As Hurricane Florence battered the Carolinas, President Donald Trump stirred a tweetstorm of his own creation by continuing to deride an estimated death toll from two hurricanes that hit Puerto Rico last year.

He said the count of Puerto Ricans killed by Hurricane Maria jumped from 16 during his October visit to 64 deaths a few months later, and "then, like magic, ‘3000 PEOPLE KILLED.'"

“When Trump visited the island territory last October, OFFICIALS told him in a briefing 16 PEOPLE had died from Maria.” The Washington Post. This was long AFTER the hurricane took place. Over many months it went to 64 PEOPLE. Then, like magic, “3000 PEOPLE KILLED.” They hired.... — Donald J. Trump (@realDonaldTrump) September 15, 2018

He said in a second tweet that a method by George Washington University researchers to come up with a death count "was never done with previous hurricanes because other jurisdictions know how many people were killed. FIFTY TIMES LAST ORIGINAL NUMBER - NO WAY!"

....GWU Research to tell them how many people had died in Puerto Rico (how would they not know this?). This method was never done with previous hurricanes because other jurisdictions know how many people were killed. FIFTY TIMES LAST ORIGINAL NUMBER - NO WAY! — Donald J. Trump (@realDonaldTrump) September 15, 2018

Trump’s defiance echoed his initial tweets Sept. 13 in which he said 3,000 people "did not die" from the storms and that such a number was boosted by counting deaths from "old age." Turning conspiratorial, he said it was "done by the Democrats in order to make me look as bad as possible."

3000 people did not die in the two hurricanes that hit Puerto Rico. When I left the Island, AFTER the storm had hit, they had anywhere from 6 to 18 deaths. As time went by it did not go up by much. Then, a long time later, they started to report really large numbers, like 3000... — Donald J. Trump (@realDonaldTrump) September 13, 2018

.....This was done by the Democrats in order to make me look as bad as possible when I was successfully raising Billions of Dollars to help rebuild Puerto Rico. If a person died for any reason, like old age, just add them onto the list. Bad politics. I love Puerto Rico! — Donald J. Trump (@realDonaldTrump) September 13, 2018

Trump ignores basic facts about reality for Puerto Ricans after Hurricanes Irma and Maria after September 2017. Trump also miscasts the estimate as a Democratic effort when it was created by experts on disaster response.

There was no "magic" to the increase in the death toll estimates. It is based in science.

"Early after a disaster, death tolls tend to be preliminary," said Roberto Rivera, College of Business University of Puerto Rico. "In the case of Hurricane Maria, indirect deaths are the reason the toll was so high, as suggested by some reports. That's the context that Trump is missing."

Death toll estimates by academics

The government in Puerto Rico initially reported 16 deaths in September 2017, and raised it to 34 in October and then 64 in December.

But for months, researchers had said that the government’s official count was an undercount.

Part of a death toll is a count of direct deaths from a storm, such as being struck by a falling tree or drowning in a flood. The more complicated count comes from indirect deaths caused by unsafe or unhealthy conditions, such as someone who relies on a respirator but loses electricity.

Usually, the death toll of an event such as Hurricane Maria is determined through an exam by a medical examiner. But Puerto Rico officials did not have the proper resources to effectively conduct forensic examinations.

Without complete medical records, researchers were left with other ways to try to come up with an estimate. Multiple studies used different methodologies and time periods, and therefore arrived at different results about "excess deaths" — comparing the number of deaths with historical trends during the time period in previous years.

Excess death measurement has been a standard in the measurement of deaths attributable to environmental and climate events since the early 1960s, said Alexis Santos-Lozada, an assistant teaching professor at Pennsylvania State University.

However, in some ways the case in Puerto Rico is unique. Before Hurricane Maria, governors and stakeholders were usually the first ones to raise alarm about the number of deaths — as the mayor of New Orleans did after Hurricane Katrina.

"This was not the case of Puerto Rico, in Puerto Rico we turned to estimates because both the governor and the president minimized the number," Santos-Lozada said.

Origins of the 3,000 estimate

Trump was referring to an estimate published in late August by George Washington University’s Milken Institute. That estimate was higher than some earlier estimates by academics and the New York Times that were around 1,000, but lower than the 4,645 midpoint of a Harvard study.

Gov. Ricardo Rosselló contacted George Washington University in December, which led to commissioning the university to do a study.

The Milken Institute published the first phase Aug. 28 and found a midpoint of 2,975 excess deaths in the six months following the hurricane.

That number was 22 percent higher than the number of deaths that would have been expected during that period in a year without the storm. Researchers found that lack of communication and training for doctors about how to certify deaths resulted in an undercount.

Trump misrepresents what the Milken Institute study actually concluded about deaths. The study did not include anyone who died for "any reason, like old age," as he said. If that were the case, the number of deaths would have been much higher. The study found that there were 16,608 total deaths during the six months — and approximately 77 percent were at least 65 years old.

The study didn’t attribute individual deaths to Maria; it tried to determine a number of "excess" deaths. In other words, it tried to find how many deaths would have been expected were it not for the but rather came up with a counterfactual: how many deaths would you expect to see each month if the hurricane hadn’t happened and then subtract the actual number to arrive at an "excess" number of deaths.

Dr. John "Jack" Sandberg, an associate professor in the department of global health, told PolitiFact that the contract stipulated that the study would be done with no government interference by officials in Puerto Rico — and none occurred.

"I did the number crunching on this, no one ever said boo to me about anything," he said. "We are quite shocked that this is having political repercussions."

Lynn Goldman, the dean of the Milken Institute, responded to Trump's tweets in a Washington Post op-ed.

"To set the record straight, our study was carried out with no interference whatsoever from any political party or institution," she wrote of the study done in collaboration with scientists at the University of Puerto Rico Graduate School of Public Health. "We do not know the exact circumstances around each of the 2,975 excess deaths that occurred. Many factors — disruption in transportation, access to food, water, medications, power and other essentials — may have contributed."

The government in Puerto Rico accepted the Milken institute study and raised Maria's official death toll from 64 to 2,975.

The study's next phase is expected to more closely examine the identified deaths to look at causes through interviews with family members and medical personnel.

Our ruling

Trump tweeted that 3,000 people did not die in two hurricanes that hit Puerto Rico and that the death toll estimate was "done by Democrats."

Trump tried to cast doubt on an estimate by George Washington University that includes indirect deaths. Studies by other academics or researchers have also concluded that the number of deaths was above 1,000.

The death toll provided by the government in Puerto Rico did rise after the storm from 16 to 64 in the months following the storm. The government then hired George Washington University to research an estimate and several months later it produced a report estimate 2,975 deaths. None of that is evidence of an estimate created by a Democratic conspiracy to make Trump look bad.

We rate this statement False.