At least 43 people have been killed and millions remain without power as Hurricane Helene swept through the southeastern United States on Friday. Emergency crews conducted rescues using boats, helicopters, and large vehicles to save those stranded in floodwaters, including about 50 workers and patients trapped on the roof of a flooded hospital in Tennessee.

The storm, the most powerful to ever strike Florida’s Big Bend, made landfall Thursday night before moving north through Georgia and the Carolinas. Despite weakening, officials warn that the danger of high winds, flooding, and tornadoes remains.

Insurance companies estimate that the storm’s damage could amount to billions of dollars, as homes and roads remain submerged. One family explained how they swam to safety from their flooded house. Helene, which had reached Category 4 strength, remained a hurricane for six hours after making landfall, according to the Federal Emergency Management Agency (FEMA).

The National Hurricane Center (NHC) reported a storm surge of more than 15 feet (4.5 meters) along parts of Florida’s coastline, with the surge expected to subside by the weekend. However, the risk of high winds, flooding, and even landslides will continue. Some areas could still see up to 20 inches (50 cm) of rain.

Helene ranks as the 14th most powerful hurricane to hit the US, with a width of about 420 miles (675 km). Only two hurricanes—Ida in 2017 and Opal in 1996—were larger, both spanning 460 miles. The sheer size of Helene’s winds and rain has caused widespread damage across Florida, Georgia, Tennessee, and the Carolinas.

At least eight fatalities have been confirmed in Florida since Friday, with five of those deaths occurring in Pinellas County, which includes the city of St. Petersburg. Florida Governor Ron DeSantis reported one person died when a road sign fell on their car, while another was killed when a tree fell on a home.