Three quarters of the island's hospitals remain on emergency backup power after the storm destroyed the electrical grid, leaving them without air conditioning and vulnerable to generator failures. Many also lack a local supply of running water. The net effect is higher patient mortality, hospital administrators report - a rising number of indirect fatalities that have not yet been included in the storm's official tally.

The U.S. Department of Health and Human Services is standing up its reservist "DMATs" — short for Disaster Medical Assistance Teams — to support the restoration of patient services at all 69 of Puerto Rico's hospitals. The department's assistant secretary for preparedness and response Robert Kadlec is on the island to oversee the effort. He told El Nuevo Dia that the extent of the damage was unprecedented. "I had never seen such a scale and extent of devastation as here," said Kadlec. "Hurricanes Harvey and Irma were significant, but there is not a single person or place in Puerto Rico that has not been touched by Hurricane Maria."

The Military Sealift Command hospital ship USNS Comfort is deployed in San Juan to help fill in the gaps left by the damage. Comfort brought 800 Navy medical personnel, 12 operating rooms, four X-ray machines and a variety of logistics assets to get patients on board. On October 4, Comfort accepted five critically ill patients from Ryder Memorial Hospital in Humacao after the facility's generator failed — an occurrence that was part of the government's emergency planning, given the length of time that the hospitals have been running on backup power.

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