The climate just got its annual checkup, and the results aren’t looking so hot.

“If Earth were a patient coming in for an annual physical, I would say its condition is serious and getting worse,” Oregon State University researcher Bill Ripple says.

Ripple is the lead author of a new paper chronicling the state of the climate, published on Wednesday in BioScience. The findings show that seven of the 16 planetary vital signs tracked by the researchers have never been in a more extreme state.

That includes the amount of carbon dioxide in the atmosphere, which is 50 percent higher than preindustrial levels due to burning fossil fuels, as well as symptoms of burning all that oil, coal, and gas. Greenland and Antarctic ice sheets have shrunk to record lows, while ocean heat has soared to record highs.

Climate change has already quickened the pace of warming from about 0.05 degrees Celsius per decade from 1880 through 1970 to 0.36 degrees Celsius per decade since 2010, according to the analysis. While the global average temperature, including land, isn’t at a record extreme, that may change by the end of the year as El Niño strengthens. The natural climate pattern is characterized by a hotter-than-normal Pacific Ocean, but it also boosts global heat levels by pouring more energy into the atmosphere. This year’s El Niño is shaping up to be one for the record books.

“A strong El Niño could temporarily push global temperatures even higher, while bringing additional heat and drought to vulnerable regions,” says Ripple. He adds that “El Niño is a natural phenomenon, but it’s now occurring on top of a much warmer planet. That makes its impacts potentially more dangerous.”

Of particular concern are ecosystems such as coral reefs and tropical forests. The spread of ocean heat is likely to fuel a mass coral die-off, known as coral bleaching. With each successive wave of bleaching, reefs become less resilient. Corals are among the ecosystems most threatened by climate change; if the planet warms beyond 1.5 degrees Celsius, most of the world’s coral will be unlikely to survive.

Tropical forests also face pressure from El Niño. This is especially true of the Amazon, which tends to see dry weather during this climate pattern. The timing couldn’t be more dire: The region, dubbed “the world’s lungs,” is already under intense pressure from logging and mining interests and the possible return of a right-wing government in Brazil that prioritizes extraction and land clearing over conservation.

The new report also warns that the Amazon is among the ecosystems at risk of crossing a tipping point—that is, reaching a threshold where it shifts from a tropical rainforest into something more resembling savanna. It’s highly unlikely that crossing that tipping point is imminent, let alone something that will happen this year. But this year’s blast of El Niño–influenced weather will edge it closer.

“Warming, drought, and deforestation could push the Amazon toward widespread forest degradation,” Ripple says. “My concern is that these changes could interact, making them increasingly difficult to stop.”

The report is an avalanche of bad news for the climate, though it does note that carbon-free forms of energy are playing a bigger role in the power grid. The report calls it a sign we’re in the “Age of Electricity.” Despite that, annual greenhouse gas emissions are at record highs. In other words, the world is still smoking a pack a day, even at the risk of losing a lung.

“There are some encouraging signs, especially the growth of renewable energy, but they aren’t yet enough to reverse the overall deterioration,” Ripple says. “The climate emergency is not something waiting for us in the future. We are already living through it.”