Worried health bosses fear Norfolk's healthcare system could be tested to breaking point this winter, amid a "tsunami of demand".
And a plea has been made for people to do their bit to ease the pressure on hospitals and social care - by getting jabs when available, wearing masks and social distancing.
People have also been urged to plan for how to look after loved ones over the winter, amid a warning from social care bosses that they might struggle to provide support.
When that plan was discussed by the Norfolk Health and Wellbeing Board on Wednesday, James Bullion, the council's director of adult social care was sombre about the situation.
The county's healthcare system was moved to the highest alert level of Opel 4 for a weekend in October, amid fears patient care could be compromised.
Mr Bullion said that was the earliest it had happened in the run up to winter - which does not bode well.
He said: "There is no doubt, this winter will be very testing for the system.
"We have already had one weekend at Opel 4. We have never had, I don't think, an Opel 4 in our system that early in the year."
There are concerns over staff shortages among care providers, although a recruitment campaign has been launched to try to tackle that.
And the council is looking to extend contracts with companies which offer home support, to get more people discharged from hospital back home.
But Mr Bullion warned: "I fear this winter, more than any other, that we might not be up to the work, the work may not be up to the challenge.
"We will only get through winter with the co-operation of everybody.
"We will need all families to make a plan for this winter, for the vulnerable people they are caring for, because it cannot happen without the co-operation of people themselves."
Bill Borrett, cabinet member for adult social care, said it was "an unprecedented situation" and the healthcare system was facing a "tsunami of demand".
He said people could help by getting vaccinated, getting booster jabs when available, wearing face masks and social distancing.
Analysis
Make no mistake, there is real concern about what this winter will bring for Norfolk and Waveney's healthcare systems.
Even before the pandemic, Norfolk County Council's adult social care services had been under pressure, with a growing older population with increasingly complex needs.
Covid-19 has intensified that and social care bosses are alarmed that the county has already had a high alert within the health system.
That does not bode well for the winter - a time when, for a variety of reasons, more people end up in hospital and needing social care support.
This year brings particular challenges. The uncertainty over the impact the new Omicron variant of Covid-19 is one, but there is also the issue of staff shortages within social care.
Brexit contributed to some carers leaving the profession, which was then exacerbated by those who left the frontline because of the mandatory Covid jab.
It adds up to something of a perfect storm. Council officers are doing their best to plan for this and to ensure support is in place.
But the sombre tone of adult social care director James Bullion makes clear these will be testing times.
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