Hurricanes can bring all sorts of trouble — winds, rains, floods. And early fatality data from Florence’s assault on the Carolinas suggest that being in your car, on the road, after the storm hits land has been especially deadly.
An analysis by the Los Angeles Times of 35 deaths officials have linked to the storm so far showed that more than half — 20 victims — died when they were apparently trapped in their cars by flooding or were involved in auto crashes during inclement weather.
In one of the storm’s most harrowing tragedies, a 1-year-old boy died in Union County in south-central North Carolina after his mother drove around barricades blocking a flooded road and water swept away her vehicle, officials said. The mother, Dazia Lee, survived, but she lost her grip on the boy, Kaiden Lee-Welch, as she tried to pull herself free, officials said.
Other Florence-related deaths included those caused by falling trees crashing into homes, carbon monoxide from a generator and electrocution.
The most deaths have come in North Carolina, the state hit hardest by the storm, where at least 27 people have died since Florence made landfall as a Category 1 hurricane early Friday.
Of the victims whose ages and genders have been released, four-fifths have been male, and two-thirds have been older than 55, according to death reports collected from local officials and media reports. At least three victims were infants.
Four people have been killed by falling trees, reportedly including a 46-year-old woman while driving Tuesday in Rutherford County, N.C. Two of the dead were infants killed when trees crashed into their homes.
Three deaths have been linked to generator use, including a Longs, S.C., couple killed by carbon monoxide from a generator inside their home, and a Lenoir County, N.C., man electrocuted while setting up a generator.
Hurricanes tend to unleash a wide range of deadly mayhem, and it’s common for deaths to occur after people believe the greatest danger has passed. Those most vulnerable tend to be the elderly and residents of poor areas.
A 2016 study published in the journal of the American Meteorological Society, written by officials from the National Hurricane Center and the Federal Emergency Management Agency, found that the number of deaths after a hurricane is almost as large as the number of people killed by the force of the storms.
In the 16 storms they studied from 1985 to 2008, 43% of deaths came right before or after a storm had completely passed.
Heart attacks and cardiovascular failures are the leading cause of what are called “indirect” deaths — those not directly attributable to one of the physical forces of a tropical cyclone — as well as vehicle accidents, fires and electrocutions, according to the study.
“An emergency situation is created where people need medication and oxygen and sometimes we cannot get it in time,” he said. “After a hurricane there are more threats for people. It’s not directly related to weather, but it’s a consequence of the hurricane.”
The distinction between direct and indirect deaths related to a storm has caused confusion in the aftermath of Hurricane Maria in Puerto Rico last year.
For months, officials reported that 64 people had died in Puerto Rico as a result of Maria in September 2017, but other studies — which have used statistical analysis to try to estimate the storm’s deadliness, given the collapse of public services after the storm — have estimated a vastly higher death toll.
One study published in the New England Journal of Medicine suggested as many as 8,498 people may have died because of Maria, which knocked out power to much of the U.S. island territory. Journalists have chronicled many residents dying because of a lack of access to basic medical assistance.
An ensuing study by the Milken Institute School of Public Health at George Washington University, which has been accepted as an official count by Puerto Rico’s government, has pegged the death toll at an estimated 2,975 people.
The death toll for Hurricane Katrina, which ravaged and flooded New Orleans and other parts of the Gulf Coast in 2005, is still debated. A 2014 study said 1,170 people died as a result of Katrina, whereas a 2008 study put the number at 986.
Although the U.S. Centers for Disease Control and Prevention has guidelines to help establish what qualifies as a disaster-related death — such as a guideline that informs medical examiners about citing related causes of death — there’s no standardized methodology.
Death tolls can also vary based on the length of time that researchers choose to study, said Scott Knowles, a professor and disaster historian at Drexel University in Philadelphia.
Some statistical studies have found that even evacuating nursing-home residents can lead to higher death tolls in the year after a storm, simply because of stress and disruption, even if the cause of death looks unrelated.
The story is similar for disaster survivors who might simply be in frailer health.
“After disasters, people who have chronic heart disease, asthma or diabetes find it hard to manage those conditions, so there’s a jump in the rate of people who go to the ER,” Knowles said.
Which means, for the survivors of Florence, the danger is far from over.
Matt Pearce is a national reporter for The Times. Follow him on Twitter at @mattdpearce.