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In case you need further proof that the United States government doesn’t give a shit about the people of Puerto Rico or the ongoing, systemic damage Hurricane Maria caused the U.S. island last fall: at least 4,645 people died there because of the storm and its aftermath, according to a new Harvard study released Tuesday in the New England Journal of Medicine. That number exists in stark contrast to the official government death toll of 64.

There are a variety of causes for the astronomical number, including limited access to healthcare for the elderly and ill, and isolated communities with limited resources due to weeks of road closures and no electricity. The death toll might continue to grow, as residents live with an unreliable power grid and still lack access to water and other essential services.

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From the report (via the Washington Post):

Researchers in the United States and Puerto Rico, led by scientists at the Harvard T.H. Chan School of Public Health and Beth Israel Deaconess Medical Center, calculated the number of deaths by surveying nearly 3,300 randomly chosen households across the island and comparing the estimated post-hurricane death rate to the mortality rate for the year before. Their surveys indicated that the mortality rate was 14.3 deaths per 1,000 residents from Sept. 20 through Dec. 31, 2017, a 62 percent increase in the mortality rate compared to 2016, or 4,645 “excess deaths.”

The study accounts for thousands of Puerto Ricans who died long after Trump’s quick trip to the island in October of last year, where he bragged a low death toll, and suggested citizens of Puerto Rico were lucky because Maria could’ve been “a real catastrophe like [Hurricane] Katrina.”

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The report also accounts for reasons the death toll might be so incredibly inaccurate (again, 4,645 to 64, that’s 72 times higher than what the government has reported.) Via the Post:

Every disaster-related death, they said, must be confirmed by the government’s Forensic Sciences Institute, which requires that bodies go to San Juan or that a medical examiner travel to the local municipality. And it can be difficult to track indirect deaths from a worsening of chronic conditions due to the storm.

The researchers said that the government of Puerto Rico stopped sharing mortality data with the public in December 2017.

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Read on here.