It wasn't until Tuesday, when experts from the George Washington University, commissioned by the Puerco Rican government, that it was officially acknowledged the death toll had been much higher, counting those who died between September 2017 and February 2018 as a outcome of the infrastructure damage, poor health care, lack of basic services and power cuts.
The George Washington researchers instead inspected death certificates and other records, and they calculated the excess deaths by comparing historical death rates to the actual number of people who perished.
The George Washington researchers said the official count from the September 20 hurricane was low in part because doctors were not trained in how to classify deaths after a disaster. They also found the risk of death was 45 percent higher for those living in low-income areas on the island, and elderly men were at the greatest risk of dying.
She also says the federal government "will continue to be supportive" of Gov. Ricardo Rossello's accountability efforts and says "the American people, including those grieving the loss of a loved one, deserve no less".
The president was at the White House on Wednesday announcing a grant for drug-free communities when reporters asked him about aid for Puerto Rico. He added that he could only apply the law and not require FEMA "to do that which in a humanitarian and caring world should be done".
"Puerto Rico I would say was, by far, the most difficult of the group and you know right now, FEMA and all of the people that worked so hard there, they were very fearless and they have done some job", Trump said.
Hurricane Maria wreaked widespread devastation and caused $90 billion in damage when it tore across Puerto Rico, and is ranked as the third-costliest storm in the United States since 1900.
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The death toll for Hurricane Katrina, which battered the Gulf Coast in 2005, was more than 1,800. "Shame on President Trump for not even once, not even yesterday, just saying, 'Look, I grieve with the people of Puerto Rico'".
News organizations and some members of Congress have raised questions about the official death toll in Puerto Rico, which had remained at 64 for months.
"It is anger, it is frustrating", she said.
"We have now a container overcrowded with, you know, these dead bodies", said Quinones.
"Especially between November and December, we were very concerned".
"The responsibility for adjudicating the cause of deaths rested with the doctors", Mr Rossello said. "If enacted, the recommendations of this report could help save lives in Puerto Rico and beyond".
Rescue workers come to the rescue after Hurricane Maria.