MONTGOMERY, Ala. (AP) — A health leader says Alabama is suffering a “self-inflicted wound” from COVID-19.

Hospitals are again filling up as the state trails the nation in vaccinations and pandemic precautions like face masks and social distancing are all but forgotten. The president of the Alabama Hospital Association says there’s a sense of frustration because cases wouldn’t be rising if more people were vaccinated.

Only 166 people were hospitalized statewide a month ago with COVID-19. That low point has been followed by a rapid rise, and nearly 500 people are being treated for the virus now.

Some 11,436 people have died of COVID-19 in Alabama, the 17th highest death rate nationally.