At least 27 people have died in Erie County, New York, as a result of a massive winter storm which blasted much of the United States in recent days, county officials said Monday, bringing the nationwide death toll to 49.

The  number of deaths in Erie County, which includes the city of Buffalo, comes as parts of western New York remain buried by up to 43 inches of snow, leaving vehicles stuck and power out for thousands over the Christmas holiday, just one month after the region was slammed with a historic snowstorm.

“This is a horrible situation,” Erie County executive Mark Poloncarz said in a news conference, noting officials expect between 8 and 12 more inches of snow to fall between Monday morning and 1 p.m. Tuesday. “This is not helpful as we’re trying to recover and clear off streets and get into areas that still have not” been plowed, he said.

Poloncarz tweeted Monday afternoon: “sadly, the (county Health Department) Medical Examiner has confirmed another 2 deaths from the Blizzard. Total deaths are now 27. Of these: 3 were from an EMS Delay; 14 were found outside; 3 were from shoveling/blowing cardiac events; 4 were from no heat; & 3 were in a vehicle.”