He died Sept. 20. Hurricane Florence is now being blamed.

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More than three weeks after Hurricane Florence made landfall in North Carolina, state officials have attributed another death to the storm.

A 68-year-old man in Onslow County died of “natural disease exacerbated by storm cleanup,” according to the Office of the Chief Medical Examiner, which determines whether a death is related to the storm. The addition brings the official death toll from Florence in North Carolina to 40.

The man died on Sept. 20, according to the medical examiner’s records. He was added to the list of 39 other storm-related deaths on Monday, a sign of how slow and difficult it can be to get a full accounting of a storm’s death toll.

The medical examiner’s office did not release further details about the man, including his name.

Under federal guidelines, there are two basic types of storm-related deaths — direct and indirect. While direct deaths from drowning and falling trees are relatively easy to determine, indirect deaths can take longer to identify. These include injuries suffered during cleanup or caused by medical conditions made worse by storm-related factors, such as a loss of electricity.

Hurricane Florence is now thought to have killed 51 people, including nine in South Carolina and two in Virginia.