Tropical Storm Ian is expected to become a hurricane again later on Thursday before making landfall for the second time on Friday, the US National Hurricane Centre (NHC) has said in its latest advisory.
It also issued a hurricane warning for the entire coast of South Carolina.
One man, aged 74, has died as a result of the hurricane, officials in Volusia County have confirmed, but more casualties were expected.
US President Joe Biden who has visited the headquarters of the Federal Emergency Management Agency (Fema) said: "This could be the deadliest hurricane in Florida's history," saying numbers were unclear but he was hearing there may be substantial loss of life.
Biden said his government would cover the full costs for clearing debris and search and rescue efforts in Florida.
He added his administration will cover the majority of costs to rebuild schools and other public infrastructure damaged by Hurricane Ian.
Individuals who don't have enough insurance on their homes will also get support, Biden said.
Hurricane Ian made landfall for the first time at around 3.10pm local time on Wednesday, smashing into the coast with wind speeds of up to 241km/h.
Dramatic scenes saw a hospital roof blown off, cars submerged and trees ripped out of the ground.
The category four hurricane was later downgraded to a tropical storm.
However, Floridians were warned that the most dangerous 24 hours lay ahead. The mayor of Tampa urged people to shelter in place through the night into Thursday morning.
"We are going to get the majority of the rain and the higher winds starting about 8pm, and they are going to last throughout the night," Jane Castor said during a Wednesday evening briefing.
In a message posted on Facebook, the Weather Prediction Centre told residents in the Central Florida Peninsula to expect "widespread life-threatening, catastrophic flash and urban flooding" continuing into Friday morning, with up to 76cm of rain falling locally.
Residents were ordered to leave their homes, but many have decided to remain and seek shelter indoors.
Mark Pritchett, who lives in the city of Venice, some 95km south of Tampa, described the "terrifying" moment he stepped outside his home as the hurricane made its way across the Gulf of Mexico.
"Rain shooting like needles. My street is a river," he said in a text message to the Associated Press news agency.
A little further south, in Port Charlotte, healthcare workers at HCA Florida Fawcett Hospital were forced to move their most vulnerable patients out of the intensive care unit after the roof was torn off .
In Lee County - the south-west region where Ian made landfall - police were prevented from responding to reports of looting at a petrol station because of the storm damage. As a result, a curfew has been declared "until further notice".
Lee County manager Roger Desjarlais said that the Fort Myers community had "been - to some extent - decimated". According to news agency AFP, some neighbourhoods in the city of 80,000 had been left resembling lakes.
State Governor Ron DeSantis described Ian as the "biggest flood event" south-west Florida had ever seen, and announced that 7000 National Guard troops were ready to lead rescue operations.
President Joe Biden will receive a briefing on Thursday from the Federal Emergency Management Agency. Vice President Kamala Harris urged Americans to follow evacuation orders after seeing "devastating" images of the damage caused by Ian.
Harris issued her plea from South Korea, where she is on an official visit.
Ian is now continuing to move north through Florida. Jacksonville International Airport, based in north-east Florida, cancelled all flights on Thursday.
The storm is forecast to emerge into the Atlantic by Thursday morning, local time.
It is expected to reach Georgia and South Carolina on Friday. Virginia has also joined Georgia, North Carolina, South Carolina and Florida in declaring a state of emergency.
Cuba's western coast was hit by Hurricane Ian on Tuesday. Power has now been restored in some areas after the island was plunged into a total blackout.
Two people are understood to have been killed in Cuba and more than 20 Cuban migrants, heading to the US, are believed to be missing at sea.
- Reuters
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