Hospitals are filling up with a rise in COVID-19 cases, a backlog of non-COVID-19 medical needs that were pushed off or worsened when elective procedures were delayed last year, and, unlike last year, a busy flu season.

So far, things look better for hospitals in the Philadelphia area, where vaccination rates are high, than in some other parts of the state. But case counts are rising, and public health officials have raised alarms that the post-Thanksgiving spike could grow as people gather inside for the remaining winter holidays — unless behavior changes.

Coping with the latest wave of COVID-19 cases has challenged hospital staff in new ways. As is the case in other hospitals, many of the Virtua system’s COVID-19 patients could have avoided illness by getting vaccinated, notes Paul Minnick, president of Virtua Voorhees Hospital and Virtua Marlton. Minnick was clear that he respects all his patients’ wishes, but said it can be harder to help those who are very sick, yet don’t believe in the approaches doctors have found most effective in treating the virus.

“There is some frustration — we battle that internally and one-to-one with our colleagues,” Minnick said. “We have to be so cognizant to not let our own belief system affect the care we provide.”

It’s a balancing act Minnick said is “exhausting” and “a constant struggle.”

Within the first 10 days of December, the number of COVID-19 patients at Virtua’s five hospitals spiked from 100 to 150, the vast majority of whom are unvaccinated.

“What’s different at this point is it feels unrelenting,” said Minnick, who has a doctorate in nursing practice. “It’s been so long.”

Beds line the hallways when the emergency department triage bays fill up. Patients are doubled up in rooms intended for single occupancy, and when there’s no more space, patients stay the night in short-procedure units.

Like other Philadelphia-area hospitals, space is getting tight, but Virtua’s hospitals are still able to accommodate everyone who shows up.

St. Luke’s University Health System in Lehigh Valley could be a sign of where things are heading. Its hospitals now have about the same number of COVID-19 patients as they did this time last year, said Jeffrey Jahre, a vice president at St. Luke’s and section chief emeritus of infectious diseases. About 80% of those patients are unvaccinated.

“Sadly, the current surge was avoidable. It is being driven by people who chose not to be vaccinated,” Jahre said in a statement announcing a return to more a restrictive visitor policy this week, in response to rising COVID-19 cases.

He and other hospital leaders say that employees are struggling with burnout in the 20th month of the pandemic and almost a year after vaccines first became available. Health-care workers are trained to never blame a patient for their disease, to provide compassionate care without judgment. But frustration is boiling up as intensive care units fill once again with COVID-19 patients — the vast majority of whom are unvaccinated.

“As a whole, I would say morale is good. But if you remember a year ago, health-care workers, they were widely acknowledged as being heroes, part of an extraordinarily important mission. There was a lot more of a ‘can-do, we’re going to do this, this is what we’re in this business for’ attitude,” Jahre said. “A year later, that’s a hard concept to continue with, knowing we have better weapons and people aren’t taking advantage of them, so some of these wounds are self inflicted.”

Every part of the state currently has high COVID transmission, said Rob Shipp, vice president of population health and clinical affairs for the Hospital and Healthsystem Association of Pennsylvania. Residents can do their part to help stressed hospital employees and prevent an even bigger problem after Christmas, he said, by wearing masks in indoor settings and getting either their first round of COVID-19 shots or their boosters. While you’re at it, get a flu shot now, as flu historically soars in January and February, and you need a few weeks after getting immunized for the shot to take full effect.

The U.S. Centers for Disease Control and Prevention on Friday said that flu spread remains low nationally but is continuing to increase. “There are early signs that flu vaccination uptake is down this season compared to last.” the CDC said.

Even before COVID-19, hospitals often faced high demand in December as flu cases began to build. But, this year, hospital capacity is even more “challenged” than usual, Shipp said. Philadelphia hospitals are seeing a lower proportion of COVID-19 cases than hospitals in other parts of the state, but they’re still busy, he said.

On Thursday, Shipp said, there were 4,404 patients hospitalized in Pennsylvania hospitals, up by 950 since Thanksgiving. More than 900 were in intensive-care beds, an increase of 175. Fifty-nine percent of ICU patients are on ventilators.

Shipp said waits in emergency departments are getting longer and some hospitals are delaying certain types of surgeries, especially those that will require an overnight stay or longer. He said some hospitals are also finding it hard to discharge patients who need further nursing care, because nursing homes are limiting admissions due to staffing shortages. Some of them are also reluctant to admit unvaccinated patients for fear of starting outbreaks.

Hospitals are monitoring demand and making fluid decisions about procedures and admissions. “It’s really like a day-to-day, even an a.m./p.m. situation,” he said.

Shipp said the supply of hospital beds compared to demand is most limited in northeast, south central, and western Pennsylvania.

But Philadelphia is still feeling the strain.

Jessica Lopez, a spokesperson for Jefferson Health, said Jefferson has enough room for those who need it. However, wait times are up in its numerous emergency departments. The system recommends that people who “do not require emergency services utilize the urgent care centers and/or telehealth for ease of access.”

Jeremy Walter, a spokesperson for Temple Health, said his system’s hospitals continue to be busy but are “managing the patient volume.”

“Fortunately, we are in a city where more than 90% of its adults have received at least one vaccine dose which has helped our COVID numbers dramatically,” he said. “We have not had to turn any patients away and are not restricting elective procedures. We ask everyone to remain vigilant, socially distance, wear a mask, and above all else, get your booster vaccine.”

Still, Mary Adamson, a registered nurse at Temple who has been working in the ICU and COVID-19 units since the beginning of the pandemic, said that with every new wave of patients, the job gets more stressful. More people start calling out sick, quitting, or retiring, leaving those left with an even bigger job and feeling less supported, said Adamson, who is president of the Temple University Hospital Nurses Association.

At the start of the pandemic, “everybody was reaching out ... the hospital was always making sure we were O.K.” Adamson said. “That’s not the case anymore. They’ve moved on. COVID is like the pest we can’t get rid of.”

A Penn Medicine spokesperson said Penn is also seeing an increase in patients, “particularly in under-vaccinated areas of the region we serve.” He said the system is “well-prepared to meet the current increase in COVID cases in our region, and we have maintained robust plans to ensure our continued capacity to care for patients of all kinds.”

Main Line Health has seen an uptick in COVID-19 cases since the summer — almost entirely people who are unvaccinated — but cases are still “well below” where they were this time last year, said Jonathan Stallkamp, the health system’s chief medical officer.

At St. Luke’s, most patients will be allowed two visitors during visiting hours. The health system allowed anybody to visit when COVID-19 case numbers came down earlier this year, but Jahre said the surge in new cases means nurses and other medical staff are spending too much time “policing” visitor etiquette — reminding them to wear masks properly, avoid mingling in public spaces, and eat only in cafeterias, since doing so requires removing masks.

He said there have even been instances where hospitalized patients contracted COVID-19 from visitors.

“We go through the screening, we ask all the questions … there’s no way you can entirely police this,” he said. “We need our staff to do what they’re meant to do, which is provide quality health care.”