailed by The Washington Post:

At least 4,645 people died as a result of Hurricane Maria and its devastation across Puerto Rico last year, according to a new Harvard study released Tuesday, an estimate that far exceeds the official government death toll, which stands at 64.

The study, published in the New England Journal of Medicine, found that health-care disruption for the elderly and the loss of basic utility services for the chronically ill had significant impacts across the U.S. territory, which was thrown into chaos after the September hurricane wiped out the electrical grid and had widespread impacts on infrastructure. Some communities were entirely cut off for weeks amid road closures and communications failures.

Puerto Rico was hardly prepared to take on the response to the storm, but the federal government didn’t appear to be up for it either:

The official toll included a variety of people from across Puerto Rico, such as those who suffered injuries, were swept away in floodwaters, or were unable to reach hospitals while facing severe medical conditions. No. 56 was a person from the city of Carolina who was bleeding from the mouth but could not reach a hospital in the days after the storm. Once arrived, the patient was diagnosed with pneumonia and died of kidney failure. No. 43, from Juncos, suffered from respiratory ailments and went to the hospital — only to be released because of the coming storm. That person later returned, dead.

The new study indicates there probably were thousands more, like Leon, who died in the weeks and months that followed but were not counted. Their deaths have long raised questions about the manner and integrity of the Puerto Rico government’s protocols for certifying hurricane-related deaths.

Gov. Ricardo Rosselló’s administration did not immediately release mortality data nor did officials provide much information publicly about the process officials were using to count the dead. But officials and physicians acknowledged privately that there were probably many, many more deaths and bodies piling up in morgues across the island.