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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

Whether you can afford a home depends — a lot — on the city you want to call home. A modest income can go a long way in Cumberland, Maryland, the metropolitan area with the nation’s most affordable houses. In contrast, the least affordable homes are in the San Jose, California, metropolitan area — the center of Silicon Valley.In Cumberland, a median-priced house costs less than two years’ median household income. By contrast, the typical home in San Jose costs about 10 years of household income.NerdWallet calculated affordability for 173 metropolitan areas by comparing the median annual household income and the monthly principal-and-interest payment for a median-priced single-family home. “Median” means half of the values or incomes are higher and half are lower. Those comparisons revealed the five most- and least-affordable markets for buying a home.The lists were compiled using data from the National Association of Realtors, the Census Bureau and NerdWallet surveys.? MORE: How much can you afford in your area? 1045

Who gets to be first in line for a COVID-19 vaccine? U.S. health authorities hope by late next month to have some draft guidance on how to ration initial doses, but it’s a vexing decision.“Not everybody’s going to like the answer,” Dr. Francis Collins, director of the National Institutes of Health, recently told one of the advisory groups the government asked to help decide. “There will be many people who feel that they should have been at the top of the list.”Traditionally, first in line for a scarce vaccine are health workers and the people most vulnerable to the targeted infection.But Collins tossed new ideas into the mix: Consider geography and give priority to people where an outbreak is hitting hardest.And don’t forget volunteers in the final stage of vaccine testing who get dummy shots, the comparison group needed to tell if the real shots truly work.“We owe them ... some special priority,” Collins said.Huge studies this summer aim to prove which of several experimental COVID-19 vaccines are safe and effective. Moderna Inc. and Pfizer Inc. began tests last week that eventually will include 30,000 volunteers each; in the next few months, equally large calls for volunteers will go out to test shots made by AstraZeneca, Johnson & Johnson and Novavax. And some vaccines made in China are in smaller late-stage studies in other countries.For all the promises of the U.S. stockpiling millions of doses, the hard truth: Even if a vaccine is declared safe and effective by year’s end, there won’t be enough for everyone who wants it right away -- especially as most potential vaccines require two doses.It’s a global dilemma. The World Health Organization is grappling with the same who-goes-first question as it tries to ensure vaccines are fairly distributed to poor countries -- decisions made even harder as wealthy nations corner the market for the first doses.In the U.S., the Advisory Committee on Immunization Practices, a group established by the Centers for Disease Control and Prevention, is supposed to recommend who to vaccinate and when -- advice that the government almost always follows.But a COVID-19 vaccine decision is so tricky that this time around, ethicists and vaccine experts from the National Academy of Medicine, chartered by Congress to advise the government, are being asked to weigh in, too.Setting priorities will require “creative, moral common sense,” said Bill Foege, who devised the vaccination strategy that led to global eradication of smallpox. Foege is co-leading the academy’s deliberations, calling it “both this opportunity and this burden.”With vaccine misinformation abounding and fears that politics might intrude, CDC Director Robert Redfield said the public must see vaccine allocation as “equitable, fair and transparent.”How to decide? The CDC’s opening suggestion: First vaccinate 12 million of the most critical health, national security and other essential workers. Next would be 110 million people at high risk from the coronavirus -- those over 65 who live in long-term care facilities, or those of any age who are in poor health -- or who also are deemed essential workers. The general population would come later.CDC’s vaccine advisers wanted to know who’s really essential. “I wouldn’t consider myself a critical health care worker,” admitted Dr. Peter Szilagyi, a pediatrician at the University of California, Los Angeles.Indeed, the risks for health workers today are far different than in the pandemic’s early days. Now, health workers in COVID-19 treatment units often are the best protected; others may be more at risk, committee members noted.Beyond the health and security fields, does “essential” mean poultry plant workers or schoolteachers? And what if the vaccine doesn’t work as well among vulnerable populations as among younger, healthier people? It’s a real worry, given that older people’s immune systems don’t rev up as well to flu vaccine.With Black, Latino and Native American populations disproportionately hit by the coronavirus, failing to address that diversity means “whatever comes out of our group will be looked at very suspiciously,” said ACIP chairman Dr. Jose Romero, Arkansas’ interim health secretary.Consider the urban poor who live in crowded conditions, have less access to health care and can’t work from home like more privileged Americans, added Dr. Sharon Frey of St. Louis University.And it may be worth vaccinating entire families rather than trying to single out just one high-risk person in a household, said Dr. Henry Bernstein of Northwell Health.Whoever gets to go first, a mass vaccination campaign while people are supposed to be keeping their distance is a tall order. During the 2009 swine flu pandemic, families waited in long lines in parking lots and at health departments when their turn came up, crowding that authorities know they must avoid this time around.Operation Warp Speed, the Trump administration’s effort to speed vaccine manufacturing and distribution, is working out how to rapidly transport the right number of doses to wherever vaccinations are set to occur.Drive-through vaccinations, pop-up clinics and other innovative ideas are all on the table, said CDC’s Dr. Nancy Messonnier.As soon as a vaccine is declared effective, “we want to be able the next day, frankly, to start these programs,” Messonnier said. “It’s a long road.”___The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content. 5581

WEST PALM BEACH, Fla. -- Two specially modified shotguns and ammunition were stolen from Palm Beach Zoo in the hours between late Wednesday and early Thursday.Head of Communications & Public Relations for Palm Beach Zoo, Naki Carter, says someone broke into the zoo and pried open a gun safe that stored the weapons.The shotguns were used by the zoo's "critical response team" in cases of emergency.The zoo is offering a ,000 reward for the return of the weapons.When asked if this was thought to be an "inside job", Carter had no comment.If the perpetrator(s) is caught with the weapons, which require a federal permit, they could face 10 years in prison and a fine.Carter says Palm Beach Zoo has increased security measures since the theft, but will not go into detail as to what those measures entail. 828

When professional team sports resume later this month, a number of MLB and NBA players have decided not to return to action.Over the weekend, pitchers Felix Hernandez and David Price became the latest MLB players top opt out for this year’s baseball season, which is slated to begin within three weeks.Hernandez said,” Never before has an entire MLB season depended so much on everyone in the league’s involvement. Let’s be responsible and keep each other safe. It’s not just for us, but for the game and our own families.”Price also cited concerns about his family on why he opted to sit out the 2020 season.“After considerable thought and discussion with my family and the Dodgers, I have decided it is in the best interest of my health and my family’s health for me to not play this season,” he said.Other professional athletes have expressed concern over the return to sports. Angels star Mike Trout has been seen wearing a mask during on-field workouts.MLS goalkeeper Matt Lampson said athletes aren’t as invincible to the coronavirus as it appears.“For everyone in the ‘These are pro athletes. There is no risk. Nothing happens to them if they get the virus camp - I am high risk,” Lampon tweeted. “And I know for a fact there are multiple others at MLS is Back that are as well - including other players on their way here. This is serious.”Other MLB players confirmed to not participate in the upcoming season include Ian Desmond, Ryan Zimmerman, Joe Ross and Nick Markakis.NBA players who have opted out include Victor Oladipo and DeAndre Jordan. With the MLB, NHL and NBA all scheduled to begin within the next four weeks, the leagues will be heavily relying on frequent COVID-19 testing in order to prevent spreading the virus to other players. 1762