Communities across the Carolinas became cut off and turned into virtual islands Sunday as floodwaters blocked roads, ports remained closed and officials warily monitored damaged utility systems and 3,300 "hog ponds" loaded with manure. The rivers continue to rise, with some unlikely to crest for several more days.

The death toll from Hurricane Florence rose to at least 16 Sunday night as the remnants of the storm, downgraded to a tropical depression, slid into western North Carolina and the Appalachians. The coastal storm surge, which swamped towns along tidal rivers, has subsided, but now the river flooding is intensifying as the water from Florence's record rainfall makes its journey to the sea.

Of major concern are the flooded roads, some of them more dangerous than they might first appear to motorists. More than 600 roads are closed in North Carolina, and the state's Department of Transportation said motorists should avoid the state altogether. Interstate 95, a crucial East Coast artery, is blocked in both directions in Lumberton, North Carolina, where the Lumber River on Sunday was already 5 feet above "major" flood stage.

First responders and the Coast Guard have rescued more than 900 people from the high water.

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Homes along the New River are flooded as a result of high tides and rain from hurricane Florence which moved through the area in Jacksonville. Photo / AP
Homes along the New River are flooded as a result of high tides and rain from hurricane Florence which moved through the area in Jacksonville. Photo / AP

"This storm has never been more dangerous," North Carolina Gov. Roy Cooper, D, said at midday news conference.

Cooper said approximately 20,000 people were staying in about 150 shelters across North Carolina. Local and federal officials were warning evacuees that it was not safe to return home.

"For those who have evacuated, please stay where you are," said Bill Saffo, mayor of Wilmington, North Carolina.

The storm and the flooding have created numerous distinct threats to life and health. Officials Sunday said a man and woman in their early 60s died in Horry County, South Carolina, from carbon monoxide poisoning caused by a generator inside their home. Two more South Carolinians died in car crashes, officials said. In Duplin County, North Carolina, officials said two people died when flash flooding overwhelmed roads on Saturday.

Here in the town of Kinston, hundreds of people woke Sunday for yet another day in the emergency shelter at Lenoir Community College. For Clifton Jones and his girlfriend, Traci Vann, it was their fourth day of shelter living, and another day of wondering what would happen with the swollen Neuse River.

Camrey Mosley walks down a street through floodwaters from Hurricane Florence, in Marion. Photo / AP
Camrey Mosley walks down a street through floodwaters from Hurricane Florence, in Marion. Photo / AP

"You're just kind of stuck here until you figure out where the water is going," Jones said.

"We might be stuck on this island for a few weeks," Vann said.

Jones said he doesn't have flood insurance.

"If I flood, I've lost everything," he said. "I don't know how I'd overcome and start back over again."

Ray Edwards, the shelter manager, said 300 staff members and guests were inside. Another shelter in Kinston had to divert people to the community college after it lost power and started to take on sewage.

As he spoke, his flip phone started to ring.

"Oh, food!" Edwards said. He was eager to dispatch trucks to pick up hot barbecue from a restaurant in Goldsboro.

"Where are you? How many meals you got?" he said into the phone.

David Croom, 74, had come to the shelter asking for any information on when the electricity would come back on. His home in a nearby trailer park had been without power since Thursday. His wife needed ice to keep her insulin cool, and he needed electricity for a breathing machine. He was wary of bringing his wife and daughter to the shelter because they have panic attacks in large crowds, he said.

His eyes welled up.

"I'm not worried about myself," he said. "I'm worried about them."

Some communities in North Carolina remain largely deserted, including Atlantic Beach. The sporting goods shop Pacific Superstore was badly damaged, with no one in sight working on the cleanup. Store windows had been shattered, leaving tiny cubes of glass strewn across the parking lot. An inflatable kiddie pool still tethered to the ceiling dangled out the window frame.

Members of the North Carolina Task Force urban search and rescue team check cars in a flooded neighbourhood. Photo / AP
Members of the North Carolina Task Force urban search and rescue team check cars in a flooded neighbourhood. Photo / AP

In nearby Pine Knoll Shores, Tim Bowers-Young biked through a flooded street. He had defied a mandatory evacuation order.

"I'm not supposed to be walking in the street," he said. "I think I'm breaking the law."

Resident Bill Stanley, who hadn't left his home since Wednesday, grabbed his shears and started clipping downed branches. Residential neighbourhoods look like an upside-down forest of snapped trunks and roots. Some of Stanley's favorite trees are gone, including one he planted after his first Christmas in the house. That tree now leans at a 45-degree angle.

Stanley said he wasn't sure what day it was. He squinted at his watch and decided it was Sunday.

He said he had been running his fridge and freezer on a generator, plugging each in for four hours at a time.

"I'm going through the gasoline pretty good, and that's hard to get for a while," he said.

Cynthia Capers carries her dog Lougie while being evacuated into a high water vehicle by the police as their neighbourhood begins to flood from Florence. Photo / AP
Cynthia Capers carries her dog Lougie while being evacuated into a high water vehicle by the police as their neighbourhood begins to flood from Florence. Photo / AP

In Florence County, South Carolina, Renee Matthews, 48, surveyed her family's property along the Lynches River on Sunday. The river had risen by more than five feet over the weekend. She has stocked up on water and food and has a motorboat on standby for an emergency. Her mother is sick and her father is frail, and she needs to know when it's time to get them out.

"These kinds of rain right here is what floods this area," Matthews said, noting the steady precipitation. "Next week, it'll be our problem. This river's going to keep rising."

Wilmington residents are coping with what amounts to island living. There's virtually no way in or out of the city. Interstate 40, the biggest highway leading here, is flooded in many places.

The power remains out almost everywhere. Businesses are shuttered. Residents idle in cars in long lines at a few gas stations.

At 10:09 a.m. Sunday, the Cape Fear Public Utility Authority put out a desperate plea for fuel, saying that within 48 hours it could run out and would no longer be able to provide the public with drinking water.

Damaged mobile homes from hurricane Florence which moved through the area in Jacksonville. Photo / AP
Damaged mobile homes from hurricane Florence which moved through the area in Jacksonville. Photo / AP

"It is with a heavy heart that we share this information with our customers, however, we want to give you as much notice as possible," the utility said on its website. "Please begin to make contingency plans for you and your family. Now is a good time to begin filling up bathtubs and water jugs as a contingency to a loss of water delivery."

But three hours later, the situation had grown less ominous, with the utility posting a new notice saying it had found a reliable fuel source for the duration of the recovery.

New Hanover County and Wilmington city officials Sunday asked the governor's office for additional law enforcement personnel, including from the National Guard. Police arrested some looters overnight.

The floodwater is dirty and could get dirtier, depending on the hog ponds and other environmental hazards. By midday Sunday, 28 utility systems had issued boil-water orders, the Environmental Protection Agency said.

"If you can avoid contact with floodwaters, do so," said Reggie Cheatham, director of EPA's Office of Emergency Management. Officials so far are "fairly confident," Cheatham said, that farmers had prepared adequately in advance of the storm to prevent the ponds from overtopping.

Cassie Gavin, an expert at the Sierra Club, said that it was too early to assess what was happening with hog farms and their waste lagoons. "In the 1990s, North Carolina went from 2 million to 10 million hogs virtually overnight, and with few regulations in place," Gavin said.

Studies have found that some eastern North Carolina rivers that have factory farms in the watersheds contain high levels of faecal bacteria and nutrients such as nitrogen and phosphorus, Gavin added.

Another environmental hazard comes from coal ash. Environmentalists, Duke Energy and state officials are closely watching developments at the L.V. Sutton Steam Plant in Wilmington, where heavy rains from Florence damaged a coal-ash landfill, eroding a portion of the wall surrounding it.

A home is seen in floodwaters from Hurricane Florence in Marion. Photo / AP
A home is seen in floodwaters from Hurricane Florence in Marion. Photo / AP

EPA officials said that about 2,000 cubic yards of material - the size of two-thirds of an Olympic-size swimming pool - collapsed into a ditch that leads to an on-site pond used for clean cooling water. Dozens of people from Duke Energy and a contractor were braving the weather with heavy equipment Sunday to construct earthen berms to reroute the coal-ash-contaminated ditch water and keep it from running into the cooling-water pond.

The cooling-water pond is separated from Lake Sutton by a narrow berm, and the Cape Fear River runs nearby.

On Sunday, Duke Energy, the facility operator and owner, played down the environmental threat. The situation comes against the backdrop of a regulatory change from the Trump administration that extended the lives of some existing coal-ash ponds from April 2019 to October 2020. The rule change will save the industry between $28 million and $31 million a year in compliance costs, EPA said.

The EPA treats coal ash as a toxic substance, and Physicians for Social Responsibility says that it typically contains heavy metals such as arsenic, lead, mercury, cadmium and selenium, and that if consumed or inhaled, it could cause cancer and nervous system disorders.

Duke Energy owns all 31 coal-ash ponds in North Carolina and four more in South Carolina. Paige Sheehan, a Duke spokeswoman, said that "coal-ash is non hazardous. The company does not believe this incident poses a risk to public health or the environment."