People streamed out of the Tampa Bay region on Tuesday as Hurricane Milton strengthened on its approach to Florida.

After weakening slightly, Milton regained strength on Tuesday afternoon to become a Category 5 storm again with winds of 165mph. It could make landfall on Wednesday night in the Tampa Bay area, which has a population of more than 3.3 million people.

Latest predictions suggested it will hit in the less populated areas south of Tampa, but forecasters said “it is critical to remember that even at 24 hours out, it is still not possible to pinpoint an exact landfall location.”

The 11 Florida counties under mandatory evacuation orders are home to about 5.9 million people, according to estimates from the US Census Bureau.

APTOPIX Mexico Tropical Weather
A person rides his bike through a flooded street in the rain as Hurricane Milton passes off the coast of Progreso, Yucatan state, Mexico (Martin Zetina/AP)

Governor Ron DeSantis said the state deployed over 300 dump trucks that had removed 1,300 loads of debris left behind by Hurricane Helene.

Fluctuations in the storm’s intensity are likely while Milton moves across the Gulf of Mexico, the National Hurricane Centre said, but it is expected to be a dangerous storm when it reaches Florida.

Those who defy evacuations orders are on their own and first responders are not expected to risk their lives to rescue them at the height of the storm.

“You do not have to get on the interstate and go far away,” Mr DeSantis told a news conference, assuring residents there would be enough fuel for their cars “You can evacuate tens of miles. You do not have to evacuate hundreds of miles away.”

Milton is forecast to cross central Florida and to dump as much as 46 centimetres of rain while heading toward the Atlantic Ocean, according to the hurricane centre. That path would largely spare other states ravaged by Helene, which killed at least 230 people on its path from Florida to the Carolinas.

Milton is the 13th named storm of the Atlantic hurricane season, which started June 1.

Most of Florida’s west coast was under a hurricane or tropical storm warning as the system spun just off Mexico’s Yucatan Peninsula, creeping toward shore and sucking energy from the Gulf of Mexico’s warm waters. Hurricane warnings were extended early on Tuesday to parts of the state’s east coast.

Tampa Bay has not been hit directly by a major hurricane since 1921, and authorities fear its luck is about to run out.

President Joe Biden approved an emergency declaration for Florida, and the White House announced on Tuesday that he would postpone a trip to Germany and Angola to monitor the storm.

“This could be the worst storm to hit Florida in over a century,” Mr Biden told reporters. “God willing it won’t be. But that’s what it’s looking like right now.”

Major General Pat Ryder, the Pentagon press secretary, said officials would look for a date and location to replace Saturday’s planned meeting with allies in Germany on Ukraine.

The Federal Emergency Management Agency has almost 900 staff members in the region and has stocked two staging areas with 20 million meals and 40 million litres of water, the White House said.

Stragglers were a problem during Helene and Ian in 2022. Many residents said they evacuated during previous storms only to have major surges not materialise. But there was evidence on Tuesday that people were heeding the warnings to get out before Milton arrived.

The Florida Highway Patrol reported heavy traffic northbound and eastbound on all roadways and said state troopers were escorting fuel tankers to assist with gasoline delivery.

Hurricane Milton Weather
Jim Smetzer puts up boards as his wife Annette clears merchandise from their camera store in preparation for Hurricane Milton in New Port Richey (Mike Carlson/AP)

About 150 miles south of Tampa, Fort Myers Beach was nearly a ghost town. Ian devastated the community two years ago with its 4.5-metre storm surge and 14 people died.

According to Mr DeSantis’ website, 10 hospitals have reported evacuations with 300 healthcare facilities evacuated as of this morning, said Florida Agency for Health Care Administration deputy secretary Kim Smoak. That count included 63 nursing homes and 169 assisted living facilities.

Steve McCoy, chief of the Florida Department of Health’s Bureau of Emergency Medical Oversight, said it is the state’s “largest evacuation ever.”

Health officials are using almost 600 vehicles to take patients out of the storm’s path, tracking them with blue wristbands that show where they were evacuated from and where they are being sent. They plan to keep getting patients out through the night, until winds reach sustained speeds of 40 mph and driving conditions become unsafe.

Tampa General Hospital has stocked up on more than five days of supplies, including food, linens and 5,000 gallons of water, in addition to an on-site well. In the event of a power disruption, the hospital also has an energy plant with generators and boilers located 33 feet above sea level.