Analysis by Gregory Krieg, CNN

(CNN) -- Two days after Hurricane Maria made landfall on Puerto Rico, President Donald Trump was busy kicking up a storm of his own.

Speaking in Alabama on Friday night, September 22, 2017, Trump took aim at the small group of NFL players who were kneeling, during the national anthem, as a protest against racial injustice. Team owners, he said, should be meeting their demonstrations with calls to "get that son of a bitch off the field right now," adding theatrically: "He's fired!"

As the President blustered and baited, Puerto Rico suffered. According to the official count, 64 people died during and after the ravenous storm. That estimate was always assumed to be on the low end, but a new, independent study published this week in The New England Journal of Medicine has brought to bear something closer to the true depths of the tragedy. In their report, researchers from Harvard and other institutions placed the toll much higher, at more than 4,600 lives.

One-third of the fatalities, the study found, "were reported by household members as being caused by delayed or prevented access to medical care."

The magnitude of loss on the island -- and the continued suffering of both the people still there and those forced to flee -- will be a stain on the Trump administration that outlasts its time in Washington, a searing reminder of what's at risk when a society and its leaders reveal themselves to be unequipped, in every sense, to contend with a real disaster.

The new report is the latest in a series of more thorough, independent investigations into the storm's devastation. Last year, a CNN survey of Puerto Rican funeral homes, counting deaths from September 20 through October 19, put the number of those believed to be storm-related at 499. San Juan Mayor Carmen Yulín Cruz, in an interview with CNN's Jake Tapper on November 3, offered a similar estimate.

By then, the initial shock and panicked relief efforts had passed. Reporters like CNN's Leyla Santiago kept close, but the news cycle never stopped spinning.

During the first two weeks after hurricane struck, Trump's Twitter feed featured a maddening mix of exhortations to vote in the Alabama special election primary, best wishes to the people caught in Maria's path, jabs at Republicans who opposed another failed Obamacare repeal push, tributes to FEMA and first responders, and repeated potshots at pro football players. Over time, as situation in Puerto Rico deteriorated and the administration faced criticism for its response, Trump turned bitter.

On September 25, he turned his ire on the island itself.

"Texas & Florida are doing great but Puerto Rico, which was already suffering from broken infrastructure & massive debt, is in deep trouble," he said in the first of a series of three tweets. "It's old electrical grid, which was in terrible shape, was devastated. Much of the Island was destroyed, with billions of dollars ... owed to Wall Street and the banks which, sadly, must be dealt with. Food, water and medical are top priorities - and doing well."

A day later, with Spanish Prime Minister Mariano Rajoy looking on, Trump talked up the administration's "massive" efforts in the region, praised Puerto Rico Gov. Ricardo Rosselló for praising him, and explained — as if it were some newly discovered wonder — that rescue and recovery work in Puerto Rico was more complicated than in places like Texas because "it's on an island in the middle of the ocean. It's out in the ocean. You can't just drive your trucks there from other states."

Excuses in place, Trump by September 30 had settled on a villain. He leveled a series of attacks against Cruz, the San Juan mayor, in response to her criticism of the White House's relief work, as many on the island waited on help without power or access to clean water and medical aid.

"The Mayor of San Juan, who was very complimentary only a few days ago, has now been told by the Democrats that you must be nasty to Trump," Trump tweeted early that morning. "They," he added, naming the mayor and "others in Puerto Rico," "want everything to be done for them when it should be a community effort."

In an interview later that day with Orlando television station WKMG, Vice President Mike Pence echoed Trump's complaints, calling it "frustrating" for "millions of Americans to hear rhetoric coming out from some in Puerto Rico, particularly the mayor of San Juan, instead of focusing on results."

A few days later, Trump visited Puerto Rico, where he made a show of tossing paper towel rolls, like he was playing pop-a-shot basketball, to a crowd and compared the number of dead favorably -- "Sixteen people versus in the thousands" -- to what followed "a real catastrophe" like Hurricane Katrina in 2005.

"That was a terrific visit," he told reporters on the flight home, "that visit was terrific."