WASHINGTON — From North Carolina to New Jersey, nearly 1.8 million people still without electricity were asking the same question Monday evening: Why will it take so long to get the lights back on?

Nearly three full days after a severe summer storm lashed the East Coast, utilities warned that many neighborhoods could remain in the dark for much of the week, if not beyond.

Friday's storm arrived with little warning and knocked out power to 3 million homes and businesses, so utility companies have had to wait days for extra crews traveling from as far away as Quebec and Oklahoma. And the toppled trees and power lines often entangled broken equipment in debris that must be removed before workers can even get started.

Adding to the urgency of the repairs are the sick and elderly, who are especially vulnerable without air conditioning in the sweltering triple-digit heat. Many sought refuge in hotels or basements.

Officials feared the death toll, already at 22, could climb because of the heat and widespread use of generators, which emit fumes that can be dangerous in enclosed spaces.

At the Springvale Terrace nursing home and senior center in Silver Spring, Md., generators were brought in to provide electricity, and air-conditioning units were installed in windows in large common rooms to offer respite from the heat and darkness.

Residents using walkers struggled to navigate doors that were supposed to open automatically. Nurses had to throw out spoiled food, sometimes over the loud objections of residents who insisted their melting ice cream was still good.

The lack of power completely upended many daily routines. Supermarkets struggled to keep groceries from going bad. People on perishable medication called pharmacies to see how long their medicine would keep. In Washington, officials set up collection sites for people to drop off rotting food. Others held weekend cookouts in an attempt to use their food while it lasted. And in West Virginia, National Guard troops handed out food and water and made door-to-door checks.

When it comes to getting the power running again, all utilities take a top-down approach that seeks to get the largest number of people back online as quickly as possible.

First, crews repair substations that send power to thousands of homes and businesses. Next, they fix distribution lines. Last are the transformers that can restore power to a few customers at a time.

In Great Falls, Va., just outside Washington, patent attorney Patrick Muir found out firsthand who was high on the priority list. The area is sparsely populated and wealthy, with mansions spread across secluded, wooded lots. Muir had been raiding water bottles from his powerless office to supply his home, which is on a well that was not working. His 8-year-old daughter spoke hopefully of a beach trip to escape the heat. Dad said it was under consideration.

"Great Falls always seems to be the first to go down and the last one to come back up," Muir said.

A Safeway supermarket trying to stay open with a limited power supply handed out free bags of dry ice. But after two days of temperatures in the 90s, the air inside was stale. Shopping carts with spoiled food, buzzing with flies, sat outside the store.

At a CVS pharmacy, Mahesh Tickle did the best he could. He had no cash register, so he made change with loose bills and coins stuffed inside a Ziploc bag. Tickle filled what prescriptions he could and fielded questions from customers wondering if medications such as insulin had spoiled.

Some people said the destruction over the weekend was reminiscent of that caused by Tropical Storm Isabel in 2003 and Hurricane Irene in 2011.

Some backup utility crews arrived Sunday in Maryland, but many were not expected until sometime Monday. That's because the storm arrived so quickly, unlike hurricanes, which typically approach with several days of warning and give out-of-state crews plenty of time to get into place.

After Isabel, it took electricity supplier Pepco eight days to restore power to most of the 500,000-plus customers in Washington and the surrounding areas. About 443,000 lost power at the peak of this storm, and restoration work will likely last into the weekend.

Last year, it took Baltimore Gas and Electric company eight and a half days to restore power to all 750,000 customers who lost power during Hurricane Irene. This time, the power company initially confronted more than 600,000 people without power. It said restoration efforts will extend into the weekend.

BGE said in a letter posted on its website that it would take hundreds of thousands of man-hours to clear debris and work through outages. Crews are working around the clock in 16-hour shifts.

"This type of widespread, extensive damage also complicates our ability to quickly provide accurate restoration times, especially when original damage assessments are revised upon closer inspection of the work required," the letter said.

Some customers were getting impatient Monday.

"This has happened time after time and year after year, and it seems as if they're always unprepared," said John Murphy, a professional chauffeur from Burtonsville, Md., who was waiting for Pepco to restore power Monday to the homes of himself and his mother and sister, who live nearby. "The new neighborhoods are designed with underground power lines but the old neighborhoods, they don't want to spend the money to put them underground."

Utility workers restored a steady electricity flow to Leslie Saltsman's home in Potomac on Monday afternoon. But the enormous cherry tree blocking her driveway won't be removed until later this week.

Saltsman, a nurse who takes care of her elderly mother, watched as linemen in a bucket truck repaired cables above streets lined with piles of tree branches and trunk sections. She said she was irritated by the heat but not by Pepco.

"They're doing as much as they can," she said. "I'm not frustrated with the power company at all."

However, Maryland Gov. Martin O'Malley has been blunt that the utilities must work faster: "No one will have his boot further up Pepco's and BGE's backsides than I will," O'Malley said Sunday.

Pepco spokeswoman Myra Oppel said the differences between storms can be significant. Two storms could have the same number of customers with outages, but the root of the problem could be downed wires in one situation and downed poles in another. But repairing poles takes a lot longer.

As a result, the length of time it takes to restore power "depends on what damage has occurred, not the number of outages," Oppel said.

In the case of Friday night's storms, crews are contending with trees that have to be removed before crews can get to damaged infrastructure.

She said the fact that neighboring states were also hard-hit meant many utilities were competing to get the same backup crews for help.

In Baltimore County, Eveena Felder, a registered nurse, had been relying on air-conditioned public areas to keep cool during the day and a fan to help her family sleep.

"We've purchased a ton of batteries, that's where most of our money has gone," Felder said. "Turn the fan on and keep still, don't move, less energy."

Officials were especially concerned about people in isolated rural areas, such as Greenbrier County, W.Va.

"They have no radio station. They have no TV station. They have no communications because without power, they don't have phones," said Lt. Col. David Lester of the West Virginia National Guard.

Back at the nursing home, the cable was out as well, so in the common rooms with generator power the center played movies on old VHS tapes, including the 1932 classic "Grand Hotel."

Margaret Foster and Helen Ofsharick, 93 and 95 respectively, passed the time outside.

"You wouldn't want to live this way more than a day or so," Foster said. "There are sick people here, or people who don't think too well. They need help."

___

Barakat reported from Falls Church, Va., and Silver Spring, Md. Associated Press writers David Dishneau in Rockville, Md., Dan Sewell in Cincinnati; Kantele Franko in Columbus, Ohio; and Vicki Smith in Morgantown, W.Va., contributed to this report.

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  • An American beech tree lies on Capitol Hill grounds in Washington, Saturday, June 30, 2012, in front of the U.S. Supreme Court, background, after a powerful storms swept across the eastern U.S. Friday evening. (AP Photo/Manuel Balce Ceneta)

  • Frances Lukens looks at the tangle of boards and tree limbs piercing her living room ceiling in Lynchburg, Va. on Saturday, June 30, 2012 after a huge oak tree fell directly on the house during a storm the previous night. (AP Photo/The News & Advance, Parker Michels-Boyce)

  • In this Friday, June 29, 2012 photo, a car sits damaged from where a brick wall fell on it from the second story of a store in Columbus Grove, Ohio. The bricks fell on and crushed two vehicles as strong winds tore through the region Friday afternoon. (AP Photo/The Lima News, Jay Sowers)

  • A tree sitting atop a vehicle offers free firewood in Falls Church, Va., Monday, July, 2, 2012, as cleanup continued after Friday's storm, Around 2 million utility customers are without electricity across a swath of states along the East Coast and as far west as Illinois as the area recovers from a round of summer storms that has also caused at least 17 deaths. (AP Photo/Karen Mahabir)

  • A utility pole is cracked in half by a downed tree on a residential street in Arlington, Va., Sunday, July 1, 2012. Severe storms swept through the area leaving many homes and businesses without electricity. (AP Photo/Cliff Owen)

  • Marcia McCloud (right) and her great-granddaughter Makayla Milton, find some comfort together at the Red Cross cooling shelter at Sandusky Middle School in Lynchburg, Va., July 1, 2012. Milton was visiting her great-grandmother Friday when the storm hit and the two were forced to find other shelter. McCloud explained, "It's like a vacation, vacation away from home!" (AP Photo/The News & Advance, Parker Michels-Boyce)

  • Joe Tiago

    Joe Tiago takes pictures of a downed utility pole and electric transformer on Old Keene Mill Road, Sunday, July 1, 2012 in Springfield Va. A severe storm late Friday knocked out power to approximately one million residents, traffic signals and businesses in the region. (AP Photo/Pablo Martinez Monsivais)

  • Residents of the Cleveland Park neighborhood of Washington, navigate underneath a downed tree, Sunday, July 1, 2012. A severe storm late Friday, June 29th knocked out power to approximately one million residents, traffic signals and businesses in the region. (AP Photo/Pablo Martinez Monsivais)

  • A worker uses a chainsaw to clear a tree that fell onto the 14th fairway at Congressional Country Club in Bethesda, Md., Saturday, June 30, 2012, after a strong storm blew through overnight. The AT&T National golf tournament was postponed to allow workers to clear the course. (AP Photo/Patrick Semansky)

  • A van and boat sit crushed by fallen trees, as crews work to restore power Saturday, June, 30, 2012, in Northfield, N.J. Severe thunderstorms packing heavy rain, lightning and strong winds that gusted up to 70 mph hit the state Saturday, knocking out power to hundreds of thousands and killing at least two. (AP Photo/Mel Evans)

  • Using crutches, Cooper Scott talks about the car where he and his mother were trapped in Lynchburg, Va. Saturday, June 30, 2012 after a large oak tree fell on them during the storm the night before. Both spent most of the night in the hospital but were back at home by Saturday morning. (AP Photo/The News & Advance, Parker Michels-Boyce)

  • Marilyn Golias, right, looks at the remains of a utility pole which fell across the street from her house in Falls Church, Va., Saturday, June 30, 2012. Millions across the mid-Atlantic region sweltered Saturday in the aftermath of violent storms that pummeled the eastern U.S. with high winds and downed trees, killing at least 13 people and leaving 3 million without power during a triple-digit heat wave. (AP Photo/Cliff Owen)

  • Lighting flashes Saturday morning, June, 30, 2012 in Hebron Md.. Violent storms swept across the eastern U.S., killing at least nine people and knocking out power to hundreds of thousands on a day that temperatures across the region are expected to reach triple-digits. (AP photo by Salisbury Daily Times, Kristin Roberts)

  • Cesar de Jesus,

    Cesar de Jesus, 4, from Riverdale, Md., play peek-a-boo from under a Red Cross blanket at a Red Cross shelter at Northwestern High School gym Saturday, June 30, 2012 in Hyattsville, Md. near Washington. Violent evening storms following a day of triple-digit temperatures wiped out power to more than 2 million people across the eastern United States. (AP Photo/Alex Brandon)

  • In this photo taken Friday, June 29, 2012 shows a trampoline smashed into the side of the garage in Lima, Ohio. Violent storms swept across the eastern U.S., killing at least 10 people and knocking out power to millions of people on a day that temperatures across the region are expected to reach triple-digits. The storms were blamed for the deaths of six people in Virginia; two in New Jersey; one in Ohio; and another in Maryland. (AP Photo/The Lima News, Gretchen White)

  • Larry Pellino

    Larry Pellino repairs the site of the AIDS Memorial Quilt display damaged by a powerful storm that swept across the Washington region Friday, at the National Mall in Washington Saturday, June 30, 2012. Organizers of the quilt display are planning to put the exhibit back on Sunday. Violent storms swept across the eastern U.S., killing at least nine people and knocking out power to hundreds of thousands on a day that temperatures across the region are expected to reach triple-digits. Officials said about 500,000 people were without power in West Virginia. (AP Photo/Manuel Balce Ceneta)

  • A tree lies on top of a storage building at the home Saturday, June 30, 2012 in Charleston, W.Va. (AP Photo/Jeff Gentner)

  • A passing storm brought a halt to rides Friday, June 29, 2012 at the 26th annual Italian-American Festival being held this weekend at the Stark County Fairgrounds in Canton, Ohio. A wave of violent storms sweeping through the mid-Atlantic following a day of record-setting heat in Washington, D.C., has knocked out power to nearly 2 million people. The storms converged Friday night on Washington, D.C., Maryland, Virginia and West Virginia. West Virginia Gov. Earl Ray Tomblin declared a state of emergency after more than 500,000 customers in 27 counties were left without electricity. (AP Photo/The Repository, Bob Rossiter)

  • A tree toppled by severe storms sits atop a car in Washington's Dupont Circle neighborhood on Saturday, June 30, 2012 in Washington. More than two million people across the eastern U.S. lost power after violent storms and two people died, including a 90-year-old woman asleep in bed when a tree slammed into her home, a police spokeswoman said Saturday. (AP Photo/Jessica Gresko)

  • Clouds roll over Mundelein, Ill., as a storm moves through the area Friday, June 29, 2012.(AP photo/Daily Herald, Steve Lundy)

  • Raw Video: Storms Kill 3 in North Carolina

    Authorities say three people were killed when a sudden storm struck in eastern North Carolina, damaging homes and uprooting trees.