More than 50 people have died across the United States in a massive storm that took at least 28 lives in Buffalo, New York. And the weather pattern, called by the city’s mayor a “once-in-a-generation” storm, according to NPR, is not completely done.

While blizzard conditions pounded a big swatch of the central U.S. around Christmas, Buffalo got more than 4 feet of snow, accompanied by freezing temperatures. The situation was so dire that the National Guard was dispatched to dig people out of stranded vehicles Saturday. Snow was expected to continue until at least midday Tuesday, according to a National Weather Service advisory.

After that, the weather is expected to moderate, but it will take some time until roads are all passable and the situation is stable, according to officials, who said they expect the death toll to rise.

Buffalo Police Commissioner Joseph Gramaglia told CNN Monday, “Unfortunately, they are still recovering bodies.” He added, for area residents, “Stay home. Don’t go out.”

Erie County Executive Mark Poloncarz tweeted that 14 of the deaths in the Buffalo area resulted from exposure to extreme cold. He said three people were found dead in their vehicles, four died without heat, three died from shoveling or snow-clearing related cardiac events, and three died after EMS services couldn’t reach them in time.

He told CNN, “We’ve had so many bodies that various hospitals are full and we’re just having to go through and determine if the individuals have died from a blizzard-related death.”

CBS affiliate WIVB said that 19 of the Erie County deaths were confirmed in the city of Buffalo, three in Amherst and three in Cheektowaga. The station said a 27-year-old man died in Lockport of suspected carbon monoxide poisoning. The ages of the deceased in Erie County range from 22-93.

What started as heavy rain was hit by an arctic blast that turned into massive snowfall. According to an Accuweather report, emergency vehicles and first responders were in some cases unable to reach people who needed help.

Though conditions have improved somewhat, driving is still dangerous in spots. Per CNN, “While driving bans have been lifted in some communities, one such order remains in place in Buffalo, Poloncarz said, describing the city is ‘impassable in most areas,’ with abandoned vehicles scattered everywhere.” Officials noted that 11 ambulances were abandoned in the storm and had to be dug out Christmas Day.

New York Gov. Kathy Hochul has asked President Joe Biden to declare a federal emergency due to the storm to help with recovery efforts and costs in Erie and Genesee counties.

Not just Buffalo

Besides sometimes-deadly temperatures, the storm that hit a large part of the country this past week has brought power outages, dangerous driving conditions and thousands of canceled flights. The Associated Press said officials were blaming the weather on damage to lines that dropped water pressure in Jackson, Mississippi, and led to a boil-water order, while other cities including Charleston, South Carolina, “were on the verge.”

Officials in some cities were urging business owners to look for leaks that could cause problems to water systems, the article said.

Deaths related to freezing conditions have occurred in Colorado, Kansas, Missouri, Ohio, Tennessee, Wisconsin and Vermont — most of them related to auto crashes in icy conditions caused by weather conditions. In Colorado, two people appeared to have frozen to death and in Vermont officials said a woman died after a tree fell onto her house, per CNN.

Per The Associated Press, “Storm-related deaths were reported practically nationwide, including at least eight killed in crashes in Missouri, Kansas and Kentucky. A woman fell through Wisconsin river ice, and there was a fatal fire at a Kansas homeless persons camp.”

BBC reported that even in South Florida, temperatures fell so drastically that “iguanas froze and fell from trees.”

Staying safe in winter

While no one can control the weather, there are tips to improve the chance of survival should a massive, dangerous storm strike. Those who are elderly, very young or who have weakened health are particularly vulnerable, but no one is impervious to dangerous winter conditions. It’s important to take steps to protect yourself as much as possible.

A number of agencies and experts have created guides to coping with some of winter’s potentially lethal challenges, from icy roads to bitter cold, carbon monoxide poisoning to exposure.

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The Federal Emergency Management Agency’s top tips include making sure you have an emergency kit in your vehicle and making sure that vehicle is prepared for winter so it won’t break down.

FEMA says to never, ever use a generator indoors, regardless of whether you open windows and doors. That’s one way people die of carbon monoxide poisoning and is extremely dangerous.

If your heating source isn’t available, FEMA suggests trying to find a warming center, rather than trying to create alternate heat sources at home. House fires in winter are common. Only one heating source should ever be plugged into an outlet. And the stove top or oven should never be used that way.

The National Safety Council says to know the signs of carbon monoxide poisoning, which are “often described as ‘flu-like’ — headache, dizziness, weakness, upset stomach, vomiting, chest pain and confusion.”

FEMA also notes the importance of keeping the body warm, which can be done with layers of warm, roomy clothing more effectively than with bulky sweaters, as well as warm baths and warm drinks, but not alcohol or caffeine.

The council suggests reviewing its driving tips for staying on the road in snowy or icy conditions. Among the most important are ensuring you have plenty of gas and a good strong car battery.

It also recommends avoiding snow blowing and shoveling injuries, as well as those related to winter sports.