Rescuers shifted through the rubble of six miles of debris and more than 2000 damaged buildings on Monday, looking for survivors as high winds and hail continues to plague the area.
"This a community. We are more than a city ... we do things together," Joplin Mayor Mike Woolston told ABC News' Diane Sawyer. "The city sheltered a number of people the first night, but it was a hundred or so, something like that. Given that we had 2,000 structures that are damaged, you wonder where those people went. Well, they're staying with friends, they're staying with family, some of them may be staying with complete strangers they don't know but may have taken them in. The amount of donations we've had is overwhelming."
Helping among the relief efforts is TLC's "19 Kids and Counting's" Josh Duggar, a volunteer firefighter.
"The whole town is just torn apart. And I think you can just sense the people, there's a sense of 'we can do this, we're going to unite together and take care of this,'" Duggar told "Good Morning America."
Doug Westoff and his "Missouri Task Force One" desperately searched for anyone still living among these cars in the parking lot of a local Wal-Mart.
"It's mother nature, we just react to it and do the best we can," Westoff said.
So far, 9 people have been pulled alive from the wreckage. "[We] want to focus on the fact that we believe there are still rescues out there … and we want to support the men and women that are on the ground out there, literally going foot by foot searching for folks," Gov. Nixon said Monday.
Nixon declared a state of emergency Sunday evening and activated the Missouri National Guard in response to the destruction.
Five patients and one visitor were killed at St. John's Regional Medical Center in Joplin when it took a direct hit from the tornado. Patients and staff have been evacuated as damage suffered during the storm has affected the structural integrity of the building. Every window in the facility was blown out and the top two floors were blown off, ABC News affiliate KMBC reported.
Dr. Ronnie Smalling was inside the hospital when the tornado began to form overhead.
"I went over to the window and the clouds were black, wind was blowing and I began to see things fall out of the sky. I screamed at the staff to get away from windows and into the interior. The windows began to pop, and it began to sound like a freight train, just a sucking sound," Smalling told "Good Morning America."
"It was like if you were to dive 30 feet below the water. I thought I may die, that this may be my time. It lasted 90 seconds, and we heard the hail," he said.
Hospital spokeswoman Cora Scott told the station that 183 patients were in the hospital at the time and the facility only had five minutes warning that the tornado would strike. More than 100 patients have since been evacuated to other hospitals, Scott said.
The hospital declared a "condition gray" -- meaning patients, relatives and staff were instructed to leave their rooms to take cover in protected areas.
Seven people have been reported dead at a nursing home, according to police reports.
State and local law enforcement agencies, including fire mutual aid, are coordinating search and rescue and recovery operations. The Missouri State Highway Patrol sent troopers from other regions to help local officers in southern Missouri deal with the destruction, the governor's office said in a statement.
Keith Stammer, emergency management director for the city of Joplin, told "Good Morning America" that all 25 of the city's sirens did activate, and that there was a 20-minute notice from when the sirens were activated before there was a first report of a tornado strike.