A much anticipated study into the death toll from Hurricane Maria was released Tuesday. The independent report, commissioned by the governor of Puerto Rico, puts the number of people who died at 2,975 with low-income communities and elderly men at the highest risk of death.

The study, which was conducted by researchers at the George Washington University Milken Institute School of Public Health, covered the period from when Hurricane Maria hit Puerto Rico in September 2017 through February 2018.

According to the analysis, the risk of dying during this period was 60 percent higher for those living in the poorest municipalities and 35 percent higher for male Puerto Ricans aged 65 or older. And this risk persisted beyond the end of the study in February, researchers said.

Following the release of the study Puerto Rico’s Governor Ricardo Rosselló told CBS News’ David Begnaud Tuesday afternoon that he accepts the study’s findings which show a death toll significantly higher than the Puerto Rico government’s official number of only 64 deaths.

“These numbers are only the latest to underscore that the federal response to the hurricanes [Maria and Irma] was disastrously inadequate,” said Rep. Nydia Velazquez (D-NY) in a statement. Velazquez is the first Puerto Rican woman to have been elected to Congress.

“If one thing is clear from this latest estimate it is this — our nation failed the people of Puerto Rico and we can never allow such an inexcusable moral lapse to occur again,” she continued.

Hurricane Maria hit low-income communities in Puerto Rico the hardest. Credit: GW Milken Institute SPH.

HURRICANE MARIA HIT LOW-INCOME COMMUNITIES IN PUERTO RICO THE HARDEST. CREDIT: GW MILKEN INSTITUTE SPH.

President Donald Trump, however, has repeatedly touted the response efforts to last year’s hurricanes. When he visited the island following the storm he said, “If you look at a real catastrophe like Katrina, and you look at the tremendous hundreds and hundreds and hundreds of people that died … 16 people versus in the thousands. You can be very proud of all of your people.”

According to the National Hurricane Center, Hurricane Katrina killed 1,800 people. Maria’s death toll according to this latest estimate is significantly higher, and notably similar to the number of people (2,977) who died as a result of the September 11 terrorist attacks in 2001.

The study’s overall death toll — which claims to be the most rigorous to date — serves to correct the government’s official tally. It also adds to a series of other recent studies estimating the true scale of the tragedy — some previously estimated it may have been as high as 20 to 70 times more than the government’s original count.

In an effort to get a more accurate estimate, researchers analyzed death certificates and other data, comparing the total number of deaths during the six-month period post-Maria with historical patterns. The study also took into account an 8 percent drop in the island’s population after the storm as tens of thousands of Puerto Ricans fled the devastation.

The final number — nearly 3,000 people — is 22 percent higher than the number of deaths that would have been expected during the same period in a year without the storm, the report states.

Beyond calculating the final death toll, the researchers also sought to understand why the government’s official number of 64 was so low. They found that due to a lack of communication, well established guidelines, and training for physicians on how to certify deaths after a disaster, very few deaths wound up being linked to the hurricane.

Many of the people interviewed by the researchers who were involved in the death certification and registration process — such as physicians, funeral home directors, or hospitals — said that the Peurto Rico Department of Health and the Puerto Rico Department of Public Safety “did not notify them about the CDC [U.S. Centers for Disease Control and Prevention] special guidelines for correct documentation of cases, on the importance of correctly documenting deaths related to the hurricane or on an emergency protocol for handling these cases.”

There was also a lack of understanding about the distinction between deaths which are directly related to the storm — such as drowning or from flying debris — and those that are indirectly caused by it days or months later. This caused “confusion and consternation among members of the public,” according to the study.

As a result, the researchers recommend that authorities — not just in Puerto Rico, but everywhere — develop methods to rapidly assess mortality after a natural disaster, including spikes in certain areas. This will help with monitoring as well as allow public health officials to more quickly identify those at highest risk.

More staffing is needed in Puerto Rico’s response agencies, the report continues, adding that outside assistance from the CDC should also be provided. And a new crisis and emergency risk communication plan is needed, researchers advise.

“We hope this report and its recommendations will help build the island’s resilience and pave the way toward a plan that will protect all sectors of society in times of natural disasters,” said Carlos Santos-Burgoa, the principal investigator of the project and a professor of global health at GW Milken Institute SPH.

Researchers also note that follow-up interviews with affected families in Puerto Rico would help them better understand the circumstances that led to peoples’ deaths following the hurricane.

“The lessons learned from this report and subsequent studies will help not just Puerto Rico, but other regions in the U.S. and around the world that face the ongoing threat of hurricanes and other natural disasters,” said Lynn R. Goldman, the Michael and Lori Milken Dean of the GW Milken Institute SPH and a co-author of the report. “If enacted, the recommendations of this report could help save lives in Puerto Rico and beyond.”

Puerto Rico Gov. Rosselló said he plans to announce a commission to implement the report’s recommendations.