Maryland emergency rooms are being bombarded with patients who have flu-like symptoms.

According to the Maryland Institute for Emergency Medical Services Systems, there’s been a major increase of people in ERs, while the state health department has reported cases of the flu throughout Maryland.

“This puts a significant stress on the EMS and hospital-based health care system,” said Dr. Richard L. Alcorta, EMS medical director of MIEMSS.

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The CDC reports widespread flu activity in Maryland and the intensity was at the highest level for the week ending Jan. 13, which is the most recent data available. In just that week, 208 people tested positive for influenza.

Across the U.S., the flu is widespread in all 48 contiguous states and Alaska. There’s “local activity” reported in Washington, D.C.—that’s two steps down from “widespread.”

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So far this flu season, more than 30 children across the U.S. have died from the flu.