State health leaders are encouraging Minnesotans to take extra precautions against respiratory viruses during the holidays — including the vaccinations they would need in the next two days to be fully protected by Christmas Day.

Unseasonably early levels of influenza and RSV — a virus that is most problematic for infants — have combined with COVID-19 to fill up hospitals. Federal data on Monday showed 8,228 patients were admitted to Minnesota hospitals, an 86% occupancy rate that rivaled the worst days of the pandemic. More than 10% of the patients had COVID-19, influenza, or both.

Holiday gatherings are notorious for spreading germs, which could make matters worse unless people reduce their risks by staying home when sick, wearing masks in indoor crowds, covering coughs and seeking the recommended vaccinations, said Jan Malcolm, Minnesota Department of Health commissioner.

"We've always thought about those as very personal health decisions, and they are, but their impacts absolutely add up for all of us," said Malcolm, in one of her final briefings before she retires in January. "When enough people make the choices that protect their own health, and the health of others, we end up placing less stress on our health care system."

Hospitalizations related to RSV and influenza have started to decline from early season highs. The 2,100 flu-related hospitalizations in Minnesota so far doubles the total of 936 for the last two seasons combined — but the weekly total declined from 559 two weeks ago to 501 last week and health officials said it might decline again when this week's total comes out Thursday.

Health officials said it is too early to know if the respiratory virus season has peaked. Low vaccination rates and holiday gatherings could fuel another rise, along with the emergence of a B influenza strain to go with the two A strains causing illnesses now.

"We have in the past seen these kind of lulls or dips, only to see a further resurgence," Malcolm said. "So we definitely do not think that we're easily past the point of maximum pressure yet."

RSV-related hospitalizations in the seven-county Twin Cities area have declined from nearly 200 per week in November to 120 in the first full week of December. However, even the latest number is nearly twice as high as the peak in a typical season, said Dr. Ruth Lynfield, state epidemiologist and health department medical director.

"There still is a lot of virus and its still having a lot of impact," she said, "and we are worried with the gatherings ... we could have transmission happening."

Coronavirus levels have been relatively modest but steady since the summer, after two years of severe peaks and valleys in viral spread that caused 13,773 total COVID-19 deaths in Minnesota. However, viral loads found last week in sewage samples at the Metropolitan Wastewater Treatment Plant in St. Paul have increased 66% from the levels found three weeks earlier.

The BQ.1 subvariant of the SARS-CoV-2 coronavirus emerged in October and made up 51% of the viral material in the wastewater samples last week. Variants have been problematic throughout the pandemic, because they present new abilities to evade the immunity people gain through vaccination or prior infection.

COVID-19 hospitalizations in Minnesota had declined to a recent low of 458 on Oct. 15, but gradually increased to 653 on Monday, according to daily federal data.

Lynfield urged people to seek recommended vaccinations, including the bivalent COVID-19 vaccine that targets the omicron coronavirus variants that have been dominant this year. Bivalent doses have now been federally approved for those 6 months of age and older.

People tend to reach full immunity seven to 14 days after COVID-19 vaccinations, and 14 days after flu shots, she said, but gain some protection sooner.

"That does not mean it goes from zero to 100%" after two weeks, she said.

Vaccination rates have been sluggish in Minnesota this season. Malcolm said that appears to be due to fatigue after three years of the pandemic along with lack of awareness about new boosters and the importance of getting boosted when viral levels surge.

More than 95% of seniors at greatest risk of severe COVID-19 have received some vaccine in Minnesota, but only 54% are considered up to date and have maintained their immunity levels with recommended boosters.