Residents of the Carolinas struggled to return to normalcy on Tuesday after taking a beating from Hurricane Florence, but those efforts were hindered by standing water and the anticipation of more flooding from swollen rivers.

At least 32 people have been killed since Florence came ashore as a hurricane on Friday, including 25 in North Carolina and six in South Carolina. One person was killed when at least 16 tornadoes developed from Florence on Monday in Virginia, where dozens of buildings were destroyed, the National Weather Service reported.

Estimates of damage from the storm ranged as high as $22 billion.

As the remnants of Florence pushed through Pennsylvania and reached into New England, the weather service said the storm had dumped more than 30 trillion litres of rain on North Carolina.

Widespread flooding already has reached roofs, turned highways into rivers and left thousands to be saved by rescue workers.

Waterways were expected to keep rising on Tuesday in places like Fayetteville, North Carolina, a city of 200,000 in the southern part of the state, according to the weather service, hampering efforts to restore power, clear roads and return to homes.

"Flooding is still going to be a concern into the weekend and into next week," weather service meteorologist Hal Austin said, noting there is a chance of rain for the region on Tuesday and Wednesday. "No more water, not even a drop, please."

With 1,500 roads closed across North Carolina, fire and rescue crews were waiting to go into many areas to assist with structural damage after Florence dumped up to 91 cm of rain on the state since Thursday.

"Road conditions are still changing," the North Carolina Department of Transportation wrote on Twitter on Tuesday. "What’s open now may become impassable."

Florence itself was centered about 165 km north-northwest of Philadelphia, the weather service said on Tuesday, reduced to an elongated low-pressure area with maximum sustained winds of 35 km per hour. It was still dumping heavy rain capable of setting off flash floods in the northern part of the Mid-Atlantic region and southern New England.

STRUCTURAL DAMAGE

Thousands of rescues have taken place in the Carolinas, and more than 650 people were taken to safety in and around Wilmington, North Carolina, said Barbi Baker, a spokeswoman for New Hanover County. The coastal city took a direct hit when Hurricane Florence came ashore and has been largely cut off since then due to storm surges and flooding from the Cape Fear River.

More than 347,000 customers, mostly in the Carolinas, were without power on Tuesday morning, according to power companies, down from a peak of nearly 1 million outages.

North Carolina had deployed about 2,000 boats and 36 helicopters to help people stranded in floods, the state's director of emergency management has said.

The Coast Guard said it had 26 helicopters and 11 aircraft looking for people in trouble.

Property damage from the storm is expected to total at least $17 billion to $22 billion but that forecast could be conservative depending on further flooding, risk management firm Moody's Analytics said.

Risk modeling agency Air Worldwide on Tuesday said insured losses from Florence's winds and storm surge will range from $1.7 billion to $4.6 billion. Those figures do not include losses from continuing flooding.

A power outage at a wastewater treatment plant in Wilmington caused partially treated sewage water to be released into the Cape Fear River, said Reggie Cheatham, director of the US Environmental Protection Agency's Office of Emergency Management.

Sewage releases in the Neuse River were reported, as well as overflows at several hog "lagoons" used to store waste from pig farms.

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