Emergency department physician Dr. Rajiv Bahl talks about what he’s seeing in Florida.

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Hospitals across the country are taking extraordinary steps to treat patients safely. Getty Images

We’ve come a long way since the United States announced its first case of SARS-CoV-2, the new coronavirus that causes COVID-19, in Washington state on Jan. 21.

And we’re not anywhere close to having finished fighting.

Models now predict more than 220,000 deaths from COVID-19 in the United States by November.

Despite the rising numbers of deaths, most people don’t see visible evidence of the virus’s toll.

Here’s what we see in the hospital.

In the early stages of Florida’s wave in the spring, the individuals who were mostly coming to my emergency department were younger. They were walking, talking, and looked to be in little distress, which is expected, as most were relatively healthy.

They presented with upper respiratory symptoms like cough, sore throat, body aches, and congestion — all of which were consistent with COVID-19.

They didn’t seem to mind what was going on until we started to talk about COVID-19 and their potential of having the virus. At this point in the pandemic, many understood the pitfalls of the virus, and they gathered they could get worse.

These younger patients would come in, be worked up, and would usually be discharged home within a few hours. The emergency department remained efficient during these times, and many of these patients didn’t require extensive medical attention.

In the early weeks of the outbreak, these patients were stable and in no respiratory distress, even though they likely had COVID-19.

Importantly, they could stay in isolation at home.

But as the outbreak wore on, restaurants and stores opened up. The beaches started to become crowded.

With college students and younger individuals back at their family home, now multiple generations were sharing space. And then, the people coming to the emergency department started to change.

Older people are now arriving through the front door and in ambulances. We can see and feel the change in hospital and patient dynamics.

Older patients are coming in with the same symptoms as their younger counterparts, but worse. Their shortness of breath requires supplemental oxygen, the coughs are hacking, and the patients are a lot more fatigued.

To make things worse, many of these patients have underlying conditions, which lead to worse COVID-19 outcomes.

These conditions aren’t rare: Having high blood pressure, obesity, and high cholesterol raises the likelihood of a severe COVID-19 infection.

Their work of breathing is more intense. They are weaker, suffer stronger body aches, and tend to decline much faster than younger individuals. They need more from the healthcare system to survive.

In many circumstances, these patients are going through this frightening experience in the hospital alone. Patients who have COVID-19 symptoms are restricted on visitors to reduce the spread of the virus.

With the growing, busy nature of the emergency department, taking care of patients and updating families create its own challenges. Every patient had individual needs despite all attempts to create a uniform process of taking care of these critical patients.

These patients require supplemental oxygen, additional medications, and even vents or intubation.

The simple cases of COVID-19 still come into the emergency department, but now we have added pressures with patients with greater health needs and demands.

There are pressures on the healthcare system on multiple levels, including increasing demands from staff, need of beds, and the increasing critical needs of patients.

This virus is still evolving, and because of the nature of it, we’re learning as fast as we can. There’s new research that helps guide treatment plans — but we don’t have it perfected yet.

This virus is deadly. Major organs fail, breathing decreases, and hearts stop beating. While the majority survive, it’s those who don’t survive who stick with you.

In the early stages of this pandemic, the public took extended caution with the virus. We didn’t know much about it, but we knew the devastation it caused in Wuhan, China.

People were stockpiling household items, staying at home, and watching as there was a looming fear of this viral illness.

The staggering number of 539 total cases throughout the United States on March 8 was something of awe then, but today is something oddly desirable.

As the numbers grew, the country witnessed state after state lock down to help curb the virus. Undoubtedly, Washington state and New York were the hardest hit in initial stages — and as their numbers started to ease, the rest of the country seemed to ease as well.

But many in the medical community braced themselves for what was to come.

As cases declined in some of the initially hardest hit states, there seemed to be a glimmer of hope in the public’s eye. State leaders began opening in phases, eased their restrictions, and the public started to see some light at the end of the tunnel.

That light was short-lived. Many of the states that took an earlier and more aggressive approach to open, like Florida, started to see an increasing number of cases.

On June 18, for the first time, Florida reported more than 3,000 cases in just one day.

This record number would be broken almost daily with more than 11,000 daily cases in early July, and breaking the country’s single-day record with 15,299 cases on July 11.

Just because COVID-19 is making headlines doesn’t mean that our healthcare system is closed to other conditions.

In the emergency department, we still see patients with heart attacks, strokes, and traumatic injuries, and we still serve as the safety net of the healthcare system when all else fails.

Without a doubt, the healthcare system is being put to the test in Florida.

Every day I’m seeing and experiencing the healthcare systems and providers being put to the test. By using the pre-drafted plans, we can expand and take care of our population that needs the most critical care. These plans aren’t foolproof. There are delays, capacity restrictions, and increases in staffing demand.

Although other states were affected earlier, the virus’s delay in coming to Florida allowed hospitals to learn and plan.

Understanding the stresses that could come to Florida, hospitals started to reserve protective equipment, understand possible weaknesses if the surge were to come, and how adaptations could be made to ensure the safety of patients.

As cases initially decreased around the country and as states began to reopen, many of these contingency plans were put to the side.

But as we know today, things have changed.

This is a team effort that moves beyond the healthcare system. The comradery has grown stronger, and we’ve bonded together better than ever.

We realize we’re all under additional pressures to perform. Ensuring our own safety — both mentally and physically — is of the utmost importance.

Despite the most stringent safety guards, some clinicians have gotten sick caring for patients.

Physicians are having to manage an increasing number of critical patients. Nurses and technicians are being stretched as patient volumes increase. Our environmental service members, who manage the laundry and housekeeping, are working hard to ensure a clean and pathogen-free environment for our patients and staff alike.

This isn’t just a disease that affects the one age group. We’ve seen people in their 30s through their 90s succumb to this virus.

We’re ready to be back to our norm, but we’re not there yet.

This may be a disease, but the healthcare system can’t fight the pandemic alone.

I know masks can be cumbersome, and stay-at-home orders are frustrating. But wearing a mask, avoiding large gatherings, and washing your hands are all vital to stopping this virus.

Lives depend on it, including your own.

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