Leaders in 10 states renewed health protocols that increased restrictions or closed businesses again in June and July, as cases and hospitalizations related to the new coronavirus quickly began to climb. Governors in Arizona, California, Colorado, Florida, Kentucky, Louisiana, Michigan, Nevada, New Mexico and Texas reversed previously effected reopening permissions over the past two months.

A handful of those states, including Florida, Texas, California, Arizona and Kentucky, have reported the nation’s most significant outbreak resurgences and subsequently issued some of its strictest reversals. Aside from Michigan, where Governor Gretchen Whitmer implemented one of the nation’s most measured reopening strategies, each of those 10 states have seen virus cases peak, or nearly peak, during the summer.

The majority of them also launched economic reopening strategies early. Governors in Arizona, Colorado, Florida, Louisiana, Nevada, New Mexico and Texas permitted businesses and public areas to start resuming operations by mid-May. Businesses in California, Kentucky and Michigan began reopen during the following two weeks.

Governors scaled back the reopening of bars and indoor dining services in each of those 10 states. Most also issued broad face mask requirements to reduce risk of further virus transmission in public areas. California Governor Gavin Newsom and Arizona Governor Doug Ducey implemented additional restrictions for indoor entertainment venues, like movie theaters and museums. In California, health officials are using a watch list to track outbreak curves in counties where infections are trending upward.

Florida Governor Ron DeSantis directed bars across the state to close again in late June, amid a surge in COVID-19 cases. DeSantis has not issued a statewide face mask mandate, although local officials in some of Florida’s hardest hit counties have passed mask requirements for their jurisdictions.

Newsweek reached out to state health departments in California, Arizona and Florida for comments regarding the impacts of reopening amendments on virus figures but did not receive replies in time for publication.

Kentucky Governor Andy Beshear ordered bars to close and restaurants to reduce indoor dining capacities most recently. His directives went into effect on Tuesday.

Twelve additional states halted further reopening developments in response to COVID-19 spikes. Those states are: Alabama, Arkansas, Connecticut, Delaware, Idaho, Indiana, Mississippi, New Jersey, North Carolina, Oregon, South Carolina and Washington.

States that have experienced outbreak resurgences generally started to see increasing daily case counts within one month of initially reopening businesses. That pattern held true for the 20 states where economic recovery plans were later amended.

Numerous health officials, including National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci, have discussed a relationship between early or hasty reopening plans and subsequent COVID-19 spikes. Fauci has suggested slowing down reopening developments to manage outbreaks.

As of Tuesday, July 28, more than 4.3 million people have tested positive for COVID-19 in the U.S., according to Johns Hopkins University’s tracker. Of those, more than 148,000 have died.