Debate continues to rage over the number of people who died in Puerto Rico last year as a result of Hurricane Maria. The official death count from the Puerto Rican government has for months been 64, a number that many believed to be a shocking underestimate. Last week, skeptics were bolstered by a study published in The New England Journal of Medicine, which settled on an estimate of 4,645 deaths. And on Friday, the Puerto Rico Department of Health issued a new number, saying there were at least 1,400 additional deaths on the island following Hurricane Maria. But the agency did not state whether or not the deaths are attributed to the hurricane. By comparison, the official death toll from Hurricane Katrina was 1,833.

The 64 deaths directly attributed to the hurricane only include victims who have Hurricane Maria listed on their death certificate as a contributor. For a death to be counted, it needs to be confirmed by the Institute of Forensic Sciences, meaning that the body would have to be brought to San Juan, or a medical examiner would have to travel to the location in order to confirm the death. A Buzzfeed investigation found that 911 bodies were cremated before being examined by a medical examiner, meaning that they were not included in the official death toll.

According to the New York Times—which has its own tally of 1,052—the government of Puerto Rico says that it counts both direct (like drowning) and indirect deaths (like lack of access to medical care), but the New England Journal of Medicine [NEJM] report states that “indirect deaths resulting from worsening of chronic conditions or from delayed medical treatments may not be captured on death certificates.”

The government of Puerto Rico is conducting another review of the death toll, partnering with George Washington University’s Milken Institute School of Public Health. Up until Friday, it had stopped issuing statistics on deaths since December, citing the pending report as the reason why.

The researchers for the NEJM study went directly to people’s homes, using off-road vehicles because of the threat of landslides, to find out who had died there and why. The 4,645 number comes from surveying 3,299 households from January 17 through February 24th, out of an estimated 1,135,507 total households.

A New York Times story about the report points out that the number of deaths could range from 800 to 8,500, and that 4,645 was the midpoint. The study’s authors believe that this midpoint number is too low, and that adjusting for “survivor bias and household-size distributions increase this estimate to more than 5000.”

"If it were 5,000 kittens, there would be outrage, said Elizabeth Yeampierre, executive director of Uprose, one of the many groups protesting outside the United Nations this weekend. "If it was 5,000 dogs, there would be outrage. If it was 5,000 blonde-haired, blue-eyed women, there would be outrage."

Domingo J. Marqués, an associate professor of psychology at Albizu University San Juan who helped conduct the NEJM study, told the New York Times that the report's death count is much higher than the official total because of a lack of thorough accounting across the island. People “died alone in their houses," Marqués said. "Nobody went there. Some of them were covered by a landslide, and months after they’ve not recovered the bodies."

The survey also found that 2.8% of the sampled population reportedly left their homes because of the hurricane. “The median age of those who left and did not return, or were missing, was 25 years, as compared with a median age of 50 among those staying or dying in the household.” It also showed the bleak circumstances for people who remained on the island.

On average, households went 84 days without electricity, 68 days without water, and 41 days without cellular telephone coverage after the hurricane and until December 31, 2017. In the most remote category, 83% of households were without electricity for this entire time period ... Many survey respondents were still without water and electricity at the time of sampling, a finding consistent with other reports.

This method, going door to door using a random sampling, is far different than the ways news outlets have attempted to calculate deaths related to the hurricane. The New York Times used daily death tolls from the Puerto Rican government. CNN surveyed half of all the funeral homes on the island. Puerto Rico’s Center for Investigative Journalism spoke to sources in hospitals and learned that “bodies are piling up at the morgues of the 69 hospitals in Puerto Rico, of which 70% are not operating.”

Both the NEJM report and the Puerto Rico government's announcement likely puts Hurricane Maria as one of the deadliest in U.S. history. Nevertheless, the dramatically higher death toll numbers were not mentioned at all during Sunday's major political talk shows.