Some crumbled buildings in Amatrice cracked even further after the biggest aftershock of Friday morning struck at 6.28am local time. The US Geological Service said it had a magnitude of 4.7, while the Italian geophysics institute measured it at 4.8.
The shaking ground also damaged one key access bridge to Amatrice, forcing emergency crews to close it.
Mayor Sergio Pirozzi said he is working with authorities to find an alternative bypass to another damaged bridge.
“We hope to God it works because otherwise, with the damaged stretch of road, we are without any connection” to the main roads, he said.
Even before the roads were shut down, traffic into and out of Amatrice was horribly congested with emergency vehicles bringing hundreds of rescue crews up to Amatrice and dump trucks carrying tons of concrete, rocks and metal down the single-lane roads.
The aftershock was preceded by more than 50 overnight and was followed by another nine in the next hour - part of the nearly 1,000 aftershocks that have rocked Italy’s central Apennine Mountains since the original 6.2 magnitude quake early on Wednesday.
Premier Matteo Renzi has declared a state of emergency and authorised 50 million euro (£42 million) for immediate quake relief.
The Italian government also declared Saturday a day of national mourning and scheduled a state funeral to be attended by President Sergio Mattarella.
Rescue efforts continued through the night and into Friday, but more than a day-and-a-half had passed since the last person was extracted alive from the rubble.
While Mr Renzi hailed the fact that 215 people had been rescued after the quake, authorities reported a steadily rising death toll that had hit 267 by Friday morning.
Civil protection operations chief Immacolata Postiglione still insisted on Friday that the rescue effort had not yet switched to a recovery mission.
Rescue workers have noted that a person was pulled out alive 72 hours (three days) after the 2009 earthquake in the Italian town of L’Aquila.
“I confirm, once again as we have from the start, that the units that are doing the searches and rescues, including with dogs looking for other people trapped in the rubble, are absolutely fully active,” she said.
On the ground, authorities were still struggling to account for all the missing, since that number is uncertain given the large number of visitors for summer holidays and an annual food festival.
“There is still hope to find survivors under the rubble, even in these hours,” Walter Milan, a mountain rescue worker, said. But he conceded: “Certainly, it will be very unlikely.”
The vast majority of the dead were found in levelled Amatrice, the medieval hilltop town famous for its bacon and tomato pasta sauce.
The other dead hailed from nearby Accumoli and Arquata del Tronto.
Flags will fly at half-mast on Saturday on all public offices and a state funeral will be celebrated by a bishop in a gym in Ascoli Piceno for the victims of nearby Arquata del Tronto - to date, 49 of the dead have come from the tiny town and its hamlet Pescara del Tronto.
The first private funerals were scheduled for Friday, including one in Pomezia, south of Rome, celebrated by one of Pope Francis’ closest collaborators, Bishop Marcello Semeraro.
Across the area, thousands have been forced to abandon their homes, either because they were destroyed or they were deemed to be too unsafe.
Overnight some 2,100 people slept in tent camps, nearly 1,000 more than the first night after Wednesday’s quake, in a sign that a significant number had found nowhere else to go.
“I have no idea what I’m going to do now, because I had renovated the house two years ago,” survivor Umberto Palaferri said, showing a photo of his collapsed home on his phone. “It was all new and now I don’t know what to do. I’m 76 and don’t know if I can rebuild it.”