Two mental health patients who drowned when a sheriff’s van was swept away by floodwaters are among the dozens killed by Storm Florence.
US President Donald Trump, meanwhile, has arrived in storm-ravaged North Carolina and helped volunteers at a church in the hard-hit coastal town of New Bern.
“How’s the house?” Mr Trump was heard asking one person as he distributed plastic foam containers of food, including hot dogs, chips and fruit. “You take care of yourself.”
“I know it was hard to leave home, and it is even harder to wait and wonder whether you even have a home to go back to,” governor Roy Cooper said.
After submerging North Carolina with nearly 3ft of rain, the storm dumped more than 6.5 inches of rain in the northeast, where it caused flash flooding.
Mr Cooper warned that the flooding is far from over and will get worse in places.
“I know for many people this feels like a nightmare that just won’t end,” he said.
Addressing roughly 10,000 people who remain in shelters and “countless more” staying elsewhere, Mr Cooper urged them to stay where they are for now, particularly those from the hardest-hit coastal counties that include Wilmington, near where Florence blew ashore on Friday.
Roads remain treacherous, he said, and some are still being closed for the first time as rivers swelled by torrential rains inland drain toward the Atlantic.
In South Carolina, two women died on Tuesday evening after a van taking the mental health patients from one facility to another was overtaken by rising floodwaters near the Little Pee Dee River, authorities said.
The risk of environmental damage mounted, as human and animal waste was washed into the swirling floodwaters.
More than 5 million gallons of partially treated sewage spilled into the Cape Fear River after power went out at a treatment plant and the earthen dam of a pond holding hog waste was breached, spilling its contents. The flooding killed an estimated 3.4 million chickens and 5,500 hogs on farms.