MIAMI — We’re feeling it in South Florida.

Feeling the fever. The chills. The fatigue.

People with flu-like symptoms are pouring into Miami-Dade and Broward urgent care and ERs as infections across the country reach levels not seen in a decade. And for the first time since the start of the pandemic in 2020, flu-related hospitalizations and deaths have outpaced COVID.

“Some years are worse than others and this year is a worse flu season, although it’s a better COVID season,” said Mary Jo Trepka, an infectious disease epidemiologist at Florida International University.

The U.S. Centers for Disease Control and Prevention, in its most recent flu report, said the country’s influenza activity “remains elevated and is higher than it has been all season.” The agency is classifying the 2024-2025 flu season as a “high severity season overall and for all age groups (children, adults, older adults) for the first time since 2017-2018.”

“Everyone is a target. It doesn’t matter your age. It doesn’t matter where you are in the United States. Nationally, everybody is getting sick,” said Dr. Ladan Pourmasiha, medical director for Baptist Health Urgent Care in Broward County.

The virus spread quickly across Krystal Castellano’s family of five. Her husband, who “is like a tank” and never gets sick, woke up last Saturday feeling odd, and their 3-year-old son wasn’t as energetic as usual.

By the time Castellano returned from a hair appointment, she found her husband and two of their kids sick with fever. It wasn’t long before Castellano and 7-year-old Annemarie, their oldest, began to burn up, too. It was time to bring out the Tylenol and Motrin.

“Everybody slept a lot. We were like bears hibernating,” said Castellano, who lives in Palmetto Bay, owns a South Florida digital marketing agency and also runs Casita Rodriguez, a blog about motherhood, fashion, books and travel.

Last year, Castellano was the only one in her family to get the flu. She has plenty of company this year.

Castellano said several children in her 5-year-old’s class have been absent from school because of the flu. She said the school sent an email notifying parents about the rise of flu, asking them to keep sick kids home, and announcing that classroom cleanings would be increased.

And influenza isn’t the only virus making people sick in South Florida.

COVID, RSV and other respiratory illnesses are circulating, too. And the stomach bug is still going around.

South Florida’s flu forecast

Florida has recently seen high levels of flu, with the percent of ER discharges with a flu diagnosis hitting levels not seen in the past four years, state data show. The predominant strain in the state is influenza A H1N1, which caused a global flu pandemic in 2009 and continues to circulate seasonally.

The state saw a slight decrease in flu-related ER visits and positive influenza tests during the week of Feb. 9-15, according to the state’s most recent flu report. All Florida counties, except Martin on the Treasure Coast, saw a decrease in flu and influenza-like illness during this time period, including Miami-Dade, Broward and the Florida Keys.

But the virus is still circulating at high levels compared to the past four years, which means there’s a higher chance people will be exposed to the disease for the next several months, Trepka said. And while the flu for some might feel like a fatiguing cold, for others, the illness could send you to the hospital.

At Baptist Health urgent care centers, doctors are seeing more influenza compared to COVID, although Pourmasiha says patients for the past few weeks have had milder flu symptoms. Jackson Health System, Miami-Dade’s public hospital network, and Nicklaus Children’s Hospital near South Miami have also seen an increase in patients sick with the flu compared to COVID and other respiratory illnesses.

“We’ve been seeing it in our babies. We’ve been seeing it in our adults. We’ve been seeing it in our elderly. We’ve been seeing cases where you have the flu and strep.We’ve even seen cases where people are coming back with flu and COVID,” Pourmasiha said.

What about the flu vaccine?

The good news is that influenza A — the strain predominantly circulating in Miami-Dade and the rest of Florida — is one of three targeted by the 2024-2025 flu vaccine. The shot is trivalent, which means it was designed to help protect against three flu strains — influenza A(H1N1), influenza A(H3N2) and influenza B/Victoria virus.

The CDC recommends everyone 6 months and older get the single-shot flu vaccine annually, especially those who are considered to be higher risk for severe complications. This includes adults 65 and older, children younger than 2, and people who are pregnant, are immunocompromised or have certain health conditions including asthma, heart disease and chronic lung disease.

“The flu vaccine doesn’t always protect you from getting an infection but if you do get the infection it does assist in preventing the severity of that infection,” said Dr. Marcos Mestre, chief medical officer for Nicklaus Children’s Hospital.

And it’s not too late to get the shot, health experts say. It takes about two weeks after vaccination for some protection against the flu virus. While people can get sick with influenza year-round, Florida’s flu season typically runs from October to May.

“Given the level of flu activity right now, I believe we’re going to have at least a couple more months when it’s going to be around, and that means that you will absolutely have a benefit if you decide to get vaccinated today,” said Trepka, the FIU epidemiologist.

The CDC estimates that there has been at least 29 million illnesses, 370,000 hospitalizations and 16,000 deaths from flu so far this season.

What about COVID, flu, RSV and other illnesses?

Besides influenza, doctors are also seeing people sick with other illnesses, including COVID, RSV, walking pneumonia and even the stomach bug.

That’s not unusual — it is cold and flu season, after all. But South Florida’s sick season is different from the rest of the country. In South Florida, respiratory viruses tend to circulate year-round, according to Mestre.

Here’s an overview of some of the other circulating illnesses:

COVID

The main COVID strain circulating in the country is XEC, which is estimated to be responsible for about 37% of COVID infections in the country, according to the most recent CDC data. XEC is a descendent of omicron and is considered a hybrid between two pre-existing COVID subvariants, according to Yale Medicine.

This “merger” happens when one person is infected with two different COVID strains, although it doesn’t appear that XEC causes different symptoms or more severe disease compared to other strains, Yale says.

Jackson Health, Baptist Health and Nicklaus Children’s haven’t seen much COVID recently. Nationally, COVID-related ER visits are low even though federal health officials have detected high levels of the disease in wastewater, which means the disease is circulating at high levels across Florida and other parts of the country.

Just like with the flu shot, the CDC recommends everyone 6 months and older get the 2024-2025 COVID-19 vaccine, especially those who are at least 65, have never received a COVID shot, are pregnant or are considered to be high risk for severe disease.

RSV

Respiratory syncytial virus, or RSV, is a common virus that causes cold-like symptoms such as coughing and fever.

While most RSV infections are mild, some babies, young children and older adults can get severely ill, particularly those born prematurely, have weak immune systems or a medical condition such as asthma and chronic lung disease. Florida’s RSV season usually lasts longer than the rest of the country and varies by region, although in South Florida, the virus tends to circulate year-round. Currently, the entire state is in RSV season.

The CDC says that while RSV remains elevated, it’s declining in most areas of the country. In Florida, RSV-related ER visits are declining and there are low levels of RSV in the state’s wastewater. How much RSV is circulating in Florida varies by county.

While some parts of Florida saw an increase in RSV the week of Feb. 9-15, other parts of the state, including Monroe and Palm Beach counties saw a decrease during the same time period, according to Florida’s most recent RSV report. Miami-Dade and Broward counties didn’t see a change, though doctors told the Miami Herald they aren’t seeing much of this illness circulating. Overall, Florida’s RSV admissions, test positivity and ER visits decreased the week of Feb. 9-Feb. 15, state data show.

RSV vaccines are available for people who are pregnant or are at least 60. Unlike flu and COVID vaccines, it’s not an annual shot but a one-time date with the needle. RSV monoclonal antibodies also exist for babies and young children.

The CDC recommends vaccination for everyone 75 and older, the group at highest risk for contracting RSV, as well as for people who are at least 60 and have chronic medical conditions that make them more at risk for severe illness.

Walking pneumonia

South Florida is still seeing some cases of the common and contagious bacteria that led to last year’s surge of “walking pneumonia,” which primarily sickened younger children, doctors say.

The bacteria generally causes a mild respiratory illness, although it can sometimes worsen into pneumonia. If it does, it usually tends to be a less severe form of bacterial pneumonia known as “walking pneumonia,” according to the CDC.

Walking pneumonia can feel like a bad cold or a bad flu. And anyone can get it, regardless of age, although infections are most common among children ages 5 to 17 and young adults, according to the CDC. “Most will recover without medicine, but some people need antibiotics to get better,” the CDC says.

“It’s an infection that can be treated and with a good response,” Mestre, the Nicklaus Children’s doctor, told the Herald in November. “So that’s why I always tell folks not to panic about it. That being said, always take the preventative measures that are possible. Again, going back to the basics, washing your hands, being courteous of others, not being around others when you’re sick, and that should limit the spread of the illness.”

Whooping cough

Mestre says Nicklaus is seeing cases of pertussis popping up in South Florida. Pertussis, also known as whooping cough, is a very contagious and common respiratory illness caused by a bacteria.

The country usually reports more than 10,000 cases a year, though infections dipped during the COVID pandemic. Last year, the country reported more cases in 2024 of pertussis compared to 2019, prior to the pandemic, indicating that things are starting to return to pre-pandemic patterns, according to the CDC.

Whooping cough feels like a cold, but the coughing can last for weeks or months, according to the CDC. The diphtheria vaccine, which the CDC recommends for everyone, helps protect against tetanus and whooping cough and is one of the vaccines kids need to get in order to attend school in Florida.

Norovirus

Respiratory illnesses are not the only thing going around.

A virus known as the stomach bug surged across parts of the country last year and is still sending people to the toilet. Recently, more than 100 people on board a cruise ship that sailed out of Port Everglades in Fort Lauderdale fell sick with norovirus.

Norovirus is commonly referred to as the stomach flu, stomach bug or as the “cruise ship virus” because it’s often the cause of most diarrhea outbreaks on cruise ships. Florida recorded two confirmed norovirus outbreaks between Sept. 1, 2024 and Jan. 31, 2025.

People can get sick year-round with norovirus, but outbreaks are most common from November to April, the CDC shows. Most people recover within a few days. While its sometimes known as the “stomach flu,” the virus is not related to the flu, which is caused by influenza. And unlike the flu, there is no vaccine to help prevent it.

You can get norovirus in a variety of ways, such as by eating or drinking contaminated food and drinks, touching an infected surface and then touching your mouth or having direct contact with someone ill from the virus, according to the CDC.

How to avoid getting sick

Because all respiratory infections tend to cause similar symptoms, unless you get tested, there’s no way to know whether you have a mycoplasma infection or if you’re sick with the flu, COVID, RSV, or the common cold.

Dr. Hany Atallah, chief medical officer for Jackson Memorial Hospital, has tips to help reduce your risk of infection:

Wash your hands frequently and use hand sanitizer. Avoid people who are sick. Use a tissue to cover your mouth or nose when you cough or sneeze. Get vaccinated. Consider masking up if you’re planning to go somewhere crowded or travel on a plane.

And take advantage of South Florida’s warmer weather and plan gatherings and activities outside.

“It’s 80 degrees outside, the weather is beautiful. People down here tend to congregate outside more than inside, which is obviously one of the things that helps prevent spread of illness,” Atallah said.

If you do get sick, stay home from school or work, monitor symptoms and speak with your doctor. People considered to be high risk for flu-related complications, for example, could be prescribed flu antiviral drugs, which typically work best when started within one or two days after symptoms begin.

Castellano, the mom of three who recently had the flu, also has some advice:

“Take the time to rest,” she said. “Sometimes there’s things in life that force us to hit the pause button.”

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