Stop me if you’ve heard this one before, but a new COVID variant is here, and it’s the most transmissible one yet.

The new omicron sub-variant, known as XBB.1.5, is tearing through the United States, and it’s taking hold in Alabama, making up nearly 20% of new cases here, according to the Centers for Disease Control and Prevention.

The state is already seeing a rise in COVID numbers, including cases, positivity rate and – most importantly – hospitalizations.

“I think all the signs point in the wrong direction,” said Dr. Donald Williamson, head of the Alabama Hospital Association. “I just don’t know how badly they point in the wrong direction.”

The Alabama Department of Public Health reported there were 659 people with COVID in Alabama hospitals as of Thursday, a stark increase over recent weeks. This week marks the first time Alabama’s seen more than 600 COVID hospitalizations since Sept. 10, and Thursday’s number represents a 322% increase since just before Thanksgiving.

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Alabama’s COVID hospitalizations have increased just as flu cases start to diminish, but the overall load on Alabama hospitals is getting heavier, Williamson said.

“If you look at COVID and influenza, there were about 500 people with one or the other in Alabama hospitals a month ago,” he said in an interview with AL.com on Friday. “Today, there are about 750 hospitalized with one or the other. And the shift has been pretty dramatic.”

Williamson said that a month ago, most of the people in Alabama hospitals with respiratory illness – either COVID or flu – had the flu. Now, the roles are reversed.

“Back then, there were about 350 people with influenza. Now, there are about 100,” he said. over that same time, COVID cases spiked dramatically. “The total burden with respiratory virus has increased, and it’s shifted from being predominantly influenza to predominantly COVID.”

He said there are now upwards of 750 people with either COVID or flu in Alabama hospitals, the “highest numbers we’ve seen since late August.”

And it’s likely going to get worse before it gets better, he said.

“I fear we are going to see more cases and more hospitalizations in the coming weeks.”

Still, Alabama’s current COVID hospitalization numbers remain far lower than they were this time last year, when the state’s hospitals were filling up fast as the first omicron wave tore through the state. Hospitals would go on to see nearly 3,000 patients during that surge, something Williamson doesn’t think is likely with this latest strain.

“I don’t think this is going to be like the 2,000, 3,000 hospitalized we saw this time last year,” Williamson said. “But we could get to 1,000, I think, over the next two weeks to a month.”

And 1,000 hospitalizations now isn’t the same as it was last year or the year before. COVID has severely hampered Alabama’s healthcare system, and the ability for that system to adapt to new problems, Williamson said.

“My real concern is not the raw numbers – because those are obviously less than what we’ve dealt with before. It’s the staffing,” he said. “Our hospitals are filled with everything else, other than COVID. Yesterday, for the first time in a long time, we had fewer than 1,000 adult medical surgery beds available in the entire state.”

Williamson said there were just under 800 adult medical surgery beds available in Alabama as of Wednesday , or around 10% of nearly 7,400 beds total in the state.

“We have full hospitals, and what I’m worried about is, any significant increase in covid is going to strain not only our bed capacity, but the real challenge is our staffing capacity,” he said. “We have units that have never recovered from COVID. We have units that have closed, we have lots of travel staff, we have long wait times in our [Emergency Departments] because of staffing issues. It’s going to be a lot harder to manage 1,000 covid patients now than it was this time last year.”

XBB.1.5

XBB.1.5, a sub-variant of the omicron strain of COVID-19, is the most infectious strain of the virus yet, Williamson said. It’s already the most common form of the virus in the Northeastern part of the United States, according to the Centers for Disease Control and Prevention.

CDC data from this week shows the new variant accounted for 17.3% of collected virus specimens in the Southeast region, which includes Alabama and several other nearby states. That’s up from around 10% last week.

While XBB.1.5 is more infectious, it has so far not shown to be more deadly, Williamson said.

“I think it’s going to be very much like all of the versions of this variant has been,” he said. He said the number of people in Alabama intensive care units has increased along with the surge in hospitalizations, but not by much. “It’s not anything like the Delta variant.”

And while imperfect, he said the latest bivalent COVID vaccine is still recommended to help reduce infection and serious disease from XBB.1.5.

Along with hospitalizations, Alabama’s positivity rate – the percentage of COVID tests performed that come back positive – is also up. That number rose past 23% this week, up from below 5% in early November. Once one of the best indicators for measuring the pandemic, positivity rate is less valuable now that rapid home tests are so widely available.

Do you have an idea for a data story about Alabama? Email Ramsey Archibald at [email protected], and follow him on Twitter @RamseyArchibald. Read more Alabama data stories here.