"So I think January is going to be a very hard beginning to the year, but we're prepared to work as hard as we need to," says Dr. Rais Vohra.
There are 606 hospitalized, and only 10 ICU beds available in all of Fresno County.
More than 700 people have died from the virus and that number is climbing.
"We're still catching up on death certificates," Dr. Vohra said. "That number is going to be higher."
Dr. Vohra says they're also working closely with hospitals and state agencies to plan for an even bigger surge.
There's a department of defense team that's working at Community Regional Medical Center, while Vohra says another team is staffing the North Medical Plaza.
The county is also working quickly on another type of defense; getting more people vaccinated.
The county received another 32,000 vaccines Friday.
A majority of those are going to hospitals, while others will go to local primary care physicians and clinics that are now helping distribute the doses.
"Through this first part here, there has been a volunteering of some of their primary care physicians to assist in vaccinating other medical groups as well," says Community Division Manager Joe Prado. "So we've been able to get vaccines to those particular providers that have volunteered to be able to do that, and so we're moving through tier one, tier two and tier three."
There are 45 medical providers in the county who can administer vaccines, and 40 more are waiting for state approval.
They're staying hopeful as they continue to develop a mass vaccination process and hope to have the first tier of health workers all vaccinated in a little over a week.