Up to half of all hospitals beds in England could be occupied by patients with respiratory infections, including Covid and flu, NHS England says.
The warning came as NHS bosses set out further details of its plans to help the health service cope this winter.
This includes rapid response teams to help people who have fallen at home and "data war rooms" to monitor pressures.
The return of normal winter viruses along with Covid will place huge strain on hospitals, NHS England said.
It said the modelling, which has not been published, was very much a worst-case scenario - even during the peak of the pandemic, Covid did not lead to such high levels of beds being occupied.
But NHS England chief executive Amanda Pritchard said it was important to be prepared.
"Winter comes hot on the heels of an extremely busy summer - and with the combined impact of flu, Covid and record NHS staff vacancies - in many ways, we are facing more than the threat of a 'twindemic' this year," she said.
"So it is right that we prepare as much as possible - the NHS is going further than it ever has before in anticipation of a busy winter."
She said every local area would have a data-driven war room where clinicians could monitor pressures at individual hospitals in real-time so that ambulances could be diverted to the sites with greatest capacity to treat patients.
She said it was also important for everything to be done to keep patients out of hospital.
The use of rapid response teams to treat patients who have fallen at home is one solution that is being increasingly adopted.
Areas such as London and Hull have set up systems whereby teams including non-paramedics such as firefighters attend to patients who have fallen but are not deemed to be an emergency.
It has allowed quick support to be provided and reduced the numbers being taken to hospital.
Another scheme being rolled out is dedicated care hubs to support care homes to reduce unnecessary admissions.
These projects are being partly supported by the extra £500m the government has provided for the NHS this winter.
It comes on top of the NHS winter plan published in the summer which will see an extra 5,000 beds opened, brining the total to close to 100,000 as well as 2,500 "virtual ward spaces" with patients monitored at home.
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- 11 August
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- 14 July
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