4,645. And counting.

That’s the new number of estimated deaths of U.S. citizens in Puerto Rico directly or indirectly linked to Hurricane Maria, according to a new study published in the New England Journal of Medicine.

The new estimate is more than 70 times the official death toll of 64. And it coincides with the advent of the new hurricane season – June 1 – and amid brand new warnings that if another hurricane strikes Puerto Rico, even a relatively weak, Category 1 hurricane, the island’s power grid could collapse.

According to the Washington Post:

Researchers in the mainland 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 almost 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 with 2016, or 4,645 “excess deaths.”

“Our results indicate that the official death count of 64 is a substantial underestimate of the true burden of mortality after Hurricane Maria,” the authors wrote.

The study should provide new impetus for Congress to approve significantly more in the way of disaster relief for the beleaguered island.

So far, Congress has fallen far short of the estimated $95 billion some financial experts and Puerto Rico’s governor say is needed for the island to recover.  Earlier this year, Congress approved an aid package for Puerto Rico which allocated only $16 billion for recovery. Puerto Rico has requested $14.7 billion to rebuild its power grid alone, but only $3.8 billion has been authorized for that purpose.  At the time, the expectation was raised that Congress would provide additional funding for ongoing recovery efforts in Puerto Rico, the U.S. Virgin Islands, Texas and likely Florida.  There hasn’t been any action since.

In a Washington Post editorial that followed the new report’s release, the newspaper noted that the estimated death toll is greater than the almost 2,000 people who died in the aftermath of Katrina, and the almost 3,000 people killed in the 9/11 attacks.

And it placed part of the blame squarely on the President:

Think how many lives might have been saved if Puerto Rico’s devastation had been handled with the seriousness and urgency it deserved. Ask yourself whether Mr. Trump would have thought — or acted — differently if the American citizens who were affected had lived not in Puerto Rico but in Texas or Tennessee.

Indeed, earlier this year, Politico published a lengthy investigative piece that examined the federal government’s response to Hurricane Maria compared to its response to Hurricane Harvey, which primarily affected Texas:

A Politico review of public documents, newly obtained FEMA records and interviews with more than 50 people involved with disaster response indicates that the Trump administration – and the president himself – responded far more aggressively to Texas than to Puerto Rico.

“We have the U.S. Army and Marine Corps. We go anywhere, anytime we want in the world,” bemoaned retired Army Lt. Gen. Russel Honoré, who led the military’s relief efforts after Hurricane Katrina. “And [in Puerto Rico] we didn’t use those assets the way they should have been used.”

No two hurricanes are alike, and Harvey and Maria were vastly different storms that struck areas with vastly different financial, geographic and political situations. But a comparison of government statistics relating to the two recovery efforts strongly supports the views of disaster-recovery experts that FEMA and the Trump administration exerted a faster, and initially greater, effort in Texas, even though the damage in Puerto Rico exceeded that in Houston.

Within six days of Hurricane Harvey, U.S. Northern Command had deployed 73 helicopters over Houston, which are critical for saving victims and delivering emergency supplies. It took at least three weeks after Maria before it had more than 70 helicopters flying above Puerto Rico.

Nine days after the respective hurricanes, FEMA had approved $141.8 million in individual assistance to Harvey victims, versus just $6.2 million for Maria victims.

The disparities didn’t stop there, Politico reported:

During the first nine days after Harvey, FEMA provided 5.1 million meals, 4.5 million liters of water and over 20,000 tarps to Houston; but in the same period, it delivered just 1.6 million meals, 2.8 million liters of water and roughly 5,000 tarps to Puerto Rico.

Nine days after Harvey, the federal government had 30,000 personnel in the Houston region, compared to 10,000 at the same point after Maria.

It took just 10 days for FEMA to approve permanent disaster work for Texas, compared with 43 days for Puerto Rico.

Finally, the Washington Post warned of more hardship to come:

Even now, eight months after Maria slammed into Puerto Rico, parts of the island are still struggling; and with hurricane season about to start, there are concerns that Puerto Rico is ill-prepared to deal with new emergencies. “The situation is not over,” said Domingo J. Marqués, an associate professor of psychology at Albizu University San Juan, who helped conduct the Harvard study.

The Harvard survey highlighted the disruption of health care that occurred, with troubling percentages of households reporting times when they were unable to get medicine, use respiration equipment or get dialysis treatment, get to a medical facility or reach a doctor.  Not all of these conditions caused death, but they made sickness and death more likely.  With the restoration of power and transportation so fragile, it is grimly likely that more Americans will die if Puerto Rico is unlucky enough to be hit by a hurricane any time soon.