In this Oct. 3, 2017 file photo, President Donald Trump walks with FEMA administrator Brock Long, second from right, and Lt. Gen. Jeff Buchanan, right, during a tour of an area affected by Hurricane Maria in Guaynabo, Puerto Rico. Puerto Rican officials say the Trump administration is neglecting the territory because it doesn't have votes in Congress or presidential elections. The Trump administration has blamed Puerto Rico for creating delays in the disbursement process, but has not been more specific. Credit: Evan Vucci | AP

The federal government’s official tally put the death toll in Puerto Rico from Hurricane Maria at 64. This appears to be shockingly low number for an island where electricity has not been fully restored and thousands of residents remain homeless — eight months after the hurricane hit the US territory.

A new study, led by researchers at Harvard University, puts the death toll at 4,645. This would make Hurricane Maria the most deadly natural disaster to hit the United States in more than a century. As many as 12,000 people died when a hurricane hit Galveston, Texas in 1900; 1,833 people died as a result of Hurricane Katrina in 2005.

Many of the deaths in Puerto Rico are the result of delayed or inadequate medical care. In other words, many of these deaths were likely preventable.

This is a further indictment of the Trump administration’s lackluster and dismissive response in the aftermath of the deadly hurricane that devastated many parts of the Caribbean, including the U.S. Virgin Islands. The president, at times after the September hurricane, suggested that Puerto Rico was to blame for the widespread hurricane damage and slow response and rebuilding. These things were not said about communities in Florida and Texas, which were also hit by hurricanes last year. The Federal Emergency Management Agency was quick to dispense aid to American cities. The response in Puerto Rico was slow and plagued with ineptitude, including awarding a contract to distribute 50 million meals to a company that was only able to deliver 50,000.

There are two things the federal government must do in the wake of this study. The first is to update its own mortality figures to make them more accurate. This is not simply a math exercise. Knowing how many people died, and where and how, can help authorities better prepare for future disasters, like hurricanes. It is also important to dispel the idea that the US response, especially immediately after Hurricane Maria hit Puerto Rico, was adequate.

The Puerto Rican government is working on its own study, but it is way behind schedule.

The second, longer term task, is to better understand why Hurricane Maria was so destructive. Knowing this will help Puerto Rico and other islands and coastal areas better prepare for and respond to the inevitable future hurricanes. Hurricane season starts in June.

Deaths in Puerto Rico were 62 percent higher in the three months after the hurricane than during the same period in 2016, the study, published in the New England Journal of Medicine, found. Much of the higher death toll was attributed to an inability to get health care. The New York Times found, for example, there was a 50 percent increase in recorded death from sepsis, a complication from a severe infection, which can be tied to unsanitary living conditions and/or a lack of medical care.

Nearly a third of households surveyed by the Harvard-led team reported interruptions to medical care, with trouble accessing medications and powering respiratory equipment being the most frequently cited challenges.

The study was based on in-person interviews. Researchers visited more than 3,000 households by the end of 2017 to ask whether people living there had died. This is much more accurate than relying on officials reports from funeral homes and medical providers, especially when communications were disrupted for months.

A group of news organizations found that more than 1,000 people died in Puerto Rico in the 42 days after the hurricane.

In addition to a significantly higher death toll, the Harvard-led study showed that the average household went approximately 41 days without cell phone service, 68 days without water, and 84 days without electricity following the storm. Puerto Rico and other Caribbean Island had been hit by Hurricane Irma just weeks before Hurricane Maria roared through the region.

“There was a disaster caused by Irma and Maria, and then there was a disaster caused by the Trump administration, and their negligence,” San Juan Mayor Carmen Yulin Cruz said Wednesday after the higher death toll report.

This is the tragedy of Hurricane Maria — many of the deaths in its aftermath were unnecessary and could have been prevented by a better coordinated and focused response from the US government.

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