While most every hospital in the United States has made some provisions for a possible swine flu crisis, not all seem to be experiencing the surge of patients for which their emergency departments and intensive care units have prepared.
On Tuesday, the ABC News Medical Unit contacted more than 60 hospitals from every region of the country to determine where the H1N1 activity appeared to be the heaviest, as well as which hospitals had swine flu patients in their intensive care units -- a sign that at least some cases were severe enough to warrant extraordinary treatment measures.
What the reports out of these hospitals suggested was that not only does the extent and severity of the illness vary from region to region, but in some cases it varies even among hospitals in the same state.
California is one such state. Dr. Larry Satkowiak, medical director of the emergency department at Children's Hospital Central California near Fresno, said that at his hospital, the virus has certainly added to the normal emergency department caseload.
"Compared to last year, we're up about 25 percent from last October," he said. "Most of that is due to flu-related illnesses."
Roughly 300 miles south, Dr. Jake Jacoby, hospital director for emergency preparedness and response at the University of California at San Diego, said all the plans are in place for dealing with a swine flu surge that has not yet occurred.
"We have not activated any surge steps at this point," he said. "We are ready to deal with larger numbers of patients, but so far we have not had to worry about that."
But he said the situation could change immediately.
"That's the nature of pandemic flu -- it comes in waves, and different cities are affected at different points in time. It is not unexpected that some cities will be worse than others."
"We're just not overwhelmed by the flu right now," he said. "It's difficult to predict for any one city whether you're going to get hit hard or not."
But where the virus has hit hard, the burden on already-strained emergency departments is unmistakable. In Ohio, a number of medical centers reported that the virus had taken hold in their coverage areas.
Ohio State University Hospital was one medical center that reported a heavy flu burden.
"We are not in a crisis at this point, but we are trying to determine what level we can handle," said Richard Davis, associate executive director of Ohio State University Hospital and the Ross Heart Hospital in Columbus, Ohio. "The intensive care unit capacity at Ohio State, and nationally, is running at a very high capacity normally. If you insert a new incremental demand, you have to make some adjustments to deal with that."
Davis said that as of Tuesday, out of a total of 38 medical ICU beds, there were only three that were unfilled.
"That's a pretty fine margin, frankly. We, like others, have a very thin excess when it comes down to ICU capacity."
Dr. Mark Moseley, medical director of the emergency department at the Ohio State University Medical Center, said the strain is not limited to equipment and resources; staff, too, are feeling the effects of the crush.