The U.S. is struggling to meet ambitious vaccination timelines and handle its record numbers of COVID-19 patients with hundreds of the nation’s intensive care units (ICU) running out of space. With more infectious strains found worldwide, coronavirus cases in the U.S. surpassed 25 million on Sunday, according to Johns Hopkins University. U.S. deaths have also soared this year as more than 70,000 people have lost their lives in the last 25 days, taking the toll to more than 417,000 – a figure predicted to surpass 500,000 by February.

The number of hospitalized patients has fallen in the past 10 days and last Thursday dropped below 120,000 for the first time since Dec. 27 but some health officials are concerned the current vaccines may not work well against the South African variant of the virus.

Analysis of federal hospital data also shows that since November, the share of U.S. hospitals nearing the breaking point has doubled. More than 40% of Americans now live in areas running out of ICU space, with only 15% of beds still available. Intensive care units are the final defense for the sickest of the sick – patients who are nearly suffocating or facing organ failure. Nurses who work in the most stressed ICUs, changing IV bags and monitoring patients on breathing machines, are exhausted.

According to data through Thursday from the COVID Tracking Project, hospitalizations are still high in the West and the South, with over 80,000 current COVID-19 hospital patients in those regions. Encouragingly, hospitalizations appear to have either plateaued or are trending downward across all regions. It’s unclear whether the easing will continue with more contagious versions of the virus arising and snags in the rollout of vaccines.

In New Mexico, one surging hospital system brought in 300 temporary nurses from outside the state, at a cost of millions of dollars, to deal with overflowing ICU patients, who were treated in converted procedure rooms and surgery suites. In Los Angeles, Cedars-Sinai Medical Center ran into shortages of take-home oxygen tanks, which meant some patients who could otherwise go home were kept longer, taking up needed beds. The biggest problem, however, is competing with other hospitals for traveling nurses. Houston Methodist Hospital recently paid $8,000 retention bonuses to keep staff nurses from signing up with agencies that would send them to other hot spots. Pay for traveling nurses can reach $6,000 per week, an enticement that can benefit a nurse but can seem like poaching to the hospital executives who watch nurses leave.

"There’s a lot of these agencies that are out there charging absolutely ridiculous sums of money to get ICU nurses in," Houston Methodist CEO Dr. Marc Boom said. "They go to California, which is in the midst of a surge, but they poach some ICU nurses there, send them to Texas, where they charge inordinate amounts to fill in gaps in Texas, many of which are created because nurses in Texas went to Florida or back to California."

Space is another problem. Augusta University Medical Center in Augusta, Georgia, is treating adult ICU patients who are under age 30 in the children’s hospital. Recovery rooms now have ICU patients, and, if things get worse, other areas – such as operating rooms and endoscopy centers – will be the next areas converted for critical care. To prevent rural hospitals from sending more patients to Augusta, the hospital is using telemedicine to help manage those patients for as long as possible in their local hospitals.

"It is a model I believe will not only survive the pandemic but will flourish post pandemic," said Dr. Phillip Coule, the Augusta hospital’s chief medical officer.

Hospitals say they are upholding high standards for patient care, but experts say surges compromise many normal medical practices. Overwhelmed hospitals might be forced to mobilize makeshift ICUs and staff them with personnel without any experience in critical care. They might run out of sedatives, antibiotics, IVs or other supplies they rely on to keep patients calm and comfortable while on ventilators.

At Cullman Regional Medical Center in Cullman, Alabama, the ICU has been overflowing for six weeks, with 16 virus patients on ventilators in a hospital that a year ago had only 10 of the breathing machines.

"There just hasn’t been a lot of respect for the illness, which is disappointing," Dr. William Smith, chief medical officer for Cullman Regional Medical Center said, according to release in quotes carried by The Associated Press (AP)

"It has taken a lot of people," he said of the virus, adding that the death toll – 144 people in six months in a county of 84,000 – "has opened their eyes to the randomness of this."

The U.S. had planned to vaccinate 20 million citizens against the coronavirus by mid-January but instead, only 5 million people have received jabs so far despite 17 million doses having been delivered to the states and then to hospitals and pharmacies. Many critics say there is a complete lack of federal leadership.

According to a Reuters' report, the Trump administration had no distribution plan for the coronavirus vaccine. President Joe Biden's chief of staff, Ron Klain, said Sunday that the process to distribute the vaccine, particularly outside of nursing homes and hospitals out into the community as a whole, "did not really exist when we came into the White House."

After taking over from Republican President Donald Trump last week, Biden has promised a fierce fight against the pandemic. He signed a series of executive orders last week, including some that target vaccine distribution.

Biden plans to partner with state and local governments to establish vaccination spots in conference centers, stadiums and gymnasiums. The new administration will also deploy thousands of clinical staff from federal agencies, military medical personnel and pharmacy chains to increase vaccinations, and make teachers and grocery clerks eligible.

"We've seen this factor all over the country where millions of doses have been distributed, but only about half have been given out," Klain said on NBC's "Meet the Press."

"So the process of getting that vaccine into arms – that's the hard process. That's where we're behind as a country. That's where we're focused in the Biden administration – on getting that ramped up," he said.