At a hospital in Annapolis, some emergency room patients waited three to five hours to see a doctor yesterday. At the University of Virginia, twice as many students as usual have reported flulike illnesses. And in the District, Elizabeth Latwin couldn't seem to find anyone who wasn't feeling lousy.
"Everyone in the office was sick. Everyone I go to school with is getting sick," said Latwin, a Catholic University law student. "We're passing it around to each other."
The winter season for flu and other illnesses has hit the Washington region later than usual this year, emptying offices and schools and sending overflow crowds to emergency rooms with gastrointestinal problems and upper respiratory infections.
By 2:30 p.m. yesterday, the Maryland agency responsible for coordinating emergency medical treatment reported that 24 hospitals, most in the Baltimore area, were filling with so many sick people that their staffs could no longer accept ambulance runs in cases that were not life-threatening.
Twelve hospitals in the state were operating under a "red alert," which meant that their emergency rooms were so crowded that they had to turn some patients away, according to the Web site operated by the Maryland Institute for Emergency Medical Services Systems. Among the hardest-hit areas are Anne Arundel and Howard counties.
"I've been working in D.C. for more than nine years, and this is the worst I've seen," said Jack Dubin, medical director of the emergency room at Washington Hospital Center. "Every hospital is busy. There are very long waits."
Other sufferers, among the walking wounded, soldiered on with their trusty Z-PAKs, green cardboard packets of the antibiotic Zithromax, which is commonly prescribed for bronchial infections.
Latwin, an Arlington County resident who juggles her law studies with an internship in the Montgomery County state's attorney's office, said she came down with what she thinks was just a nasty cold, not the flu. But it sent her temperature soaring and robbed her of her voice for six days.
A spokeswoman at Anne Arundel Medical Center said yesterday that about 40 people had been admitted to the Annapolis hospital in the previous 24 hours. That's up from an average of about 25, said the spokeswoman, Martha Harlan.
"It's not just one bug that's causing all this," said Richard L. Alcorta, who heads the Maryland Institute for Emergency Medical Services Systems. At one emergency room, he said, doctors found that about 20 percent of the patients had the influenza A strain. The rest were suffering from viral infections that caused upper respiratory and gastrointestinal distress.
Some doctors also reported a seasonal jump in the number of cases of strep throat.
But gauging the severity of the flu outbreak was difficult because in many jurisdictions it is an illness that is reported on a voluntary basis to health officials.
"Especially with the weather going hot and cold, hot and cold, we usually see it," said Stephen M. Bane, an ear, nose and throat specialist in private practice near Potomac Hospital in Woodbridge. He said the number of flu cases seems to be lower than typical for this time of year.
"There have been some isolated flu outbreaks in the D.C. area, but nothing like we usually get. We may get away without a major flu outbreak this year," he said.
Maryland's Department of Health and Mental Hygiene reported a total of about 1,030 laboratory-confirmed cases of influenza as of yesterday, spokesman John Hammond said. He cautioned that because influenza is not a medical condition that health care providers must report to state officials, the numbers give only a rough approximation of the illness's spread.
A chart on the agency's Web site shows that confirmed cases are coming in at a rate of about 250 a week, still well below the peak of about 350 a week reported in the 2003-04 season. That spike in flu cases also occurred in the last three weeks of 2003.
Public officials across the region have been urging people to use common sense before heading to the hospital. If a person is breathing well, running a fever that can be managed with over-the-counter medications and keeping down fluids, the person probably can ride it out, the officials said.
But a sick person who runs a higher temperature, feels short of breath, has trouble keeping fluids down and becomes lightheaded when going from sitting to standing should seek medical attention -- preferably from a primary-care physician first, Alcorta said. People with serious underlying health conditions, such as asthma or HIV infections, should not hesitate to seek medical care, he said.
Staff writers Michele Clock, David A. Fahrenthold and Susan Kinzie contributed to this report.