PENSACOLA, N.C. — Rescue crews and volunteers facing obstacles at every turn in North Carolina’s remote mountains paddled canoes across swollen rivers and steered horses past mudslides in the rush to reach those stranded or missing by Hurricane Helene’s rampage that killed more than 200 throughout the Southeast.

Now a week since the storm first roared onto Florida’s Gulf Coast, the search continued for people who have yet to be heard from in places where phone service and electricity were knocked out. Pleas for help came from people running low on medicine or in need of fuel for their generators.

How many people are missing or unaccounted for isn’t clear. The death toll soared to 215 people on Thursday as more victims were found, making Helene the deadliest hurricane to hit the mainland U.S. since Katrina in 2005. Roughly half the victims were in North Carolina, while dozens more were killed in South Carolina and Georgia.

Along the Cane River in western North Carolina’s Blue Ridge Mountains, rescuers from the Pensacola Volunteer Fire Department were cutting their way through trees at the top of a valley nearly a week after a wall of chocolate-milk colored water swept through for hours.

Pensacola, which sits a few miles from Mount Mitchell, the highest point east of the Mississippi River, lost an untold number of people, said Mark Harrison, chief medical officer for the department.

“We’re starting to do recovery,” he said Thursday. “We’ve got the most critical people out.”

Harrison was helping dispatch volunteers driving all-terrain vehicles on supply runs to people still on ridgetops. Many don’t want to leave their houses, while others lost their vehicles and need help getting to town.

Bradley Billheimer, who hiked down to the fire station to access the internet, said he just talked to his mom for the first time since the storm. He feared his house will be without power for months.

“I think we’re going to walk out in a couple of days,” he said.

In another county that sits alongside the Tennessee state line, crews were just finishing clearing main routes and reaching side roads that wind through switchbacks and cross small bridges that can be tricky to navigate even in the best weather. Each road presented a new challenge.

“Everything is fine and then they come around a bend and the road is gone and it’s one big gully or the bridge is gone.” said Charlie Wallin, a commissioner in Watauga County. “We can only get so far.”

Most people the crews come across turn out to be fine and just in need of water, but every day there are new requests to check on someone who hasn’t been heard from yet, Wallin said. When the search will end is hard to tell, he said.

“You hope you’re getting closer, but it’s still hard to know,” he said.

A week into the search and rescue operations in Buncombe County, which includes the hard-hit tourist city of Asheville and where more than 72 have been killed, the county doesn’t have an official tally of people who are unaccounted for or missing.

The county sheriff said his office believes more than 200 people are missing, although other officials said the number is constantly changing when crews make contact with people who hadn’t been accounted for or receive new names of people who may be missing.

“We’re continuing to find people. We know we have pockets of people who are isolated due to landslides and bridges out,” said Avril Pinder, the county manager. “So they are disconnected but not missing.”

Frank Johnson, who owns a company that makes robotic cutting machines in Mars Hill, N.C., said he feels like he is running a relief mission on his own. He’s using his own workers, volunteers and supplies and know-how from his company to get water, food, fuel and other supplies to his neighbors.

“I’ve been hearing there are entire neighborhoods gone. I’m still not sure people have the whole grasp of what we’re dealing with,” Johnson said.

Electricity is being slowly restored, as the number of homes and businesses without power dipped below 1 million for the first time since last weekend, according to poweroutage.us. Most of the outages are in the Carolinas and Georgia, where Helene struck after coming into Florida on Sept. 26 as a Category 4 hurricane.

John Savage said his grandparents were found hugging one another in their Beech Island, S.C., home where one of the biggest trees on the property crashed on top of their bedroom and killed them.

The family thinks it was God’s plan to take them together, rather than one suffer without the other, he said.

“When they pulled them out of there, my grandpa apparently heard the tree snap beforehand and rolled over to try and protect my grandmother,” Savage said.

Two firefighters killed when a tree fell on their truck also were among at least 40 people killed across South Carolina.

Month-old twin boys, born in mid-August, were the youngest known victims. Khyzier and Khazmir Williams died alongside their 27-year-old mother Kobe Williams when a large tree fell through the roof of their home Monday in Thomson, Georgia.

Kobe’s father, Obie Lee Williams, said he’s devastated that he will never have the chance to meet his grandsons in person. He described his daughter as a lovable, social and strong young woman who cared deeply about her family.

Other young victims of the storm include a 7-year-old girl and a 4-year-old boy from Washington County, Georgia.

President Joe Biden spoke with survivors and first responders and surveyed damage Thursday in Keaton Beach, Fla., walking past mountains of splintered wood, demolished homes and massive pieces of siding crumpled like paper. Biden met with people who had lost homes; one couple was living out of a trailer near the wreckage of their home, their personal belongings strewn on the ground.

Later at a badly damaged pecan farm outside Valdosta, Georgia, he said the victims of Helene had gone through “hell.”

“I want you to know I see you … I grieve with you,” Biden said while also thanking emergency workers and saying it was a moment to “put politics aside.”

Biden flew over the devastation in North and South Carolina on Wednesday. The administration announced a federal commitment to foot the bill for debris removal and emergency protective measures for six months in North Carolina and three months in Georgia. The money will address the impacts of landslides and flooding and cover costs of first responders, search and rescue teams, shelters, and mass feeding.