(WHTM) — This week, the providers of UPMC Children’s Community Pediatrics in York and Spring Grove are continuing to see cases of flu, COVID-19, and upper respiratory infections. They are also seeing a viral stomach bug.

WellSpan Pediatric Medicine Physicians across the Midstate are seeing the flu, RSV, COVID, and a stomach bug.

This week, pediatricians at Penn State Health are seeing flu, strep throat, stomach bugs, colds, some cases of COVID, and RSV.

The CVS MinuteClinic in York is seeing more COVID cases. They’re also seeing the flu, strep throat, pink eye, and impetigo. They’re also diagnosing secondary illnesses like sinus and ear infections.

Penn Medicine Lancaster General Health Physicians Roseville Pediatrics reports a sharp increase in COVID cases. They’re seeing continued high numbers of the flu and an increase in strep throat and the stomach bug. They’re also seeing a lot of general viruses, ear infections, and asthma exacerbations

Dr. Joan Thode offered the following advice on breathing concerns:

“Wheezing is a high-pitched, whistle-like sound, either with inhale or exhale, related to inflammation in the lungs. Inflammation is caused by the immune system attacking a threat or a perceived threat, and the result can be partial or complete closure of the small airways in the lungs. This inflammation can be due to a virus, asthma or more specific conditions like bronchiolitis. Wheezing is not a “rattle” feel in the chest and isn’t harsh or voice-like. Any case of wheezing should be evaluated by a physician, because regardless of the source, it indicates inhibited air flow through the lungs. Many, but not all, cases of wheezing can be helped with nebulizer or inhaler treatments, though sometimes other interventions are needed.

“Barky cough, often compared to a seal cough, is heard with croup, an inflammatory condition resulting from one of a few viruses, that affects the vocal cords. In croup, the muscles that attach to the vocal cords, which are at the top of the airway, outside of the actual lungs, are swollen and less functional due to the virus. This prevents them from fully opening. As a result, a child will cough through a small space between the cords, causing them to vibrate and giving the cough a very voice-like, barky sound. This is in itself not dangerous, and croup actually does not always need to be treated. If the child can remain calm and keep their breathing under control, observation and supportive care during viral symptoms are all that is needed. But a sound called stridor is concerning. The nearly closed position of the vocal cords in severe croup causes the child to breathe through a much smaller hole, which can give the sense of not being able to “get the air in.” This will often cause the child to pull air faster through the small space, thus vibrating the vocal cords, creating a voice-like sound (stridor) when inhaling. Stridor should be evaluated promptly.

“A wet-sounding cough is most commonly due to a cough bursting through postnasal drainage in the lower throat. The smaller length of the airway in infants and young children causes the nasal mucous that naturally drains into their throat to get to the airway faster than in adults. We therefore expect a wet-sounding cough during viral colds in these populations. A wet cough would be concerning in the context of a prolonged or worsening wet cough longer than 10 days, or if you notice sustained fast breathing; using the belly to breathe; an exaggerated expansion of the ribcage with every breath, called “retractions”; inability to eat or drink due to the fast breathing, and/or any purple or blue color around the mouth or lips. For any of these symptoms, regardless of the sound of the cough, call your child’s doctor right away.”