Hospitals are going back into surge protocols, creating new beds and ICU beds for COVID patients.
Doctors say they're better prepared now, but they're noticing some big differences in the surge of patients they're treating now.
Alarm bells are going off at Fresno County hospitals.
July started with only about 50 hospitalized COVID patients, eight of them in ICU beds.
But as the delta variant became more prevalent, case counts rose, and the system has started to feel the stress.
As of Tuesday, there are 236 in the hospital and 49 in ICU, and the system has started to feel the stress.
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"Since the July the Fourth weekend, we've had a steady increase that has intensified here, particularly over the past weekend," said Dr. Gene Egerton, chief medical officer at St. Agnes Hospital.
"These are really sick, mostly unvaccinated patients who are really fighting for their lives," said Dr. Mickey Sachdeva, a pulmonary and critical care doctor who treats ICU pastients at Kaiser in Fresno.
Younger, sicker, and quicker is how doctors describe the changes brought on by delta.
They say most ICU patients now are between the ages of 30 and 50.
St. Agnes, Kaiser, and Community are all adapting to the new reality and expanding their COVID capabilities.
Fresno County health officer Dr. Rais Vohra says hospitals may have to delay elective surgeries again soon to handle the surge.
It's disheartening to see for ICU doctors like Dr. Sachdeva because it felt like vaccines had delivered a light at the end of this long COVID tunnel.
He says more than 90% of the COVID patients he sees are unvaccinated.
"I've met a lot of patients who wished that they had gotten the vaccine and not ended up in the hospital," said Dr. Sachdeva.
Dr. Egerton says the light is still there, but people have to turn it on to end the surge.
"I think a lot of that will depend on people getting vaccinated and adhering to masking and personal accountability around hand washing and social distancing," he said. "We've said it over and over and over and over again, but that's what it's going to take."
One piece of good news about the surge is that the number of deaths so far has been relatively small - just three in Fresno County over the last week.
Deaths are a lagging indicator, though, meaning the recent surge in hospitalizations could drive up the death rate, but we won't really know if it's happening for a few weeks.