For this second wave, he says they've learned so much. He said, maybe the most important thing is getting oxygen to patients early who can barely breathe.
"We've had success with Hi Flow Nasal Cannula, which is an oxygen system in which you're giving someone a faster, higher liter flow, with a higher oxygen concentration," said Alvarado.
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Sometimes, it's given to patients even before arriving to the hospital.
"Instead of waiting for them to get to the ICU setting, for example, or to get to a floor, that's started actually in the emergency room now," said Alvarado.
He also said the new drugs approved by the FDA, like Remdesivir, are helping too, and because of that, they're optimistic for this second wave.
"Our ICU numbers are fine at this point, but have the numbers increased? Of course, they have," he said.
In fact, Pennsylvania COVID-19 hospitalizations have hit a new milestone. More patients are now admitted than ever before, with 2,900 across the state.
Over in Montgomery County, Lankenau Medical Center staff said they too are seeing an increase - as well as every hospital in the Main Line Health system.
"We've seen slow, steady increases over the last couple of weeks," said Dr. William Surkis. "Things that we were seeing more in the spring than we're seeing now is injury to peoples' kidneys, where their kidneys were unable to function to do their job."
Just like the first wave of COVID, ventilators are still needed, as are their ICU capabilities.
"It's still a very unpredictable virus which is why the best case of COVID is not to get COVID," said Surkis.