On Wednesday, Sandy unleashed its wrath on Jamaica, where one person died, and on Haiti, where 29 people died. Two people were reported dead in the Dominican Republic and one in the Bahamas.
The powerful hurricane earlier claimed 11 lives in eastern Cuba, including several people who died in the rubble of buildings that collapsed in the fury of the massive storm.
It damaged hundreds of homes, flooding crops and downing trees, according to media reports.
The so-called “Frankenstorm” is expected to make landfall somewhere between Virginia and Massachusetts early Tuesday, hitting during the frenzied final week of campaigning before the US elections on November 6.
The storm was at category one hurricane strength at 1500 GMT, with sustained winds of 75 miles (120 kilometers) per hour as it moved along the east coast, the National Hurricane Center said.
“Tropical storm-force winds are already near the coast of North Carolina,” the center said, adding that the storm was traveling in a northeasterly direction at a speed of 10 miles (17 kilometers) per hour.
Starting Saturday night, forecasters at the National Weather Service warned the storm would “result in significant impacts along coastal North Carolina.”
Sandy could cause “moderate coastal flooding and rough surf” through Monday, drenching the state with three to five inches (seven to 13 centimeters) of rain inland and as much as five to eight inches along the coast, they warned.
But forecasters and emergency officials were far more worried about what would happen further north.
The storm’s likely collision early next week with a seasonal “nor’easter” weather system was predicted to super-charge it while dragging it west to slam into states such as Virginia, West Virginia, Pennsylvania, New York, Massachusetts and even inland Ohio.
Alex Sosnowski, an expert senior meteorologist for Accuweather.com, called it “an extremely rare and dangerous storm,” menacing 60 million people, that “could lead to billions of dollars in damage.”
Residents were bracing for huge tidal surges, power outages, inland flooding and even heavy snowfall on high ground far from the coast.
“Sandy will be more like a large nor’easter on steroids,” Sosnowski wrote.
It could have the strength of a category one or two hurricane, he explained, but with powerful winds extending out hundreds of miles from the center.
Emergency response teams were mobilizing and frightened families were stocking up on supplies, with the National Weather Service warning “now is the time to rush to completion preparations for the protection of life and property.”
A state of emergency was declared in Maryland, New York, Pennsylvania, Virginia, the US capital Washington and a coastal county in North Carolina, directing officials to speed up storm preparations.
Virginia’s department of emergency management created a blog for the latest storm advisories, with a post late Saturday morning featuring a video clip asking “Are you ready? Are you really ready?”
The sprawling US Navy base in Norfolk, Virginia said it had sent some of its fleet out to sea to get out of the way of the storm, while taking extra precautions for the ships remaining in port and pulling smaller vessels out of the water entirely.
Further north, the mayor of New York, Michael Bloomberg, said the Big Apple was ready for anything Sandy could throw at it, and cautioned against panic.
Meanwhile, concern is also mounting that storm damage and power outages could have a major impact on voter turnout, polling station readiness and last-minute campaigning by President Barack Obama and his Republican rival Mitt Romney.
US Vice President Joe Biden canceled a Saturday appearance in Virginia Beach to allow officials to focus on storm preparations and Romney did the same.
Meteorologists have nicknamed the unusual confluence of weather patterns a “Frankenstorm,” because it is on track to hit just before Halloween on October 31 and is composed of parts from different sources, as was Frankenstein’s monster.