An outbreak of three tornadoes howled across as much as 150 miles of Tennessee early Tuesday leaving hundreds of homes shattered, destroyed or badly damaged and 25 people dead along its four-county path.

The largest number of deaths came in Putnam County, where eighteen people are confirmed to have been killed, including several children, and 88 were left injured as the tornado tore the roofs off homes and flattened others. An emergency morgue was set up by the county to handle the dead.

The storm’s northeasterly path included Benton County, 73 miles southwest of Davidson County, then Nashville, the state’s capital, through Mount Juliet in Wilson County before ending its deadly route in Putnam County, 71 miles east of Nashville.

The tornado that ripped through Mount Juliet had winds up to 160 miles per hour.

Warning sirens sounded across Nashville just before the tornado struck, catching many people while they were asleep in bed.

“Things started hitting the window, and my girlfriend and I shot out of bed and darted for the bathroom. We could hear objects slamming against the building ... it was terrifying,” a Nashville resident told ABC News. “They say tornadoes sound like a train ... they were not lying. The feeling in my head from the pressure was insane. I've never felt anything like it. We were shaking.”

The storm wreaked havoc on multiple neighborhoods of Nashville, including Germantown and the Five Points area of East Nashville, damaging restaurants and high-end homes and condominiums. Two people were killed and 156 were treated for injuries as buildings were damaged and the wreckage was thrown through the air.

Metro Nashville police reported that Michael Dolfini, 36, and his girlfriend Albree Sexton, 33, were killed by flying debris as they left the East Nashville bar where Dolfini worked.

In the old area of East Nashville there were historic buildings that also suffered the same fate of newly built “tall-and-skinny” homes, designed to fit two houses on old single housing lots to make the most out of the housing boom.

“It’s this beautiful Richardsonian Romanesque church; the bell tower is gone, the triptych window of Jesus the Good Shepherd that they just restored and put back up a few weeks ago is gone,” a resident told the Associated Press.

The Nashville Electric Service (NES) reported that more than 44,000 customers lost their power early Tuesday.

The 25-person death toll from Tuesday’s storm may have been influenced by the twister’s arrival in the early hours of the morning and a lack of advanced warning.

A Facebook comment by Shawna Farmer from Putnam County provided an abbreviated but evocative image of the night’s human suffering. “I seen last night [people] were walking around dazed woken up out of sleep [because] there wasn’t a warning before about this, just thought it was a hard rain and went to sleep.”

According to Putnam County sheriff Robert L. Langley Jr., the tornado struck between the city of Cookeville, the county seat, and the town of Baxter at about 2 a.m. Television aerial video of the Putnam County devastation showed severe damage to modest homes on small lots in subdivisions.

Putnam County, home to Tennessee Tech University, is one of the poorest counties in the state, especially when compared to Metro Nashville and Wilson County.

According to the last census, the household median income was only $33,092, compared to $65,919 for the greater Nashville area which includes Franklin and Murfreesboro. Wilson County, a “bedroom community” for Nashville, has a median household income of $66,123.

Nearly one quarter of Putnam County residents, 23.3 percent, live in poverty. With a population of a little over 72,000, Putnam County was the most unequal county in the nation in 2013, according to a Huffington Post report.

The impoverishment of a large share of Putnam County’s residents is certainly a significant factor in the higher death toll.

A 2017 study published by Regional Science and Urban Economics found that in areas in the United States where tornadoes are more likely, it is the higher-poverty areas which are more likely to report fatalities. These areas have more cheaply constructed trailer homes and other types of housing, which are easily blow apart by tornadoes, and they lack appropriate emergency shelter. For each one percent increase in the poverty rate, the number of tornado fatalities increases by two percent. The study also found that increased inequality in a community also exacerbated the number of tornado deaths.

A lack of advanced warning may also have played a role. Recent press reports indicate that there are now 113 active tornado sirens in Nashville but in Putnam County there appears to be an uncertain number and they are poorly maintained.

The Cookeville Herald Citizen quoted an official last year on the patchwork state of the emergency warning system in the county: “The outdoor warning siren at 15th and Brown Avenue was down for a period of time due to maintenance issues. The siren is back working as of January of this year. The City of Cookeville owns and maintains all outdoor warning sirens within the City of Cookeville, with the exception of Tennessee Tech’s outdoor warning sirens. Putnam County Emergency Management Agency does not maintain any of the sirens within each city in Putnam County. EMA only activates the sirens during tornado warnings issued for Putnam County.”