Fears of a ‘tripledemic’ this year are gaining traction as America’s public health system braces for what could be a challenging winter.

COVID-19 regulations have loosened, there is an unusually high rate of respiratory syncytial virus (RSV) in children and flu season is off to a severe start.

U.S. flu cases began ticking upwards earlier this year and have already reached a level of severity not seen in over a decade.

The Centers for Disease Control and Prevention released data recently that showed there have been about 880,000 flu cases this year so far, with 6,900 hospitalizations and 360 deaths. 

That hospitalization rate is the highest it’s been this early in the season since the H1N1 flu outbreak in 2009.

Flu season typically begins in late October and lasts until the spring – and peaks between December and January. This year, however, the CDC is reporting unusually high cases six weeks earlier.

The flu cases are rising as the Biden administration struggles with another lingering healthcare obstacle: COVID-19. The White House has been pressing Americans to get the latest updated bivalent COVID-19 booster shot

Despite launching new vaccination initiatives recently – including Biden receiving the jab himself and the government rolling out a video ad campaign – the uptake remains low.

That hesitancy, perhaps coupled with pandemic fatigue, has bled over into flu vaccinations. Regular flu vaccinations are also lagging this year, with only 128 million flu doses distributed compared to 139 million at this time last year.

The south and southeast U.S. are currently being hit the hardest by the early start of the flu season, though some east coast areas like New Jersey and New York City also made the list.

In its report, the CDC noted that the annual flu vaccine “is the best way to protect against the flu” by preventing serious illness and hospitalization. The agency currently recommends that anyone over the age of six months old receive the vaccine every year.

In addition to vaccinating, public health experts are recommending the factors that everyone knows well from COVID-19 that will also lead to curbing cases – including mask-wearing, staying home and isolating if ill, testing and taking antiviral treatments if the case comes back positive.