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US rescue teams are racing to locate dozens of people after tornadoes devastated towns across Kentucky, with at least 50 confirmed deaths.
With many residents of one small town unaccounted for, families are still awaiting news of loved ones.
State governor Andy Beshear warned the death toll could pass 100, saying he was hoping for "some miracles".
No-one has been found alive since Saturday morning, but search crews have continued to work through Sunday night.
Emergency workers, including 300 members of the National Guard, have been scouring debris for survivors and distributing water and generators to residents.
Mr Beshear said dogs were also being used to help search through rubble, adding that "we're still finding bodies" in some locations.
"Nothing that was standing in the direct line of [one] tornado is still standing," the governor said. "The devastation is unlike anything I have seen in my life."
A resident in the town of Mayfield, one of the areas worst-hit, said he had "dropped down to my knees and covered my head" when the tornado hit.
"My ears popped, and debris started coming through the doorway," Rick Foley, 70, told Reuters, adding: "It was gone in 30 seconds."
Another Mayfield resident, David Norseworthy, said the storm ripped the roof of his property clean off and destroyed his porch as his family hid in a shelter.
"We never had anything like that here," the 69-year-old told AFP news agency.
Elsewhere in the town, eight deaths were confirmed at a candle factory, where 110 employees were feared to have been trapped inside at the time. Others were reported missing.
Later, the governor said the factory's owner believed more of the workers had been located and were safe.
Kyanna Parsons Perez, a factory worker who made a desperate plea for help on Facebook from under the wreckage, told the BBC that other businesses had shut down for the storm and staff there should not have been at work.
Mr Beshear said a tornado had wrecked places all along its 227-mile (365km) path. Thousands of people had their homes destroyed - but the exact number was still not clear.
Ghost town
By Nomia Iqbal, BBC News, Cambridge Shores, Kentucky
Jerry Neal is going through the wreckage of what was once his home in southern Kentucky.
He picks up some Christmas decorations - two Father Christmas tree baubles and blue beads. "The heart's gone out of Christmas," he says.
Things have not been the same since his mother moved into a nursing home last year, he says. It was just him and his elderly father in the house.
"My mom designed this decades ago, she went back and forth with designers, she kept changing things, making them go crazy," he laughs. "Mom got the house she wanted. It was beautiful and now it's trash."
Meanwhile, at least 13 deaths have been reported in four other US states.
In Illinois, six people were killed in a collapsed Amazon warehouse in Edwardsville and more were still missing.
Four deaths were confirmed in Tennessee, while two people were killed in Arkansas, one of them in a nursing home after it partly collapsed. One death was confirmed in Missouri.
A tornado was also reported in Mississippi.
On Sunday, President Joe Biden described the tragic event as "one of the largest" storm outbreaks in American history.
Mr Biden declared a major federal disaster in Kentucky and ordered federal aid to be made available to the hardest-hit areas.
The president said he would ask the Environmental Protection Agency to examine what role climate change might have played in the storms.
Previously, the longest a tornado had travelled along the ground in the US was a 219-mile storm in Missouri in March 1925 that claimed 695 lives.
Such major events outside of the spring and summer months are extremely rare.