COVID-19 cases have reached record highs, and so have hospitalizations. Two years after the first patient was diagnosed on American soil, the pandemic appears to show no signs of slowing down.

More than 145,900 people were hospitalized with the virus as of January 11, according to data from the Department of Health and Human Services. That’s a 100% increase in two weeks and a record high, surpassing the previous peak in January 2021.

At the beginning of the surge, there was hope that a new group of antiviral drugs could help quell the rush of Omicron across the country. The Food and Drug Administration issued emergency use authorization (EUA) for Pfizer’s Paxlovid, which the company says cuts the risk of hospitalization or death by 89%, and Merck’s molnupiravir, which data showed cut hospitalization or death by 30%.

Both regimens are for patients with mild to moderate COVID and require 30 to 40 pills to be taken at home over the course of five days.

The U.S. purchased 10 million courses of Pfizer’s treatment in a $5 billion deal (officials announced this week that they would order 10 million more) and 3 million courses of Merck’s treatment for $2.2 billion. However, supplies of the pills are extremely limited compared with preventative treatments like vaccines; the U.S. ordered 100 million doses each of the Moderna and Pfizer vaccines prior to when they launched.

And no matter how potent the new antiviral drugs might be, shortages and supply-chain issues have rendered them relatively ineffective, doctors say. Even considering relatively small orders of a few million, as of last week, only about 365,000 courses of the Pfizer and Merck pills had shipped out, though President Joe Biden assured more were coming.

Because of the complexity of the medicines, explained Biden at a press conference last week, “it takes months literally to make a pill."

The Mountain Comprehensive Health Center in Kentucky, a state in which just 55% of people are fully vaccinated, received only 200 treatment courses of the Merck antiviral and 40 of the Pfizer antiviral this week.

"Basically, it's just a drop in the bucket," Mike Caudill, CEO of Mountain Comprehensive, which serves 50,000 patients in seven counties, told the Louisville Courier Journal. "We're going to try to use it in such a way to treat people at extreme risk."

Will Harper, a spokesman for Contra Costa Health Services in San Francisco, echoed that view, and even used the same language.

“At this point, there’s simply not enough of it for it to be a game changer,” he told the San Francisco Chronicle, adding that “120 courses is a drop in the bucket when we are seeing more than 1,300 new COVID cases each day.”

The rate of increase in COVID-19 cases far outstrips the rate at which the antiviral medications, the allocation of which is being managed by the federal government’s Office of the Assistant Secretary for Preparedness and Response, can be produced and shipped out.

Dr. Anthony Fauci, the president’s chief medical adviser, echoed Biden's explanation about the lengthy pill-making process as explanation for the delay. “The sobering news is, unfortunately, it is really a quite complicated and complex synthetic process, which we will be working with the company to figure out how we can help alleviate the stress of the long duration that it takes to make it,” he said at a press briefing at late December 2021. “Hopefully we’ll be able to shorten that process.”

Vaccinations and boosters have protected against the severity of Omicron (ICUs are not as busy as they were during previous spikes), but many Americans are still experiencing symptoms that require hospitalization, and health care systems are overwhelmed. Death rates are also typically a lagging indicator of severity of illness, and while they’re still far from record highs, they’ve increased by 31% nationwide over the past week.

About a quarter of hospitals in the U.S. are now experiencing critical staffing shortages, according to the Department of Health and Human Services. Some states, like Illinois and Massachusetts, have delayed elective surgeries. Oregon deployed the National Guard to help in hospitals. Maryland Gov. Larry Hogan, declared a state of emergency last week, and warned that this will be the "most challenging time of the entire pandemic."

Health care workers in Arizona, meanwhile, told state leaders that their health care system is on the brink of collapse. "We've had more events where people are having cardiac arrests, or decompensating and getting very sick and even dying in the waiting rooms," Dr. Bradley Dreifuss, an emergency medicine physician in Tucson, told reporters on January 7. Americans, meanwhile, appear to be losing hope for a miracle cure or treatment. A new Axios/Ipsos poll found that 52% of respondents believe it will be more than a year—or never—before they can return to their normal, pre-COVID lives.