Florida’s flu season officially has arrived — and hospitals already are seeing patients with respiratory illnesses.

The state’s flu monitoring report shows Florida’s flu season started on Oct. 2, and emergency department visits with a discharge diagnosis of flu are already on the upswing.

While the season has just kicked off, by all forecasts, the situation is about to get worse.

Florida doctors are expecting the next few months to slam emergency rooms, urgent cares and doctors offices with cases of flu, COVID and aggressive respiratory illnesses.

“Everything is different since COVID,” said Francis Amador, medical director of the pediatric emergency department at Salah Foundation Children’s Hospital at Broward Health. “We are seeing different things we have never seen before, and that’s going on in every emergency room.”

Nationwide, cases of the flu began to tick up earlier than usual, fueling concern that a rough winter lies ahead with the combination of influenza and a potential COVID wave creating a twindemic. In addition, an upper respiratory illness, known as RSV, is beginning to circulate among children and some older adults, worrying doctors that a tripledemic could be ahead.

This year, more travel is expected, holiday celebrations are back on, few, if any, COVID precautions are in place, and after wearing masks for two years, most communities have low circulating antibody levels.

Infectious disease experts look to Australia as an indication of what’s ahead for the U.S. This year Australia experienced its worst flu season in five years and cases peaked earlier and higher. In Florida, the peak of flu season typically is late January and February. And, as the country enters its third pandemic holiday season, some doctors fear a seasonal surge in COVID as families come back together to celebrate.

“We are expecting a rough winter,” Amador said. “Much worse than last year.”

At MDNow, which has 65 locations throughout Indian River, Palm Beach, Broward, Miami-Dade, Lee and Manatee counties, doctors already are seeing cases of Influenza A.

“It’s not an overwhelmingly high volume yet but we know it’s coming, said Dr. T’anjuihsien Marx, regional medical director with MDNow.

Flu viruses always have been dangerous for the elderly, diabetics, or immunocompromised, leading to complications and killing tens of thousands of Americans each year. In Florida, hospital admissions and deaths were three times higher in the 65 and older age group last year than in the younger age groups, according to Florida Flu Review, a state generated report.

Doctors are urging vaccination. For the last three years, Florida has had low adult flu vaccination rates, ranking near the bottom. The lower rate may be traced to the mistrust of COVID vaccines, but it’s too soon to know if that will change this year.

Dr. James Roach, Broward Health chief of emergency medicine, said if there is a year to get your flu shot, this is it.

“So many people will be coming into our airports and cruise ports and spreading viruses,” Roach said. “Even if you don’t end up in the hospital, there is going to be a lot more virus prevalent in the community.”

Roach said this winter, he’s more worried about flu overwhelming hospitals than COVID. “When the flu gets in to the lungs, that’s when people need more extensive services.”

The CDC recommends everyone 6 months and older get vaccinated every flu season and the agency now recommends a higher dose flu vaccine for people age 65 and older.

“If you are in the highly vulnerable population, there is no question you should get vaccinated,” said Dr. Raul Daza, chief medical officer for Sanitas Medical Centers. “To me it’s like wearing a seat belt. Your chances of getting seriously injured are higher if you are not wearing a seat belt. “

Each year, scientists try to make a vaccine that protects against the influenza viruses likely to cause disease in the upcoming flu season.

“Even if it is not a perfect match, you are better off having a vaccine than not,” Daza said. “It’s time to get your flu shot right now.”

Antibodies from the vaccine kick in about two weeks after a shot. The flu often starts to hit Floridians hard when people are traveling and gathering for Thanksgiving, and then reaches higher levels of spread after Christmas.

“The reason to get it now is so that you will have your highest levels of immunity when the season is the worst,” he said.

The protection generated by the flu shot erodes over the course of a flu season, but most experts believe you have about four months of solid protection.

Some people mistakenly believe they will get the flu from the influenza vaccine. Flu shots are made with inactive virus and trigger your body’s immune response.

“Remember the flu vaccine protects against the flu virus but there are other viruses that will cause respiratory illness,” Daza said. “It’s not like you have protection from all viruses.”

While COVID cases and positivity continue to trend downward in the United States and Florida, Helix’s viral surveillance is closely tracking an uptick in European countries. Helix experts believe that within weeks, the U.S. will see the same uptick.

For the last two winters, Florida’s winter COVID wave arrived in December and peaked in January, triggered by a new variant.

This year, Helix forecasts a different scenario: “it’s possible not just one lineage will take over like last winter, but several lineages with a specific mutation or combination of them will contribute to the expected winter uptick.”

Scientists don’t know to what extent the new lineages will challenge vaccines or immunity from previous COVID infections. Still, they are urging those most vulnerable to get the new bivalent COVID booster that protects against the original coronavirus strain and the omicron strains BA.4 and BA.5, which were circulating this summer. The vaccines are available to anyone 5 years and older.

So far, researchers believe a winter COVID wave will mostly cause milder infections.

“We have a better understanding what it takes to protect ourselves,” said Aarti Raja, professor of biological sciences at Nova Southeastern University in Davie. “Hopefully those who are most vulnerable will get boosters. The coronavirus is going to continue to change. We just have to hope that it is not going to change to the extent that it will cause lethal infections.”

Symptoms of a cold, flu or COVID could be similar: cough, runny nose, body aches, fever. Raja said the only way to know for certain is to get tested.

At-home COVID tests can determine whether COVID is the cause of your illness, although negative test results on rapid tests don’t always mean a person is in the clear. You may need to test again the next day.

A doctor can test you for influenza A or B. If you do test positive, starting on an antiviral within 48 hours of getting sick will help you recover faster. There are four FDA-approved antiviral drugs recommended by the CDC to treat flu, and all require a doctor’s prescription.

About two weeks ago, the Broward Health’s Salah Children’s Hospital announced it had to open up overflow units for pediatric ICU patients presenting with RSV. respiratory syncytial virus. RSV is a virus that infects the lungs and breathing passages and is most common in young children.

Amador at Salah Foundation Children’s Hospital at Broward Health said the cases of RSV have slowed, but are not gone. “We started with RSV, but now we are seeing a mix of viruses, especially in infants. We are busy but we are managing. The situation changes from week to week.”

Across the country, hospitals are seeing the same trend in rising RSV cases in young children. They believe children may have little or no immunity against the respiratory infection as a result of the masking, social distancing and other behaviors aimed at protecting against COVID over the last two years.

Your Health

Your Health


The latest health news, fitness science and nutritional updates to help you live longer and better.

Children can be tested for RSV a doctor’s office.

Pediatricians are urging parents to be aware of the symptoms that signal a serious illness.

“Shortness of breath is an important symptom,” Amador said. “If you see your child has difficulty breathing or fast breathing, that’s your first clue to go to the emergency room immediately,”

There isn’t a treatment for RSV, so a child who becomes infected with the virus and is sick enough to go to the hospital is usually offered only supportive care, which can include being put on oxygen, Amador said.

Adults can get RSV. too, but symptoms are mild and typically mimic the common cold. However seniors and people with weakened immune systems who get RSV are more vulnerable and may need to be hospitalized.

Raja at Nova Southeastern said while upper respiratory illnesses already are surfacing in Florida, other states already are seeing equal numbers of COVID, flu and RSV. “It’s colder in other location and that has pushed people indoors more. We lag behind on that front so we are not seeing as much yet as other states, but it’s highly likely we will.”

Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.