Biden says COVID not a pandemic, just a problem. So what is happening with the virus in South Florida?

Chris Mazzola says the over-50 crowd has returned to his Delray Beach gym, although cautiously and often weaker from having a bout or two of COVID-19.

“There was a time when my members were terrified of catching COVID and getting sick,” said Mazzola of 50 plus Fitness Center. “Some still have fear and want to wear a mask and they do. But everyone seems to have settled in. Everyone is calmer about the concept of COVID.”

Mazzola, like many other small business owners, still wipes down surfaces and has sanitizing stations. He realizes that a member or staff might catch the virus. “It’s not a death sentence where it might have been earlier,” he said. “They will stay out for 10 days and they will come back.”

Throughout South Florida, gymgoers participate in workouts, tailgaters party before football games, and diners pack into restaurants. Life is pretty much back to normal and the U.S. President has declared “We still have a problem with COVID. We’re still doing a lot of work on it. But the pandemic is over.”

So what does that “problem” rather than a “pandemic” look like in South Florida? Is the area protected enough to withstand another fall or winter wave? Is it even worth getting a new booster with added coverage for omicron?

Throughout the state, and the South Florida area, the rate of increase in new cases and new hospitalizations is much slower than just a few months ago. But COVID continues to infect people.

On Friday, Florida’s official coronavirus case counts fell for the 10th straight week.

Florida’s Department of Health reported 17,438 new cases statewide for the week ending Sept. 22 and a total of 5,738 new cases in Miami-Dade, Broward and Palm Beach counties. That’s a big drop from 43,704 new cases statewide and 17,882 cases in South Florida reported a month ago.

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Florida’s numbers reflected the same issues as national numbers. With more at-home testing, government data misses a large number of infections.

“We’ve had 2 million cases reported over the last 28 days, and we know underreporting is substantial,” said Dr. Michael T. Osterholm, an infectious-disease specialist at the University of Minnesota told The New York Times. COVID-19, he said, “continues to be the No. 4 cause of death in the country.

Wastewater can reveal COVID trends faster than official case counts, and experts are watching levels closely in South Florida.

Most people in the area have been vaccinated, have some level of immunity from infection, or both. For now, that immunity is keeping spread to a minimum. Sewage tests from Miami-Dade and Palm Beach counties show flat or declining numbers of the coronavirus’ genetic material in the wastewater, according to Boston-based laboratory Biobot analytics. Broward County does not track COVID in its wastewater but is considering doing so.

There is concern the plateau is temporary. In recent weeks, federal data has shown that the number of U.S. wastewater sites reporting increases in the presence of COVID-19 in their samples appears to be back on the rise.

At Cleveland Clinic Florida in Weston, Dr. F. Scott Ross, chief medical officer, sees firsthand that COVID continues to sicken Floridians.

“If you look at the number of patients in our hospital today with COVID, it’s much more than after each surge but not as high as during a surge,” Ross said. “We have dropped precautions and let our guard down, and we are seeing more patients than in March.”

Ross said about half the COVID patients are admitted for other reasons and learn they have the virus, “which shows the prevalence still in the community.” Sometimes, he said, COVID may play a role in whatever illness caused the patient’s admission.

[ RELATED: A look inside Florida’s hospitals as the newest COVID wave sweeps through the state ]

Official COVID patient counts show hospitalizations statewide are down to 2,157 patients, a drop of about a thousand patients from just two weeks ago. At its worst during the delta surge, Florida had more than 17,000 COVID patients in its hospitals.

Ross said intensive care admissions are up from six months ago, but nowhere as high as they were during any of the coronavirus waves. A pattern has emerged for who lands in intensive care with COVID at this stage of the pandemic, he said. At Cleveland Clinic Florida, two groups fill ICU beds: the unvaccinated, and people previously hospitalized with COVID during initial surges who get reinfected. “If they have had lung damage in the past, they have a harder time with reinfection,” he said.

As Floridians fly on airplanes, board cruise ships and return to offices, it’s easy to overlook that 34 people a day on average are dying from COVID in the Sunshine State, according to the seven-day average reported by the CDC.

Florida coronavirus fatalities topped the nation from June through August, and September looks like it’s on track to see another 2,000 lives lost. On Friday, the state reported another 753 COVID deaths for the last two weeks.

[ RELATED: COVID rises across U.S. amid muted warnings and murky data ]

Friday’s Department of Health report shows the disease has killed more than 81,000 Floridians since the start of the pandemic. Most of the COVID deaths, about 80%, are people 65 and older.

“People are still dying from COVID … the reason Floridians don’t see it is the number of people dying hasn’t gotten to the point where it’s alarming enough to generate publicity,” Ross said. “But from a caregiver’s perspective, I can tell you they are still dying … not every day anymore, or even several a day. It’s not like that anymore, But I can tell you weekly or every other week, I still sign death certificates with COVID-19 pneumonia as the cause of death.”

Helix, a company that sequences positive samples, found the BA.5 omicron subvariant, which fueled a wave of infections this summer, is the dominant strain circulating in Florida. While several other contagious strains also are present in the state, none are increasing in a significant way.

However, virus experts are carefully tracking BA.2.75.2 as a potential candidate for a fall and winter wave. That strain has been in Florida since at least mid-August, yet remains only 1% of positive tests sequenced.

Scott Wester, CEO of Memorial Healthcare, said he is hopeful the newest booster shot will “temper any future variant” and avert a fall wave.

“Only time will tell,” Wester said. “I’m not going to be optimistic at all because every time I am optimistic something happens. So we always have to be on guard for what may happen next. We have been relatively steady at our hospitals, but there is still a lot of community spread of COVID out there.”

Sun Sentinel health reporter Cindy Goodman can be reached at [email protected].