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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

When a vaccine is approved, who will get it? How will it get to them?Johns Hopkins has a plan to make front line workers and those most vulnerable first in line. Other experts say that may not be the best approach.“It may be better to immunize people who are at high risk of transmitting the virus both because of jobs, living situations and other circumstances,” said Dr. Ezekiel Emanuel while speaking with the head of the Journal of the American Medical Association. “And that I think we have to leave an open mind and look at some detailed modeling about what the best way is to reduce the premature mortality.”Emanuel says transmission between health care workers and patients is basically zero where he is. He says effective PPE use is the reason.The groups Johns Hopkins said should get a vaccine first could be as big as 90 million people.Emanuel says there won't be enough doses out of the gate to get all of any initial groups.“You don’t actually distribute it evenly among countries,” he said. “You concentrate on countries that at the moment when you have the vaccine have severe hot spots and where the vaccine is going to make the biggest difference in terms of reducing premature death.”Johns Hopkins experts say a vaccine's effectiveness is measured on preventing disease. That doesn't mean it prevents infection and transmission. We won’t know how effective it will be until after it’s in use.“A disease transmission strategy makes a lot of sense, but we need a lot more information before we can know who to prioritize,” said Dr. Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security. “It’s quite possible we will go to a strategy like that.”The World Health Organization said younger people in their 20s, 30s and 40s are increasingly driving spread.The first vaccines will likely be two doses. Experts say that means double the syringes, needles, vials and other supplies, along with getting people to come back for a second dose. 1980

WISCONSIN — An update on the expected re-entry of China's old Tiangong-1 space station has been announced.The space station was initially launched in September 2011. An official Chinese statement declared that Tiangong-1 terminated its data service on March 21, 2016. Since the Chinese government has lost control of the station, it's hard to predict where and when it will fall.The European Space Agency predicts the space station will fall back to Earth between March 30 and April 6, while research organization Aerospace predicts a re-entry on April 1, give or take 4 days.Aerospace says it is much easier to predict a re-entry time than a location. This explains the wide scope of possible re-entry zones, which both Aerospace and other organizations predict will be between 43 degrees North and 43 degrees South latitudes. 855

When you hear wedding bells, you often see dollar signs. But there are additional costs to consider besides basic ones like the venue, dress, photographer and cake.Here are some often overlooked wedding expenses and how to budget for them. 257

Widespread flash flooding along small streams, urban areas, and roadways is expected to begin this afternoon into Thursday from far eastern Texas, across Louisiana and Arkansas. This will also lead to minor to isolated moderate freshwater river flooding. #Laura pic.twitter.com/z71y3icU29— National Hurricane Center (@NHC_Atlantic) August 26, 2020 356