Visits to emergency rooms by people with respiratory illnesses have skyrocketed in December, and the flu appears to be the top culprit, according to the Alabama Department of Public Health.

The U.S. Centers for Disease Control and prevention classifies flu levels as “very high” in Alabama right now.

South Carolina, Louisiana, Alabama, New Mexico and New York City had the highest rates of flu-like activity in the country for the week ending on Dec. 16, according to the CDC. Flu activity rates were high or very high in most of the South and western United States that week.

A graph published by the Alabama Department of Public Health shows a sharp increase in flu-like illnesses in mid-December. They represented 6.52 percent of visits to emergency departments for the week ending on Dec. 16. Two weeks earlier, flu-like illnesses only accounted for about 3 percent of emergency room visits.

Diagnosed COVID-19 cases represented 1.68 percent of visits and RSV cases accounted for a little more than 1 percent of cases.

The symptoms of all three viruses are similar and include fever, fatigue and coughing. All three are especially dangerous for older patients. Young children and babies can also suffer dangerous complications from flu and RSV. Alabama has not reported any pediatric flu deaths this year, but had four last year.

Vaccines are available for all three viruses. The RSV vaccine, which was approved earlier this year, is recommended for people ages 60 and older and pregnant women.

The state health department recommends the flu vaccine for all children and adults ages 6 months and older. The agency also says people should stay home if they are feeling sick, cover sneezes and coughs and wash hands with soap for at least 20 seconds.

Doctors can also prescribe antiviral drugs for flu within the first few days of symptoms. People who are older or at higher risk are encouraged to call the doctor early for treatment, according to the state health department.