At West Boca Medical Center, Dr. Cory Harlow sees patients coming into the emergency department with many of the same symptoms they complained of during the early days of COVID in Florida: pneumonia, high fever and shortness of breath.

Although Harlow no longer has to rush patients into intensive care and put them on a ventilator, he does admit them to a regular room in an area dedicated again for COVID patients.

“COVID hospitalizations were trending down and then with this strain, they took a left turn,” he said.

COVID hospitalizations in Florida rose 25% in the past four weeks to more than 4,400 patients as BA.5 began exerting its dominance in the state. But inside local hospitals, the patients and the care they need look different in this wave than they did in the initial omicron wave that peaked in January.

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The COVID floors, which are reopened in many hospitals after a spring lull, now treat two different types of patients. The first are people whose COVID symptoms cannot be managed at home — mostly seniors over 70 with a large majority over 80, according to Florida data from the U.S. Department of Health and Human Services. Most have co-morbidities such as obesity, diabetes and respiratory conditions but few are so sick they need intensive care. As of Tuesday, only 7% of intensive-care beds in the state are filled with COVID patients.

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Today, the general standard of care for hospitalized patients is antiviral remdesivir, along with steroids and oxygen support in some cases.

“Ventilators are only used in severe cases, and they are a fraction of what they were before,” said Mark Doyle, president and chief executive officer of Holy Cross Hospital in Fort Lauderdale.

Even those admitted for COVID are only staying three to four days to manage their symptoms, compared to seven or more just months ago, Doyle said.

In prior waves, the majority of hospitalized patients for COVID complications were unvaccinated. But in this wave, even vaccines that have proven highly effective at preventing serious illness are not keeping everyone out of the hospital.

“What confuses the picture is a lot who got vaccinated and did not get their booster,” said Harlow, with West Boca Medical Center. “When you are a year out, the protective effect is significantly degraded. It’s less clear whether you are any more protected than if you are not vaccinated at all.”

The second group of patients in COVID wards are people who come to the hospitals for other procedures such as gallbladder removal, or heart issues and test positive for coronavirus.

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Doctors say this last group has nuances. “Someone may have had a heart attack and we swab them and they are positive,” explains Harlow. “It’s a challenge to tease it out because COVID is a risk factor for heart disease. It has the chicken-and-egg aspect to it. Did COVID make their heart problem worse, or did it just happen and they also have COVID?

The COVID census at Florida hospitals is nowhere as high as it was during previous waves, particularly the omicron surge in January that brought a crush of patients and overwhelmed emergency rooms. Hospital visitation policies, which had been restricted in January, have been restored at most hospitals.

At Miami’s Jackson Health System, where a high of 564 COVID patients were admitted during the January omicron wave, the current count is 135 across its five hospitals.

Dr. O’Neill J. Pyke, chief medical officer of Jackson North Center, said some signs within his health system are encouraging. For example, he said, “Most of our COVID patients are in the regular units, not the intensive care. I think that’s in large part because of how vaccines mitigate severe disease.”

Even admitted patients aren’t as sick as those during previous surges, he said. “Most of those admitted to regular rooms are being monitored because of what could happen, not because of what’s already happening. They are vulnerable so we have to be cautious.”

HCA hospitals across Florida have only about 20% of the COVID patients they had during the omicron peak in January, said Dr. Jason Kelly, chief medical officer for HCA East Florida Division, which comprises 14 hospitals.

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Kelly said even the COVID patients in the ICUs aren’t as sick as they had been earlier in the pandemic. “The ICU is almost more precautionary for a lot of patients, where it was a necessity with omicron or delta.”

By now, the country has more tools to lessen the severity of COVID and reduce the risk of hospitalization. Beyond vaccines, antiviral drugs such as Paxlovid are being given to high-risk individuals.

In Florida, COVID deaths have declined significantly since March and are contained mostly to individuals over 65, state health data shows.

“The virus is more infectious but from what we are seeing in the hospitals it’s less virulent,” Kelly said. “It’s become a fairly mild respiratory illness. Obviously, there are still people who get very sick, but I think it’s much more of an endemic disease.”

Still, public health experts are renewing pleas for caution — concerned that new case rates will rise when school resumes in the fall. In fact, forecasting models show that nearly 40 states and territories — including Florida — are projected to see increases in new hospitalizations over the next few weeks.

For now, hospital leaders say they are balancing the summer uptick in cases, with employees falling sick with COVID-19 themselves. They are coping by shifting staff between departments and bringing in temporary workers. But that’s not a struggle they can afford to continue indefinitely.

“Not a day goes by that we don’t have people out with COVID,” said Doyle at Holy Cross. “We are still sufficiently staffed to handle the latest surge, but I urge anyone who feels sick to get tested, wear a mask, and don’t infect others.”

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