Pennsylvania and New Jersey enter the last week of the year with COVID-19 cases continuing to rise, a trend expected to continue as the highly transmissible omicron variant spreads and people gather for the holidays.

“It’s very concerning,” said Maureen May, a nurse at Temple University Hospital and president of the Pennsylvania Association of Staff Nurses and Allied Professionals (PASNAP), comparing last week’s case numbers with those of the surge a year ago. “It’ll be a surge that will repeat itself and remains scary for all of us.”

With a large percentage of the population strongly protected against severe illness either from vaccinations or retained immunity from prior COVID-19 infections, some health experts have said surging cases are less alarming than they would have been a year ago, but the possibility of overwhelmed hospitals remains a concern. Hospitalizations and deaths always lag behind case trends, so today’s new cases could lead to new hospitalizations in the next week or two. With hospitals still seeing the consequences of a delta variant surge, the pressure remains acute.

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“We’re hearing from hospitals statewide that they are strained and many are at, approaching, or beyond capacity,” said Liam Migdail, a spokesperson for the Hospital and Healthsystem Association of Pennsylvania.

New Jersey was averaging 2,348 hospitalizations a day as of Sunday, a 57% increase compared with two weeks ago, according to data compiled by the New York Times. Cases are up to an average of 13,055 daily, a 201% increase from two weeks earlier. Cases are particularly high in the northern part of the state.

In Pennsylvania, the pressure on hospitals is less acute, with the daily averages as of Sunday roughly flat compared with two weeks ago, the Times reported. York, Franklin, and Adams Counties have the highest case rates in the state, with 151 to 224 cases per 100,000 people. Philadelphia and its surrounding suburbs have case rates ranging from 60 to 80 per 100,000 people.

An average of 4,860 daily are hospitalized for COVID-19 in Pennsylvania. The state is averaging 9,232 cases a day, 15% more than two weeks ago.

Last week, Pennsylvania’s 151 hospitals’ inpatient beds and intensive care units were at least 90% full, Migdail said, and 27 hospitals in the state were at 100% capacity or more.

On Sunday, 30 out of 35 patients experiencing a 4½-hour wait in Temple’s emergency room were there for COVID-19 symptoms, May said.

“The wait times, it’s universal, the wait times are long,” she said of hospitals statewide. “The staffing is reduced because of the health workers, whether it’s nurses or health-care support, they’re getting COVID as well.”

Five Temple nurses have tested positive for COVID-19 in the last three days, May said.

A Temple spokesperson could not be reached for comment Sunday, but Migdail agreed that emergency departments statewide are experiencing long wait times. While COVID is exacerbating the workload for hospitals, it isn’t the only thing stressing the health-care system.

“Hospitals are treating more patients for reasons other than COVID-19, due to a combination of the flu and other seasonal illnesses, more people resuming regular activities, and issues related to routine care being deferred during the early part of the pandemic,” he said. “This is all compounded by a staffing crisis that has significantly intensified over the past year as more clinicians and support staff leave their positions due to burnout and fatigue.”

In the Philadelphia region, the delta variant appears to remain the most common strain of COVID-19, according to genetic sequencing data maintained by the University of Pennsylvania. It is unclear how omicron will affect case counts and, more importantly, hospitalizations, though officials say omicron is likely playing a role in the current rise in cases.

» READ MORE: Omicron is spreading, and likely is why COVID-19 breakthrough cases are growing in Philly

The omicron variant appears to be highly transmissible, the Centers for Disease Control and Prevention has reported, but there are more indications omicron causes less severe illness than delta. In South Africa, where omicron was first identified at the end of November and the surge it caused is already subsiding, a study found those infected with it were 80% less likely to be hospitalized than those with other strains, and 70% less likely than those with delta.

Denmark, a country that had a quick introduction of booster shots and gathers detailed testing data, is experiencing a surge in omicron cases. Indications are the variant is meeting the most optimistic predictions for hospitalizations, the Washington Post reported. Denmark’s government science institute had projected new hospital admissions ranging between 120 and 250 patients daily, the Post reported, but for several days that number has remained about 125 a day.

Health officials, though, have expressed concern that even if a smaller percentage of those infected with omicron get seriously ill, the overwhelming numbers of people expected to contract the variant could still lead to a significant number of people needing hospitalization.

People who are unvaccinated continue to account for a large majority of COVID-19 patients who need to be hospitalized in the region, hospital personnel have said.

Health officials continue to urge people to take precautions to protect themselves from COVID-19: Wear a mask indoors or in crowds outside, get vaccinated and, if eligible, a booster shot.

“We can reduce pressure on our health systems and their staff by using all the tools and resources available to us,” said Christina Miller, administrator for the Montgomery County Office of Public Health. “The same strategies that we have been practicing for two years can still help us control the spread of COVID.”

Health officials have discouraged people from traveling or meeting in person with family and friends for the holidays, but have acknowledged that, after almost two years of COVID-19 precautions, many will want to connect with loved ones. If they do, officials said, keep gatherings small and outdoors, if possible, try to take COVID-19 tests immediately before meeting others, and anyone feeling any signs of illness at all should stay home.

“You might feel 90% fine, but if you give it to someone else, they might not be as lucky,” James Garrow, a spokesperson for the Philadelphia Department of Public Health, said in a statement last week. “No one wants to put a loved one in the hospital.”