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WASHINGTON — From North Carolina to New Jersey, nearly 1.8 million people without electricity were asking the same question: 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.

The storm arrived Friday 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 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.

The lack of power completely upended 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. 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.

Baltimore Gas and Electric 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.

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.”

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