The massive winter storm expected to pummel the US east coast has begun its snowy deluge, grounding flights and shuttering vaccination sites.
By Monday morning, snowfall had begun in New York State, New Jersey and Pennsylvania, where up to 60cm (24in) of snow may fall in the coming days.
Wind gusts of up to 80km/h (50mph) are also forecast for several days creating a blinding, blowing snow storm.
New York City and New Jersey have both declared a state of emergency.
The storm – which is expected to bring snowfall for two days straight – has already wrought havoc on local travel. New York City Mayor Bill de Blasio issued an order restricting non-essential travel from 06:00 local time (11:00GMT) on Monday.
In New Jersey, Governor Philip Murphy suspended the state’s bus and rail operations on Monday. His emergency order allows authorities to shut roads and evacuate homes.
Major airports in the storm’s path, including Newark Liberty International Airport, John F Kennedy Airport, and Philadelphia International Airport, have cancelled hundreds of fights. At New York’s La Guardia Airport, all flights were suspended as of Monday morning.
The storm will also halt vaccine distribution in Connecticut, New Jersey, Rhode Island, Philadelphia, parts of Washington, DC and the New York area.
In New York City vaccinations will be cancelled through to Tuesday, as Mayor de Blasio has said it is “not safe” for older residents to go outside in the blizzard conditions.
“We’re in a local state of emergency,” Mr de Blasio said at a press conference on Monday. “I am fearful that this tough situation we have now could get worse.”
The snowstorm already hit the west coast, with California experiencing more than 2m (6ft) of snow last week.
In Washington DC, many have enjoyed the snow in front of the capital’s iconic landmarks. After a day of snow on Sunday, the winter weather advisory from the National Weather Service has been extended until Tuesday at midnight in the DC area. Freezing rain and sleet showers are expected through the day.
President Joe Biden has met advisers to discuss “a range of issues, including the approaching winter storm”, a White House official said.