The death toll of Hurricane Maria in Puerto Rico has jumped from 64 to nearly 3,000 after an official report was released.
Governor Ricardo Rossello raised the toll to 2,975 after a government-commissioned study found deaths from the storm were severely undercounted.
He has also said he will create a commission to implement the recommendations in the new report, and create a registry of those expected to be most vulnerable in a future storm, such as the elderly or bedridden.
The new estimate of 2,975, 46 times more than the original figure, was made by researchers with the Milken Institute School of Public Health at George Washington University.
Maria devastated the island in September 2017, knocking out the entire electrical grid.
The government’s previous estimate had been 1,400 more deaths than normal in the three months after the storm.
Dean of the Milken Institute School, Lynn Goldman, said: “We are hopeful that the government will accept this as an official death toll.
“A lesson from this is that efforts for assistance and recovery need to focus as much as possible on lower-income areas, on people who are older, who are more vulnerable.”
According to researchers, part of the reason the toll had been so low is that doctors were not trained in how to classify deaths as a result of a disaster.
The number of deaths between September 2017 and February 2018 was 22% higher than the same period in the year before.
It could have political implications, as Donald Trump had marvelled over the small number of fatalities compared with “a real catastrophe like Katrina” and was criticised for responding half-heartedly to the disaster.
The researchers counted the deaths over a longer period because of how long people were without power.
Dr Goldman added: “That caused a number of issues. It’s fairly striking that you have so many households without electricity for so long.
“That’s unusual in the US after a disaster.”
Puerto Rico’s government released data showing increases in several illnesses which could have been linked with the storm, including sepsis and heart illnesses.
Puerto Rican Bethzaida Rosado said she didn’t believe the government was ready for the storm, and is still angry about the death of her 76-year-old mother.
She died because oxygen tanks were not available on the island after the storm.
The study also found the government only had plans in place to deal with a Category 1 storm, and Maria was Category 4 with 154mph winds.
Damage was estimated to cost the island $100bn (£77bn).