The hurricane came ashore early Friday, pounding the state with torrential rain and high winds.
Five people died in the immediate effects of the storm's landfall, including a mother and her baby whose house was crushed by a falling tree and a woman who could not be reached by emergency services when she suffered a heart attack.
Hundreds of people needed to be rescued after becoming trapped in their homes by a storm surge of up to three metres in New Bern, a town of 30,000 in North Carolina at the confluence of the Trent and Neuse rivers.
The now Category 1 storm's intensity diminished as it neared land, with winds dropping to 90 miles per hour (135 kph) by nightfall. They had heeded officials warnings that the storm was treacherous, with record-setting rains and storm surges not seen in North Carolina in decades.
Officials in New Bern said over 100 people were rescued from floods and the downtown was under water by Friday afternoon.
As of 5pm (2100 GMT Friday), maximum sustained winds had weakened to 110kph (70mph) but the NHC warned Carolina residents to be alert for life-threatening storm surges and "catastrophic freshwater flooding". Duke Energy expects between 1 million to 3 million homes and businesses to lose power.
A North Carolina city says about 70 people have been rescued from a hotel whose structural integrity is being threatened by Hurricane Florence.
It was expected to begin pushing its way westward across SC later in the day, in a watery siege that could go on all weekend.
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USA media said a fifth death may have occurred when a man tried to connect two extension cords in the rain.
The town of Oriental, North Carolina, had gotten more than 18 inches of rain just a few hours into the deluge, while Surf City had 14 inches and it was still coming down.
That deluge will lead to "catastrophic flash flooding and prolonged, significant river flooding", according to the NHC.
North Carolina alone is forecast to get 9.6 trillion gallons (36 trillion litres), enough to cover the Tar Heel state to a depth of about 10 inches (25 centimetres).
The group, which included an infant, children and pets, have been taken to the Jacksonville Center for Public Safety after portions of the roof collapsed.
He added that around 20,000 people had taken refuge in 157 emergency shelters throughout the area.
Airlines canceled more than 2,100 flights through Sunday.
"Very eerie, the wind howling, the rain blowing sideways, debris flying", said Orsa, who lives nearby and feared splintering trees would pummel her house.
"It's important to note that the two individuals in the background are walking on concrete, and Mike Seidel is trying to maintain his footing on wet grass, after reporting on-air until 1:00 a.m. ET this morning and is undoubtedly exhausted", the network said in a statement responding to the now viral clip, according to The Hill.
More than 1.7 million people in the Carolinas and Virginia were warned to evacuate, but it is not clear how many left. A 78-year-old man was electrocuted attempting to connect extension cords while another man perished when he was blown down by high winds while checking on his hunting dogs, a county spokesman said.