Hospitalizations from the flu are the highest they have been in a decade as experts warn that other Covid variants and respiratory illnesses are on the rise.

Flu-related cases, hospitalizations, and deaths are all at a 10-year high, reported the US Centers for Disease Control and Prevention (CDC) on Friday, with adults over the age of 65 and young children most affected.

“We’re seeing the highest influenza hospitalization rates going back a decade,” said José Romero, director of National Center for Immunization and Respiratory Diseases, at Friday’s briefing. “We are also reporting the second influenza-related pediatric death of the season.”

Heading into the weekend, there were at least 1,600,000 cases, 13,000 hospitalizations, and 730 deaths from the flu, higher than the usual case count during this time of year.

Rising flu cases come when hospitals are also battling against the respiratory syncytial virus (RSV) and Covid variants that are dodging immunity from prior infection or vaccination.

Hospitals feeling the strain from increased admissions are urging community members to get their wintertime vaccinations and keep the number of serious illnesses as low as possible.

But vaccinations against the flu have decreased, with 5m fewer flu vaccines being administered to US adults compared to last year, Reuters reported.

Flu vaccination rates have also fallen among pregnant people, reported Reuters, a worrisome trend given that the vaccination protects the parent and baby.

Health experts have said that it only appears flu season has arrived earlier than in years past, and it was not immediately clear how severe the spread of respiratory illnesses will be this winter.

“Right now, we’re not seeing anything that would lead us to believe that it is more severe,” said Lynnette Brammer, a CDC team leader for domestic influenza surveillance. Brammer added that it is still early, as most winter illnesses tend to peak in December and January, NBC News reported.

“There’s no doubt we will face some challenges this winter,” said Dawn O’Connell, the assistant secretary of health and human services for preparedness and response. O’Connell also added that the earlier start to flu doesn’t necessarily mean more severe season.

Southern parts of the US are most affected right now by the flu, ABC News reported. Texas, North and South Carolina, Alabama, Tennessee, Maryland, Mississippi, Georgia and Virginia, all reported high levels of flu-like illnesses.

New York and Washington DC similarly high levels.