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While officials in Puerto Rico placed the official death toll from last year's Hurricane Maria at 64, researchers from Harvard believe the death toll was actually in the thousands. According to Harvard's study, there were an estimated 4,645 deaths directly or indirectly tied to the hurricane, which struck the island in September. Harvard estimated a mortality rate of 14.3 deaths per 1.000 people from September 20 through December 31, 2017 in Puerto Rico. Harvard said in its study that it believes its estimate is rather conservative due to a "survivor bias."Harvard conducted the study by performing a random survey of 3,299 households in Puerto Rico. "In our survey, interruption of medical care was the primary cause of sustained high mortality rates in the months after the hurricane, a finding consistent with the widely reported disruption of health systems," the study says. "Growing numbers of persons have chronic diseases and use sophisticated pharmaceutical and mechanical support that is dependent on electricity. Chronically ill patients are particularly vulnerable to disruptions in basic utilities, which highlights the need for these patients, their communities, and their providers to have contingency plans during and after disasters."Part of why there the death toll might have been underreported is due to how hurricane-related deaths are counted. In order to have a death counted as storm related, bodies had looked at by a medical examiner, which required a body to be transported to San Juan, or the medical examiner to travel to remote locations. With a lack of electricity and blocked roads, some bodies were likely buried before the government could count fatalities. Maria is considered the third-costliest hurricane in US history.  1816

White House chief of staff John Kelly announced at a senior staff meeting Monday that President Donald Trump asked him to stay on as chief of staff until at least 2020 -- and that he agreed -- three White House officials confirmed to CNN.The news came after Kelly marked his first anniversary as chief of staff amid a swirl of rumors about his potentially imminent departure. The Wall Street Journal first reported news of Kelly's plans.Kelly has seen his status as chief of staff diminished in recent months, with the President circumventing many of the policies and protocols the retired Marine Corps general put in place when he entered the West Wing last year.In the two weeks leading up to Trump's disruptive swing through Europe, senior aides predicted that Kelly had days or hours left. Those same aides now think the ensuing chaos of the trip may have helped Kelly hang on a little longer.The-CNN-Wire 917

Wildfires have killed one person and forced the evacuation of four towns in Oklahoma, authorities said.The state chief medical examiner's office reported a 61-year-old man died Thursday in Roger MIlls County as a result of injuries sustained in a fire that began southeast of Leedey, the Oklahoma Department of Emergency Management said.A 54-year-old hunter reported missing in the large Dewey County fire was found alive, Oklahoma Forestry Services Fire Chief Scott Huff said. The man was flown to an area hospital Friday, but his condition was unknown. 562

We've heard about telehealth for people, but now it's there for animals too. According to the American Veterinary Medical Association, there's been a significant increase in telemedicine, and some veterinarians are entirely virtual.The pandemic has proven we can do almost anything from our couches, computers and phones. We've grown accustomed to all things virtual and it seems our pets are used to it too.“It really highlights the value of something like this and it also really highlights where society is living. Even before the pandemic, turned to google, turned to the internet first. It's our first step in almost everything,” says Dr. Sarah Machell.Machell is the lead veterinarian for Vetster, which provides on-demand virtual care for your pet.“Consultations, meeting pet owners in their homes, where they are with their pets, and helping to address urgent and preventive care health conversations to them,” Machell said.She says the company, which launched in October 2019, wasn’t formed because of the pandemic, but they certainly evolved at the right time."The veterinary clinics themselves are feeling a really heavy surge with the pandemic. It’s a pretty crushing situation for them. We already as a profession had some staffing challenges, not enough veterinarians for how many pets and pet owners there are,” Machell said.Pet owners, she says, often have a hard time getting an appointment. Or they have to wait in their cars with their animal outside of their clinic. And, according to Vetster, 50% of pet owners don't even have an established home clinic.“There was a poll recently that showed 37% of American households welcomed a new pet into their home during the pandemic. Pandemic puppies are a real thing,” Machell said.“I think it offers a great addition to the tools I have at my disposal. Telehealth can be used very much the same way,” said Dr. Douglass Kratt, president of the American Veterinary Medical Association. The AVMA serves roughly 96,000 veterinarians across the country. They've been through a lot this year, adjusting to new norms, like all of us. As in human medicine, they've had to perfect, or initiate virtual options.“It doesn’t replace your veterinarian. What it does is help your vet better serve you and your family member,” Kratt said.Kratt admits there are some obvious challenges.“I can’t hear if your dog is coughing, I can’t listen to the heart and lungs via telemedicine so that wouldn’t be amenable,” Kratt said.He says, however, it's effective overall, and especially worthwhile if it's with your established vet. But if you don't have one, Vetster and other businesses like it aim to help.“There are so many pets and pet owners who sometimes sit on things and aren’t sure if they need to go into a clinic, really appreciate that piece of mind in the middle of the night that no, you don’t need to pack yourself up and get into a vet clinic. This is something you’re okay to wait until the morning,” Machell said.And she says they're prepared to help all animals from pocket pets to exotic and large animals. It’s yet another adjustment and another pivot in 2020. 3131

WILLIAMSTOWN, Ky. — Northern Kentucky law enforcement officials are working extra hard this time of year to keep any "Grinchiness" out of their respective "Whovilles."Before Grant County Sheriff’s Deputy Scott Conrad hits the road these days, he arms himself with kindness, in the form of gift cards.“It’s part of the Sheriff's Santa Project,” Conrad said.It’s an idea that was brought to the office three years ago by their chaplain.“I really think projects like this give us a glass-half-full attitude, rather than a glass-half-empty,” Grant County Sheriff’s Office Chaplain Rev. Tim Polley said. “Don’t we all need some joy in our lives?”The answer for Grant County’s deputies is "yes."“We make a legit traffic stop,” Conrad said. “In lieu of writing a citation, we hand out a gift card to our local businesses.”Several drivers who got a Sheriff's Santa surprise were both grateful and thankful, a nice reminder to use a turn signal.The project does more than just promote good driving, it also drives business to local shops and restaurants who could use a customer boost during the coronavirus pandemic.“Typically, we deal with the more negative aspects of humanity, so when we can do anything that's positive, it's a blessing to us,” Conrad said. “We swore an oath to the Constitution. I got into this job 15 years ago 'cause I wanted to help people.”Now he’s helping people by helping to give back to the community.“Everybody thinks they're out to get us, but they're here to help us,” said driver Justin Ost, who got a gift card to a local barbecue restaurant.Polley sought out local businesses to donate the gift cards, or people to donate money to be exchanged into cards. “It is just that little nudge that some people need to say there is still good in this world,” he said.The Sheriff's Santa Project runs through Christmas Eve.This story originally reported by Kristyn Hartman on wcpo.com. 1912

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