If it feels like everyone around you is fighting off a cold or recovering from the flu, it may be because respiratory illnesses are running rampant in most of the United States, and cases are only increasing.

The overall respiratory illness activity level in the U.S. was rated as “high” by the Centers for Disease Control and Prevention on Jan. 13, based on the number of cases of COVID-19, flu and RSV, and how often those cases needed medical attention.

When broken down by state, most of the country is experiencing elevated respiratory illness, including a few states with “very high” ratings that act as national hotspots, CDC data shows.

Arizona, Oklahoma, Kentucky, Hawaii, Delaware and New Hampshire all showed particularly high case numbers and doctor visits, while states such as Montana, North Dakota and Washington have maintained “moderate” levels, the CDC said.

Data from Wyoming and Missouri was unavailable for the report.

Here’s what you need to know.

COVID, RSV, flu cases up

“COVID-19 activity has increased in most areas of the country. Seasonal influenza activity remains elevated across the country. RSV activity is very high in many areas of the country, particularly in young children,” the CDC said.

The rise in COVID-19 cases are mainly driven by the KP.3.1.1 omicron variant, known as a FLiRT variant, and the XEC variant, which spread from Germany across Europe.

The XEC variant accounted for just 17% of cases in October but is now the variant responsible for nearly half of new cases, according to the CDC.

However, compared to influenza and RSV, or respiratory syncytial virus, cases of COVID-19 are considered “low” by the CDC. Flu cases were labeled as “high,” and RSV cases were categorized as “very high.”

All three respiratory cases have been increasing in recent weeks, CDC data shows.

“CDC continues to expect the fall and winter virus season will have a similar or lower peak number of combined hospitalizations from COVID-19, influenza, and RSV compared to last year,” the CDC said. “However, peak hospitalizations from all respiratory viruses remain likely to be much higher than they were before the emergence of COVID-19.”

Case hotspots not grouped together

Six states received the “very high” case classification, according to the CDC, but they are not geographically grouped together, and are experiencing different spikes.

Arizona had no change in its COVID-19 case numbers leading to hospitalizations but saw a significant increase in flu numbers while RSV levels have remained “moderate,” data shows.

Delaware, on the other side of the country, also saw an increase in flu cases but had a higher number of RSV cases, earning a “very high” rating for RSV specifically.

Oklahoma had moderate COVID-19 and flu cases, but “very high” RSV cases, while Hawaii has “very high” flu cases, “moderate” RSV cases and “minimal” cases of COVID-19.

The combined cases for all three illnesses were most severe among those under the age of 4, data shows, with nearly 20% of all emergency room visits belonging to that age group. There was a small spike at the beginning of fall before leading into significant increases in cases in 2025, CDC data shows.

Severe COVID-19 cases were dominated by young children earlier in the fall, but are now about equal between those under 4 and those over the age of 65.

Emergency room visits from influenza infections are currently highest among children between the ages of 5 and 17, following the same trend as last year, according to CDC data.

Severe RSV cases are almost exclusively those under the age of 4, reaching alarming numbers that rival the high cases of January 2024.

Vaccination rates considered low this year

Part of this rise might be due to a lack of updated vaccines for many Americans, according to CDC data.

Only 11% of children have received the most recent COVID-19 booster, while 22.8% of adults older than 18, including 46.4% of adults over the age of 65, have been vaccinated. Many older Americans were even encouraged to receive two boosters this fall.

Less than half of children under the age of 18 have reported receiving a flu shot this year, about the same as adults over the age of 18, CDC data shows. About 68% of adults over the age of 65 have gotten a flu shot for the 2024-2025 season.

Rates of RSV vaccination are even lower, with only 44.5% of adults over the age of 75 reporting they have ever received an RSV vaccine, let alone recently.

“Vaccination coverage with influenza and COVID-19 vaccines are low among U.S. adults and children,” the CDC said. “Vaccination coverage with RSV vaccines remains low among U.S. adults. Many children and adults lack protection from respiratory virus infections provided by vaccines.”

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