The latest attempt to get an accurate death toll in Puerto Rico following last year’s Hurricane Maria paints a grim picture: 2,975 “excess” deaths could be attributed to the storm, according to George Washington University researchers. That’s 46 times more than the 64 deaths first reported last fall.

But the counting is far from over, and nobody should be surprised if the death toll in Puerto Rico reaches or exceeds 4,000 by the end of the year.

Here’s why: Many of the conditions responsible for continued excess deaths remain and are unlikely to be appreciably ameliorated anytime soon.