Government weather satellites captured this image of Hurricane Florence shortly after its landfall September 14, 2018.
A mother and infant were killed in Wilmington, N.C. after a tree fell on a house there while the Category 1 hurricane throttled the eastern North Carolina coastline Friday morning.
The father was also in the house and had to be taken to a local hospital for treatment after the incident.
In Pender County, North Carolina, a woman suffered a heart attack and died because hurricane debris blocking roads prevented paramedics from reaching her.
A fourth person reportedly was killed while plugging in a generator in the state's Lenoir County, according to U.S. media.
Two people in Lenoir County were killed: a 78-year-old Kinston man who was electrocuted when connecting extension cords in the rain and a 77-year-old man who was blown down by the wind when he went to check on his hunting dogs.
About 20,000 people hunkered down in 157 schools, shelters and a coliseum in Winston-Salem.
The storm originally made landfall at Wrightsville Beach, North Carolina, on Friday morning as a category one hurricane.
By mid-afternoon the winds had dropped to 75 miles per hour (120 kph) and the center was moving west at 6 miles per hour (10 kph), the NHC said, and parts of North and SC would get as much as 40 inches of rain (1 meter).
Forecasters said Florence's surge could cover all but a sliver of the Carolina coast under as much as 11 feet (3.4 metres) of sea water.
Florence will dump 40 inches (101.6 cm) of rain in some parts of the Carolina coast, forecasters said. Twenty inches (50 cm) were reported by early Friday afternoon in the town of Oriental.
Farther up the coast, in New Bern, population 29,000, flooding on the Neuse River trapped people.
Resident Jay Manning said he and his wife watched with alarm as water filled the street.
"They cleared out 75 percent of the patients", she said. "These are folks who are maybe in one-story buildings and they're seeing the floodwaters rise".
He urged residents to stay inside and not get in the way of emergency workers.
Soon after Florence made landfall, President Trump touted the work from FEMA and first responders.
Russ Lewis covers his eyes from a gust of wind and a blast of sand as Hurricane Florence approaches Myrtle Beach, S.C., on September 14, 2018. The National Weather Service said the floods likely will last for weeks.
"It's insane", he said in a phone interview.
"I think we kind of let our guards down", he said of his community's response to the storm's being downgraded to Category 2 from 4. The crews tried to move the debris with a front loader, but a tree went through the windshield, causing further delays, the officials said.
Forecasters say it is now moving into eastern SC, crawling along at just 3mph (4.8km/h).
Right now, the National Oceanic and Atmospheric Administration's National Hurricane Center is predicting that Florence will become a tropical storm tomorrow (Sept. 15) over SC, continue northwest to eastern Kentucky, then swing northeast and track over most of New England early next week. Gradual weakening was expected Friday night, the hurricane center said.
More than 60 people had to be pulled from a collapsing cinderblock motel at the height of the storm. Some of those who stayed went to shelters while others stuck it out in their homes. Ballance called the rainfall "biblical", saying he's gotten reports from friends that his downtown seafood restaurant was flooded, just like the rest of the small city's historic downtown, and he's anxious about the hundreds of people who needed to be rescued overnight in the city.
"It looks heavy outside", she said.