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Trump once again attacked San Juan Mayor Carmen Yulín Cruz, tweeting: "We got A Pluses for our recent hurricane work in Texas and Florida (and did an unappreciated great job in Puerto Rico, even though an inaccessible island with very poor electricity and a totally incompetent Mayor of San Juan)".

The Republican president suggested the hurricane death toll was artificially boosted by adding those who had passed away from natural causes such as old age. Bad politics. I love Puerto Rico!'

Conducted by George Washington University, the study Trump is attempting to discredit as a Democratic plot was commissioned by the Puerto Rican government, which revised its earlier Hurricane Maria death toll to 2,975 after the study was published in August.

On Wednesday, Puerto Rican officials said about 20,000 pallets of water bottles shipped to Puerto Rico after Maria went unused and became too contaminated to drink.

People online were aghast that the president would somehow blame Democrats for an accurate death toll being reported.

Repeated power cuts also led to an increased number of deaths from diabetes and sepsis.

The George Washington University study, requested by the governor of Puerto Rico, examined an unusually long period of time following the storm in an attempt to detect the hurricane's lingering, indirect effects on mortality.

Almost 3,000 people died from the effects of Hurricane Maria in Puerto Rico. You will never take away our self respect.

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"Casualties don't make a person look bad, so I have no reason to dispute these numbers", he said.

"How stupid, how tone deaf, how surreal, how insensitive, how offensive", Navarro told CNN. Sober as the New York Times is in reporting Trump's latest big lie, it still represents in characterizing him how low we've sunk.

The statement Thursday is in response to President Donald Trump's tweet rejecting the study's conclusion. "What kind of mind twists that statistic into 'Oh, fake news is trying to hurt my image, '" she said. One thing's for sure, and I told (the media) before, one thing I'm proud, we're standing up on our own two feet.

He added in a tweet: "The loss of any life is tragic; the extent of lives lost as a result of Maria is heart wrenching". "It was devastating. It was a disgusting storm". And that's really no one's fault. "Those are just the facts of what happened".

Trump's comments came as Hurricane Florence, a potentially catastrophic storm, headed for the Carolina coast.

Florence was to be the first major test of FEMA since its response to the Puerto Rico disaster, which was widely criticised.

A report released this summer by the Federal Emergency Management Agency identified deficiencies in the administration's response, including that the agency was not adequately staffed heading into the hurricane season.