After Hurricane Maria struck Puerto Rico, last September 20th, leaving three and a half million Americans without power, clean water, or access to medical care, President Donald Trump publicly suggested that maybe, for people like them, the situation was kind of normal. The island “was already suffering from broken infrastructure”; the electrical grid was already in “terrible shape”; the government was in debt, the leaders didn’t know how to lead, and its truck drivers had to be exhorted even to show up for their jobs. Even as Puerto Rico slipped into a blackout that lasted, in parts of the island, for months—and, last month, again engulfed it almost entirely, after some post-hurricane repairs went wrong—Trump said, “They want everything to be done for them.” The implication was that these Americans were trying to turn images of their ordinary poverty into a special bonus, all because of a little rain and wind.

That stance—that disdain—is one of the reasons why a new report on the number of deaths in Puerto Rico attributable to Maria, led by researchers at Harvard’s T. H. Chan School of Public Health and published, this week, in The New England Journal of Medicine, is so crucial. It should be a source of shame for everyone who got tired of thinking about Puerto Rico—perhaps especially, but not only, the President. The researchers’ approach was, precisely, to try to determine what was normal in Puerto Rico, in terms of the number of deaths in a three-month period, and to compare that figure to the numbers in the storm’s wake. They found that there were four thousand six hundred and sixty-five excess deaths.

“We calculated a 62% increase in the mortality rate from September 20 through December 31 in 2017 as compared with the same period in 2016, corresponding to an annual mortality rate of 14.3 deaths” per thousand residents, the researchers wrote. And they added that that number might actually be conservative, because of their methodology: they also relied on household surveys, conducted between January 17th and February 24th of this year, and “we could not survey single-person households in which a death had occurred.” That is, if a person living alone had died in the darkness of the storm, that death would remain obscure. For that single-person population, the researchers used the “normal” numbers from 2016. If they had not—if they had been less cautious—the number of excess deaths their study yielded would have been five thousand seven-hundred and forty.

The official death toll, calculated by the Puerto Rican authorities, is sixty-four, but no one—except, perhaps, the President, who, when the number was still sixteen, bragged about how much better the outcome was than with Katrina—really believed that. (There is still uncertainty about the Katrina death toll, which many estimates place between one and two thousand.) For one thing, for a death to make it into that two-digit tally it had to be confirmed by an office in San Juan, which meant that either the body had to be taken to the capital or that a medical examiner had to go to where the body was. The wide discrepancy in the numbers, in other words, is not simply attributable to differing definitions of what it means to die as the result of a storm. There is a shared recognition that it does not just mean, say, drowning. As the Harvard report notes, “According to the Centers for Disease Control and Prevention, deaths can be directly attributed to a tropical cyclone if they are caused by forces related to the event, such as flying debris, or if they are caused by unsafe or unhealthy conditions resulting in injury, illness, or loss of necessary medical services.” One might add deaths that can be attributed to conditions resulting from political indifference and bigotry.

Other analyses, based on incomplete official data—which the Puerto Rican government has said it is reviewing and, according to the Harvard researchers, has, in part, declined to share—have put the total at more than a thousand deaths. Rick Scott, the governor of Florida, who is running for a seat in the U.S. Senate, visited Puerto Rico this week—Florida has many voters who care about the island. When he was asked if he thought that the Harvard numbers were reliable, he said, according to the Tampa Bay Times, “Whatever the number is, it’s—I mean, you just—you know, it’s horrible.” That’s true enough, but what the real number is, and what contributed to it, matters. There are other studies underway; every lost American deserved to be counted.

One in ten of the deaths that the report tallied were directly attributable to the storm; the greatest number, though, came because medical care was interrupted or denied. The problems included not being able to get medicine, finding medical facilities closed, being unable to reach a doctor, and having no electricity to run respirators and other equipment. The study also captured a high level of household disruption, with people moving around or off the island; the full scope and political impact of the post-Maria migration still needs to be measured. There were also homes that couldn’t be surveyed because they had been abandoned.

Among the more devastating statements in the report, in a quiet way, is this one: “Our estimates are roughly consistent with press reports that evaluated deaths in the first month after the hurricane.” That is, they matched the stories in the media—the interviews, the footage—about what was happening on the ground. Similarly, the Harvard report notes that the deaths from a lack of medical care are “consistent with the widely reported disruption of health systems.” And again: “Many survey respondents were still without water and electricity at the time of sampling, a finding consistent with other reports.” And yet we somehow suppose that those same estimates come, now, as a shock. We saw the pictures; we heard the reports. What did we think they added up to? Not to sixty-four; not to the grade that Trump said that he would give his Administration’s response, on a scale of one to ten: “I’d say it was a ten.” The shocking thing is that we can still pretend to be surprised.

When Sarah Huckabee Sanders, the White House spokeswoman, was asked about the Harvard report, she responded with a vague restatement of how well everyone was working together. It was, for this White House, a normal response. And it was not enough. It didn’t even come close.