Last year's influenza season turned out to be the mildest on record, but health experts have renewed warnings that a ‘twindemic’ – in which flu and COVID-19 cases simultaneously rise and overwhelm hospitals – may be possible this year, and they urge Americans to get their flu shot. The Centers for Disease Control and Prevention reported 1,675 cases of influenza from Sept. 28 to May 22, representing only .2% of specimens tested. But it’s difficult to predict what this year will look like, health experts say.

They worry it may resemble a more typical flu season, as students get back to in-person learning and states loosen mask and social distancing mandates amid a return to social gatherings. That is especially concerning as COVID-19 cases driven by the highly contagious delta variant rise throughout the country. Analysis of Johns Hopkins data suggests the U.S. reported more than 1.05 million cases in the week that ended Monday, amounting to 104 cases every minute. Severe illness and deaths are also rising, filling ICU beds and threatening hospital capacity.

The country recorded more than 7,200 COVID-19 deaths in the week that ended Monday, the equivalent of a Pearl Harbor attack three times a week, or a 9/11 attack every three days. “We were worried about the ‘twindemic’ last year and we face the same threat this year,” said Dr. Daniel Solomon, a physician in the division of infectious diseases at Brigham and Women’s Hospital. “COVID-19 is likely to continue, and we face the threat of dual respiratory viruses that could put a strain on our health care system.”

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