Tourist Trap: The Truth About All Those Deaths in the Dominican Republic.

By Daniel Engber, Slate

01 July 19

The media is selling a scary story about tourist deaths in the Dominican Republic. Don’t buy it.

hen U.S. tourist Khalid Adkins passed away in Santo Domingo last week, after getting sick and being pulled off his return flight , the 46-year-old’s name was added to a growing list of Americans who have died this year while visiting the Dominican Republic. Though most or all of these tragedies—which now number at least 12—could have been caused by heart attacks or other mundane causes, a stranger, bigger, dumber understanding of this story has taken hold throughout the media. According to the news, we’ve come across a “mystery” that hasn’t yet been solved, a string of autopsies with “eerily similar” results, and a “disturbing trend” that merits daily, panicked updates.

“When there’s 11 deaths in the past year, there’s an explanation in order,” claimed Fox News medical expert and occasional Slate contributor Marc Siegel the other day, before the news of Khalid Adkins’ death had broken. Many have been posited in recent weeks. Could the tourists have been drinking bootleg liquor laced with battery acid? Were they gassed with pesticides? What about Legionnaires’ disease? “How do we know it isn’t cyanide?” Siegel wondered.

Toxicology results for some of these deaths, due out in the middle of July, ought to answer some of those questions. But in the meantime, we’d do well to put this talk on hold—because there is no wave of tourist deaths that demands an explanation. The dozen deaths reported this month represent at most a tiny fraction—just a few percent—of all the ones that would be expected to occur in any year of U.S. travel to the Dominican Republic. They do not compose a “trend,” “spate,” “string,” “cluster,” or any “mystery” to speak of. They are, strictly speaking, from a news perspective, nothing.

How, exactly, did this bogus cloud of fear and speculation come to spread so far and wide? The bonfire of innumeracy was set in March, when a pair of U.S. tourists on the island disappeared. Two weeks later, they were found to have perished in an accident. (Their car went off the road during a late-night drive to the airport.) This wasn’t so unusual: An average of 12 American visitors to the DR die every year in road accidents, according to statistics compiled by the U.S. State Department. But two members of Congress, Reps. Eliot Engel and Adriano Espaillat, started calling for another, better set of answers. “The FBI must work quickly to conduct a thorough investigation regarding details of their reported deaths,” they wrote to the agency’s director, Christopher Wray, at the time.

Then, at the end of May, a woman named Tammy Lawrence-Daley posted a first-person account on Facebook—now shared several hundred thousand times—of having been beaten, and possibly raped, while visiting a Dominican beach resort earlier in the year. (Dominican authorities suggested there may be some inconsistencies in Lawrence-Daley’s story.)

These events would set the frame for everything that followed. One day after Lawrence-Daley’s posting, another couple were found dead in their hotel room; each was found to have had respiratory failure and fluid in the lungs. A day or two after that, news broke that another tourist, who had checked into a neighboring hotel on the same day as the couple with respiratory failure, had also died in her room.

Now the bigger story had a template: Tourists were dying unexpectedly, maybe in their rooms, from what seemed—but maybe only seemed—like natural causes. Sure enough, two more U.S. tourists died in just this way on June 10 and June 13. Another hotel guest death, by respiratory failure, occurred on June 17.

On June 19, Wray received a second letter from Congress, this time from Rep. Frank Pallone, demanding that he investigate all these “unexpected and highly suspicious deaths.”

A week later, Khalid Adkins died while trying to get home.

That already sounds like a lot of deaths, but there were more. As coverage of the “mystery” expanded, the families of other victims—more men and women who had passed away while staying at Dominican hotels—started to emerge. The rules for inclusion in the “spate of deaths” got somewhat looser as the story spread: What had started as a strange, time-limited coincidence—six dead tourists found within a stretch of several weeks in June—had turned into a larger, less discriminating catalog of misfortune. Deaths of hotel guests in prior months—including two from April—were added to the media’s list of “unexpected and highly suspicious deaths.” Then the press lumped in three more tourist deaths from heart attacks that each occurred in 2018. Two more, from 2016 and 2017, also made the list.

As the story moved into Week 4, the “disturbing trend” of tourist deaths was stretched until it could include a woman who’d felt completely fine throughout her honeymoon on the Dominican Republic in May and then passed away about a month after her return. She did not die or even sicken while visiting the island. Nevertheless, news reports would list her as “the latest American fatality.”

Are we talking about a spate of tourist deaths this year, or a passel in the past three years, or what? One problem with this story is that it doesn’t seem to matter: New cases may be found in any month or year, involving any cause of sudden death, and still get tossed onto the pyre.

What a morbid waste of everybody’s time. Whether we’re talking about 12 deaths, or 25, or even 50, it’s wrong to treat the mere proliferation of these tragedies as proof that U.S. tourists are in danger. If we want to know for sure that something is amiss—or even to make an educated guess about the same—we’ll need to have a baseline death rate for comparison.
How often do Americans usually die while drinking whiskey in their rooms in Punta Cana? Or, to be less specific: How many U.S. tourists die during a normal year of visits to the Dominican Republic?

No one keeps careful track of tourist deaths. The U.S. State Department does count up the number of Americans who die from “non-natural” causes in each foreign country—homicides, suicides, drowning, car crashes, and the like. But it has no records of the natural ones, and no other governing body does, either. The number of Americans who die of heart attacks or strokes or any other illness while overseas remains unknown.

There haven’t been many academic studies of this topic, either, with respect to U.S. tourists or those from any other country. Perhaps the topic is too grisly to think about—as the authors of one recent paper on tourist death rates put it, “Encountering mortality seems not normally associated with travel and leisure behavior and therefore remains understudied.” Still, the modest research that does exist provides some useful context.

For a paper out in 2010, a Finnish scholar studied death certificates for about 570 of his countrymen whose corpses were repatriated after they had died while abroad between 2005 and 2007. A Scottish study, out in 2011, did the same for 572 Scottish travelers whose bodies were sent home to be cremated between 2000 and 2004. Each study tallied up the overall mortality rate among travelers and the reasons they had died.

The numbers from these studies lined up very well. According to the Finnish work, out of the 3.2 million overnight trips taken by Finns during the study period, about 0.018 percent resulted in the death of a traveler. Among those who passed away, 69 percent died from natural causes and two-thirds of those natural deaths were blamed on “cardiocirculatory” causes. According to the Scots, roughly 0.012 percent of all Scottish travel had ended in death, and 76 percent of those deaths were deemed to be of natural causes. Three-quarters of the natural deaths were blamed on a cardiovascular event.

Meanwhile, a pair of studies from Australia, which examined all recorded deaths among visitors to that country between 1997 and 2003, concluded that 0.008 percent of these trips ended in death and that 73 percent of those deaths were of natural causes.

So, let’s see what happens when we extrapolate from those figures to the Americans who visit the Dominican Republic. Our average life span lies somewhere in between those of the Finns and Scots, so perhaps it’s reasonable to peg our average rate of death while traveling as somewhere in the middle of theirs, too. Let’s say it’s 0.015 percent. We might similarly estimate that roughly 73 percent of American deaths overseas occur from natural causes—and that about 70 percent of those deaths would be related to heart disease or stroke.

It’s been widely reported that 2.7 million Americans now visit the Dominican Republic every year. (That’s almost double what it was five years ago; the nation’s tourism industry has been booming.) Based on my assumptions above, that means we should expect that roughly 400 American tourists will die while visiting the country in any given year. To be more specific, about 295 American tourists will die of natural causes during their trips, with 207 of those deaths being the result of a cardiovascular event.

Now compare those projected numbers to recent deaths described in the media. The “disturbing trend” we’ve heard so much about consists of 12 reported cases in 2019 (or maybe 17 in the past three years, depending how you count). Most of these have been attributed to heart attacks. Taken all together, these represent at most 3 percent of the total number of American tourists that would be expected to die while visiting the Dominican Republic in any given year and at most 6 percent of the total number of American tourists that would be expected to die from circulatory problems in particular.

What about the remarkable spate of six tourist deaths that have occurred since the end of May? Even that amounts to almost nothing. Based on the numbers above, one would guess that an average of 25 American travelers to the Dominican Republic will die, just from heart attacks and related issues, in each month. That average is likely to be higher still in June, which is near the high season for tourists. In other words, if the six most recent deaths reported in the news are surprising, it’s because they’re so few in number!

I will concede that by comparing the 12 well-publicized deaths from 2019, or the six deaths since late-May, against the total number of expected deaths, I’ve more or less ignored the fact that the cases in the news have been labeled “highly suspicious.” But I remain highly suspicious of the suspiciousness of these deaths. Yes, it’s weird that a couple passed away together in their room. The official explanation for their deaths—that one died from natural causes and the other died from shock at seeing it happen—is hardly satisfying. But the rest? They don’t seem that unusual at all.

Let’s assume, for the sake of argument, that I’m wrong, and that all these deaths are suspicious. Let’s pretend we know that each of the deaths reported in the media really did result from some bizarre, non-natural cause. If that were true, then we’d have tallied 12 such deaths of U.S. tourists in the Dominican Republic by the end of June, or 14 if you count the two who died in the car accident from March. That’s disturbing, sure, but it’s more or less in line with what we’ve seen in recent years. State Department records indicate that since 2003, an average of 20 U.S. citizens have died from non-natural causes every year in the DR.

I’m not the only one to notice that this panic has been manufactured out of nothing. That point has been made at length—and with understandable frustration—by the Dominican authorities. (As much as 17 percent of the country’s economy has been threatened by this smoke-and-mirrors coverage.) But it’s far too late for them to make this crisis—or this “crisis”—go away. What started as a few reported anecdotes—tick-tocks of the victims’ final hours at their beach hotel—has turned into a full-blown media phenomenon. First there were the pieces on the tourists who had died, and then the tourists who had nearly died or gotten “sick enough to die,” and finally, the tourists who may (or may not) have gotten diarrhea. We’ve also had explosions of explainers and columns of advice for worried, would-be travelers and follow-ups on how this news is killing travel plans.

In the past few weeks, the panic over tourist deaths has even turned into a topic all its own, in isolated form, pulled apart from any details of the tourist deaths themselves. Savvy, second-order stories skip right past the people getting heart attacks to diagnose an “image problem” or an “image crisis.” Now experts can be called to ponder not the safety of U.S. travelers but “the perception of safety,” or to muse about “public relations dynamic” that is now in play. The story has begun to feed itself: We’re getting news about the news that wasn’t ever really news.

I don’t know how to stop the cycle now that it’s spiraled to this point. But if you want a cheap, and possibly less crowded, tropical destination this summer, I’d suggest the Dominican Republic.