Puerto Rico's governor raised the US territory's official death toll from Hurricane Maria from 64 to 2,975 on Tuesday after an independent study found that the number of people who succumbed in the desperate, sweltering aftermath had been severely undercounted.
The controversy began two weeks after Hurricane Maria struck Puerto Rico, when President Trump said the disaster wasn't a "real catastrophe" like Katrina, because the death toll - then just 16 - was so small by comparison.
Independent researchers from George Washington University on Tuesday said the death toll from Hurricane Maria was more than double the 1,427 people the Puerto Rican government calculated.
It was unclear whether the island's government would adopt the researchers' estimate as its official toll.
Some media and academic studies estimated the death toll at more than 1,000, and a government report to Congress conceded that there may have been 1,400 more deaths in Puerto Rico after the storm than the previous year.
The government has not commented on findings of Tuesday's report, which is based on an analysis of death certificates and other mortality data for six months from September 2017 through February 2018.
The study analyzed hurricane-caused deaths from September 2017 through the end of February 2018.
Puerto Rican Gov. Ricardo Rosselló, who commissioned the study, told El Nuevo Dia that the territory had not been adequately prepared for a direct hit from a major hurricane.
"These numbers are only the latest to underscore that the federal response to the hurricanes was disastrously inadequate and, as a result, thousands of our fellow American citizens lost their lives", she said in a statement.
The team also found that poor communication about deaths after the disaster, and especially the distinction between deaths directly related to the storm and those indirectly tied to it, contributed to confusion and consternation among members of the public.
Researchers counted deaths from Maria over the span of six months - a much longer period than usual - because so many people were without power during that time, which probably led to more deaths.
Households went for an average of 84 days without electricity, 64 days without water, and 41 days without cellular telephone coverage after the storm.
Nevertheless, Santos-Burgoa said the high death toll, ranking Maria among the worst natural disasters in USA history, was evidence that "we lack a culture of preparedness".
Puerto Rico is still recovering from the damage caused by Hurricane Maria. They also said those most at risk for death were poor people, and the elderly.
The research represents the most rigorous study of excess mortality due to the hurricane done to date.
That makes Maria the deadliest hurricane to hit the United States in more than 100 years, and one of the nation's deadliest disasters ever.
Over this same period, older male Puerto Ricans had a risk of death that was 35 percent higher than expected and that elevated risk continued past the study observation period.
Rossello pledged to carry out the recommendations, though there are questions about Puerto Rico's ability to do so.