NASHVILLE, Tenn. (WKRN) — Tennessee is one of four states in the CDC’s highest category for flu spread.

Along with Georgia, South Carolina, and the District of Columbia, hospital visits for respiratory illnesses, including fever plus coughs or a sore throat, in Tennessee are “very high,” according to CDC data.

“This is the most severe flu season we’ve had since the 2009 H1N1 pandemic,” said Dr. James Antoon, Vanderbilt Associate Professor at Monroe Carell Jr. Children’s Hospital. “We are not sure the reason for this. Flu is highly unpredictable from season to season, but it’s likely that the pandemic measures which resulted in a lot less flu and RSV circulating the past couple of years have resulted in a much lower amount of immunity amongst children.”

Dr. Antoon says while RSV cases have plateaued in Nashville in recent days, he is seeing an uptick in flu cases.

“We know we are having an early and very severe flu season right now, but we don’t know if that’s going to taper off or be sustained throughout our typical flu season,” he said.

As the holidays approach and families gather, Dr. Antoon worries about the potential for these respiratory viruses to transfer from children to grandparents.

“RSV also has a high burden on the elderly and those over 65. It is an underrecognized cause of lower respiratory tract disease in the elderly. And so just like flu, we see the biggest burden of RSV in the tail ends, in the kids less than five and people over 65,” he explained.

Dr. Antoon said, thankfully, this season’s flu vaccine is proving to be highly effective against the current strain and the COVID-19 vaccines continue to be effective at preventing death and serious illness.

However, what will happen with this “tripledemic” in the months to come is still unclear.

“What we don’t know is what will be happening with COVID — whether it will peak like it did last year or if it will be out-competed by flu and remain low this year,” he said.

Currently, Dr. Antoon says the pediatric hospital is busy but not lacking beds or ventilators like other children’s hospitals around the country.

According to the Tennessee Department of Health, 13% of floor beds, 21% of pediatric ICU beds and 44% of ventilators are filled.

“One good thing that came out of the pandemic is we did an excellent job here at Vanderbilt at streamlining a lot of services both in the emergency department and the hospital in order to get kids out when they are ready and get kids in when they need to be in the hospital,” he explained.

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Yet, whether they are able to keep beds and ventilators available, will depend in part on the precautions people take this holiday season.