A massive tornado that tore a six-mile path across southwestern Missouri killed at least 116 people as it smashed the city of Joplin, ripping into a hospital, crushing cars and leaving behind only splintered tree trunks where entire neighborhoods once stood.

City Manager Mark Rohr announced the new death toll at a Monday afternoon news conference. He said seven people had been rescued, and Missouri Gov. Jay Nixon said he was “optimistic that there are still lives out there to be saved.”

Authorities warned that the death toll could climb as search-and-rescue workers continued their efforts. Their task was made more miserable early Monday by a new thunderstorm that brought strong winds, heavy rain and hail.

Much of the city’s south side has been leveled, with churches, schools, businesses and homes reduced to ruins by winds of up to 198 mph.

Jasper County Emergency Management Director Keith Stammer said about 2,000 buildings were damaged. Joplin Fire Chief Mitch Randles estimated the damage covered a quarter or more of the city of about 50,000 people some 160 miles south of Kansas City. He said his home was among those destroyed.

An unknown number of people were injured, and officials said patients were sent to any nearby hospitals that could take them.

Police officers staffed virtually every major intersection as ambulances screamed through the streets. Rescuers involved in a door-to-door searches moved gingerly around downed power lines and jagged debris, while survivors picked through the rubble of their homes, salvaging clothes, furniture, family photos and financial records, the air pungent with the smell of gas and smoking embers.

Some neighborhoods were completely flattened and the leaves stripped from trees, giving the landscape an apocalyptic aura. In others where structures still stood, families found their belongings jumbled as if someone had picked up their homes and shaken them.

Nixon had said earlier that he feared the death toll would rise but expected survivors to be found in the rubble.

“I don’t think we’re done counting,” Nixon told The Associated Press, adding, “I still believe that because of the size of the debris and the number of people involved that there are lives to be saved.”

The National Weather Service’s director, Jack Hayes, says the storm was given a preliminary label as an EF4 — the second-highest rating given to twisters. The rating is assigned to storms based on the damage they cause. Hayes said the storm had winds of 190 to 198 miles per hour. At times, the storm was three-quarters of a mile wide.

Crews found bodies in vehicles the storm had flipped over, torn apart and left crushed like empty cans. Triage centers and temporary shelters quickly filled to capacity. At Memorial Hall, a downtown entertainment venue, emergency workers treated critically injured patients.

At another makeshift unit at a Lowe’s home-improvement store, wooden planks served as beds. Outside, ambulances and fire trucks waited for calls. In the early hours of the morning, emergency vehicles were scrambling nearly every two minutes.