Ian is likely Florida’s deadliest hurricane since 1935. Most victims drowned.

FORT MYERS BEACH, Fla. — The water was rising quickly, so the women ran to the top floor of the vacation house they had rented for Nishelle Harris-Miles’s 40th birthday and huddled together on a bed.

But Hurricane Ian’s storm surge gushed through the floor, lifting the mattress higher and higher until the four were smashed against the ceiling. Then the roof collapsed, lodging a nail into the neck of the woman they affectionately called Nene.

“Nene died right there with us,” said Chanel Maston, 48, sobbing as she recounted the ordeal. “She took her last breaths with us.”

As stories of death emerged from the destruction in southwest Florida, President Biden, Florida Gov. Ron DeSantis and local authorities have clashed over Ian’s casualty toll. Lee County Sheriff Carmine Marceno told “Good Morning America” that deaths could range into the hundreds. Biden warned that Ian could be the “deadliest hurricane in Florida’s history.” The governor has downplayed deaths in daily briefings, saying the tropical cyclone’s numbers will not come near the 1928 hurricane that killed a record 2,500.

Yet Ian already is shaping up to be the deadliest storm to pound Florida since 1935. State authorities have documented 89 deaths thus far — a number that is slightly higher than Hurricane Irma’s toll in 2017, according to the National Hurricane Center. County sheriffs have reported dozens more, pushing the total to at least 117. That makes Ian more fatal than Hurricane Andrew in 1992.

Ian’s storm surge has claimed the most lives, according to the Florida Medical Examiners Commission, which is tallying direct and indirect deaths. Sixty percent of the nearly 90 victims for whom a cause of death has been provided drowned, underscoring what experts call a frequently overlooked reality: Water usually kills more people than wind.

Storm surge as high as 18 feet blasted through homes, trapping some people inside while sweeping others into brownish rivers. One woman was found tangled below her house in wires. Many of those who drowned were elderly.

“I don’t want to scare people, but they need to understand: The leading cause of death is going to be drowning,” said W. Craig Fugate, former head of the Federal Emergency Management Agency and the Florida Division of Emergency Management. “Storm surge doesn’t sound inherently deadly unless you understand it.”

One week after landfall, rescue teams continue to wade through wrecked communities — often with only a vague idea of who might be buried in the rubble. Lee County Manager Roger Desjarlais admitted at a news conference Monday that officials do not know how many people they are searching for. First responders are relying on cadaver dogs.

“We don’t have anything,” Virginia Task Force 2 leader Brian Sullivan said Tuesday as his team scoured Red Coconut RV Park in Fort Myers Beach, the storm’s ground zero. “The sheriff’s office was trying to work to compile a missing persons list. We haven’t received any information regarding that area.”

Counting the dead is an imprecise science — there is no certain tally from Hurricane Katrina, for instance — and throughout the years, officials have debated what qualifies as a storm death. Hurricane Maria’s toll was initially in the dozens, with officials including only drownings and blunt force trauma. But an analysis of excess deaths later pushed the total into the thousands. Many elderly people died in Puerto Rico as the island’s blackout continued for months and medical care was hard to reach.

DeSantis at first indicated that indirect deaths might not be counted.

“For example, in Charlotte County, they recorded a suicide during the storm,” he said the day after the storm. “They also had somebody pass away from a heart attack because you don’t have access to emergency services.”

But the agency tasked with cataloguing the deaths, the Florida Medical Examiners Commission, adheres to a broader definition.

“We include motor vehicle accidents if someone is trying to evacuate and they hydroplane,” spokeswoman Gretl Plessinger said. “If someone had a heart attack when medical services were down. … If there was any suspicion it was related to a hurricane, that’s a storm death.”

Water — storm surge, rainfall, inland flooding and surf — directly cause 90 percent of tropical cyclone deaths in the United States, according to the National Hurricane Center. The top indirect killers: car wrecks, carbon monoxide poisoning, electrocution and heat. And the lethal danger persists after the skies have cleared, said Jay Barnes, a hurricane historian in North Carolina.

“Deaths often occur during cleanup,” he said. “Everything from carbon monoxide poisoning and chain-saw victims to people falling off roofs.”

Many Americans underestimate the power of hurricane torrents, disaster experts say. They tend to picture powerful gusts and falling trees — perhaps because the nation’s best-known…

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