When an urgent care in Pasadena opened its doors at 8 a.m., three people were waiting.

Flu tests lined a counter in the back, but Haley Schweizer, a physician assistant, said she often doesn’t need to see the telltale red line.

“I can look in the waiting room at their faces,” she said as the long Monday began. “They look pretty sick.”

It’s the season for influenza, as well as RSV and COVID and an assortment of other respiratory illnesses.

This season has been a doozy, just like the last one. It came early and may not peak for weeks or could surge again, like it did around the holidays.

Respiratory infections statewide are officially “very high,” according to the Maryland Department of Health, based on voluntary reporting from doctors’ offices and hospitals, as well as wastewater testing.

While a lot of icky stuff is going around, flu leads the pack. There have been 3,176 people hospitalized since the beginning of the season with flu infections and nine adults have died, according to state data through Jan. 3.

Flu remains a dangerous virus, Schweizer and others say, and has been particularly hard on children. Nearly 290 died last year across the country, including seven in Maryland, the highest number in recent years.

The University of Maryland Medical System, which operates about a dozen centers, including the one in Pasadena, has been steering people to urgent care and doctors’ offices — and away from hospital emergency rooms, which are overwhelmed by the sickest patients.

Most people recover after a week or so at home from whatever is causing their respiratory symptoms, treating themselves with Tylenol or Advil and extra fluids. But many turn to urgent care for certainty, especially if their symptoms persist or get worse. Medical professionals point people to emergency rooms when they have trouble breathing, can’t keep fluids down or have a serious underlying condition putting them at high risk.

Schweizer says people come to UM Urgent Care at Pasadena, a storefront in a suburban shopping center, to take a test, to receive Tamiflu to reduce their symptoms and for an X-ray to rule out pneumonia. Sometimes parents just want to allay their fears about a child’s scary-high fever.

Propped up on a stool in patient room No. 1, Kim Groves sat masked and fairly certain what results would show in the next 10 minutes.

She had been feeling crummy and wanted to know if it was flu so she could take extra precautions to protect coworkers and family.

Many of the latter had a case over the holidays and, she said, “I thought I had squeaked through.” Then, sure enough, symptoms began. (Yes, it’s the flu.)

Kaitlyn Barron came into the center after feeling all the congestion in her head sink into her chest.

Have you been coughing? asked Kristen Kurtz, an X-ray tech.

“Oh yeah,” Barron said as she positioned herself for an image of her lungs.

It was her second trip to the center. She had a child with the flu, and after testing negative herself, she began taking a course of Tamiflu, a medication that can help treat but also prevent flu.

Then her coughing began — and it lasted weeks.

Schweizer planned to send the images through an electronic system to a specialist for review, but she thought it looked like bronchitis and not pneumonia. She said bronchitis could be treated with an inhaler and steroids, but she also referred Barron to her primary care doctor for asthma-like symptoms.

Other patients continued to trickle in throughout the morning, some for routine medical injuries or illnesses, but others looking like they’d had an uncomfortable night.

They would be met with hand sanitizer and a sign asking them to “grab a mask.” That includes children, who get masks with smiley faces. Some had appointments and others walked in.

The UM urgent care network reported 13% of the people tested in the last week were positive for flu and about 2.5% had COVID. Nearly 32% had a respiratory illness that was neither.

The Pasadena center is now seeing some 40 people a day, a large load, though not as many as during the recent holidays. Together, the UM centers tended to nearly 3,700 people last week.

Schweizer estimated that only about a third of her center’s patients were vaccinated against the flu, matching lower-than-usual national rates. Federal health officials recently stopped the long-term recommendation that everyone 6 months and older get the vaccination, troubling Maryland health officials and major medical associations that continue to urge people to get the flu shot to stave off more severe illness.

Specialized lab tests, which aren’t available at urgent cares, are finding the flu surge is fueled by a new variant called subclade K. It comes with high fevers, plus the usual gauntlet of congestion, coughing and aches. Kids are developing gastrointestinal issues, some from coughing, Schweizer said.

Staff members swab the nostrils of everyone with symptoms. Similar to home those in heavy use during the coronavirus pandemic, they require a dip in a medium to transfer the sample to a rapid test. Then the timer is set for 10 minutes. There’s a red control line and spaces for both flu and COVID.

Alma Riojas had a cough when she arrived from Texas to visit her daughter, Cindy Crockett, and her grandchildren and great-grandchildren. She didn’t initially think it was the flu. Her daughter thought it best to get a test and maybe an X-ray to rule out complications.

“I didn’t feel good, and then my chest started hurting,” Riojas said. “I could hear gurgling.”

Crockett said she’d get her mom home and tend to her with soup and other fluids.

As they headed to the X-ray room, Schweizer was already looking for the next patient. The center would be open for another eight hours.