Flu cases are officially high in Maryland and COVID-19 is on its tail, making clear the snotty, achy season is in full swing.

The worst cases are filing area hospital beds for the fifth winter in a row.

“We’re definitely seeing a big spike in respiratory viruses — flu, COVID, RSV and some that aren’t showing up in testing,” said Dr. Lucas Carlson, an emergency physician at MedStar Union Memorial Hospital in Baltimore. “I don’t think it’s anything to raise alarms about, but it is showing us what our new normal may be.”

That new normal is all those viruses infecting people in Maryland and across the country every winter. With fewer people getting COVID-19 or flu vaccines this year, and waning immunity, people are still getting sick enough to go to the hospital.

And while the viruses may be expected as people spend time indoors at school, work and special events this time of year, COVID still isn’t considered seasonal.

“Yes, there are winter upticks, but there have been summer rises, too,” said Matthew Frieman, professor of viral pathogen research in the Center for Pathogen Research at the University of Maryland School of Medicine. “This is driven by variants and immunity, not any seasonal aspects of humidity or temperature like other respiratory viruses that rise in the winter.”

There were 452 people hospitalized with COVID-19 at the end of December, according to Maryland Department of Health figures. There were close to 900 at the peak last winter, and more than 3,300 the winter before that. There were also peaks in between, though not as large.

What Frieman said should become seasonal is a COVID-19 vaccine with broad protections against multiple variants circulating, just as there is for flu. The new variants are what’s making people extra sick, though the shots can often help moderate that, he said.

Data from the U.S. Centers for Disease Control and Prevention, however, show fewer people are getting the available vaccines.

As of mid-December, just over 18% of U.S. adults and less than 8% of children had gotten the newest COVID-19 shot that would protect against the dominant strains, including the omicron subvariant JN.1.

Also, according to the CDC, only about a quarter of parents definitely or probably planning to vaccinate their children against flu, a drop from last year. The figure for adults was only a bit higher.

Experts say people should consider precautions, especially this time of year. Carlson said universal masking may not be necessary or practical, but those looking forward to a big event or seeing family or friends particularly at risk ought to consider wearing masks.

Seniors and pregnant people can now get an RSV vaccine, in addition to a flu and COVID-19 shot.

And while some people are getting severely ill, most can recover at home. Carlson said to go to the hospital only if you are severely lightheaded, short of breath or unable to eat or drink.