U.S. weather officials said the tornado that hit at dinnertime on Sunday may have been the single deadliest in the country since 1953.
Rescue crews from throughout the region worked all night and battled a driving rain and thunder storm on Monday morning in the town of about 50,000 people, searching for anyone still alive in the rubble.
More than 500 people were confirmed injured, many with massive internal injuries, officials said. The number of dead and injured was expected to climb as rescue workers dig through collapsed homes and businesses.
A number of bodies were found along the city's "restaurant row," on the main commercial street and a local nursing home took a direct hit, Newton County Coroner Mark Bridges said.
At St. Johns Hospital in Joplin, 180 patients cowered as the fierce winds blew out windows and pulled off the roof. Others took refuge in restaurant coolers, huddled in closets, or just ran for their lives.
Roaring along a path nearly six miles (9.5 km) long and about 1/2 mile to 3/4 mile (1 km) wide, it flattened whole neighborhoods, splintered trees, flipped cars and trucks upside down and into each other. Some 2,000 homes and many other businesses, schools and other buildings were destroyed.
An estimated 20,000 homes and businesses were without power on Monday morning.
"It is a significant tragedy," said Missouri Governor Jay Nixon. "We're working on all cylinders. We've got to get an active and complete search ... to make sure if there is anyone still alive in the rubble that we get them out."
The city's residents were given about 20 minutes notice when 25 warning sirens sounded throughout the southwest Missouri town around 6 p.m. CDT, said Jasper County Emergency Management Director Keith Stammers.
But the governor said many people likely were unable to get to shelter in time. "The bottom line was the storm was so loud you probably couldn't hear the sirens going off." He declared a state of emergency and called out the Missouri National Guard to help.
The tornado in southwestern Missouri was the latest in a string of powerful twisters that has wreaked death and devastation across many states, and it comes as much of the Mississippi River valley is underwater from record flooding.
Twisters killed more than 300 people and did more than $2 billion in damages across southern states last month, killing more than 200 in Alabama alone.
COLLECTING BODIES
"The loss of life is incredible," said Joplin Mayor Mike Woolston. "We're still trying to find people. The outlook is pretty bleak."
Two refrigerated trucks were brought in to serve as a make-shift morgue at a local university and more were being brought in to handle the additional bodies expected, the coroner said.
"I would be surprised if we don't find more today," Bridges said, though he declined to speculate about how many more victims might be found. Multiple victims were taken from several locations around the city, including a nursing home.
"I haven't got any kind of real numbers on who is missing right now," said Bridges. "People ... have been pouring in looking for loved ones and they can't find them, looking for friends, can't find them. I'm just really concerned that there is going to be a number more."
Joplin City Councilwoman Melodee Colbert-Kean, who serves as vice mayor, said the town was in a state of "chaos."
"It is just utter devastation anywhere you look to the south and the east -- businesses, apartment complexes, houses, cars, trees, schools, you name it, it is leveled, leveled," she said.
President Barack Obama called the governor Sunday evening to "extend his condolences" to the families of Joplin. White House spokesman Nicholas Shapiro said Federal Emergency Management Agency head Craig Fugate was on his way to Joplin to help with recovery.
The tornado in Joplin was one of a string over the weekend.
On Saturday night, a tornado ripped through Reading, Kansas, killing one and damaging 200 homes and businesses. Another person was killed in a tornado in Minneapolis on Sunday.
The storms that hit Joplin continued a path of destruction eastward through the Ohio Valley region, bringing golf ball-sized hail and 50 mile-per-hour winds to Tennessee, knocking down trees and power lines and stripping roofs from building.
HUDDLED IN RESTAURANT COOLER
Sharon Hurtt 60, and Bill Dearing, 59, had no basement to flee to when the tornado descended on their single-story home, so they huddled in a closet between two bedrooms. Within minutes, the roof was gone and powerful winds ripped the door off the closet.
"We were holding on to keep from blowing away," said Hurtt.
A mattress blown off the bed somehow became wedged in the doorway.
"It probably saved us," said Hurtt.
When the couple emerged, the daycare center next door was gone and mangled cars and other debris littered their yard.
Carla Tabares said she, her husband and several families with children squeezed into the kitchen cooler of an Outback Steakhouse restaurant when the twister neared, huddling in the chilly darkness until the howling of the storm passed.
"It was really awful, really scary," she said. The restaurant was largely unscathed, but other buildings were badly damaged. "I'm just thankful we got out alive, and I really feel sorry for the people who didn't."
Joplin-area resident Denise Bayless, 57, said she and her husband were at church when their adult son called to say the tornado was hitting his house. The couple got in their car to race to his aid.
"We just had to weave in and out of debris. Power lines were down everywhere, and you could smell gas," she said.
After stopping to assist a woman they heard screaming, trapped inside her home, Bayless said she ran five blocks to her son's house, where she found every home on the street -- some 20 dwellings including his -- were gone.
"I just lost all my bearings. There was nothing that looked familiar," said Bayless, whose son was unhurt.
Leslie Swatosh, 22, ducked into a liquor store with several others as the tornado descended on them. The group huddled on the floor holding onto each other, and prayed.
"We were getting hit by rocks and I don't even know what hit me," said Swatosh. When the tornado passed, the store was destroyed but those inside were all alive, she said.
"Everyone in that store was blessed. There was nothing of that store left," said Swatosh.
