NHS bosses have urged the Government not to drop any Tier 3 area down to 2 – as officials hold late-night crunch meetings to decide plans for the hardest-hit areas.
Millions more Brits are braced to be told they will be plunged into the toughest restrictions.
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Whitehall insiders said they expect areas to only be moved up into Tier 3, and none to see rules relaxed and slide down into Tier 2.
And now health chiefs are putting pressure on the Government not to loosen laws for any Tier 3 areas – including those where cases are dropping.
Areas in Oxfordshire, East and West Sussex, Brighton and Hove and Northamptonshire have all seen a rise in infections in the last seven days, but Greater Manchester’s rates have fallen.
Despite that, a source told The Sun: “I would be surprised if any area goes down a tier.
“It would look very strange to loosen restrictions when everyone is so worried that the Christmas rules could fuel higher rates.”
And NHS Providers, which represents the 216 NHS acute, ambulance, community and mental health trusts in England, has now written to Boris Johnson warning of a third wave.
Urging "extreme caution" on moving areas down a tier, officials from the organisation said: "Trust leaders are worried that if infection rates remain as high as they are the moment, relaxing the restrictions will trigger a third wave."
The review, chaired by Health Secretary Matt Hancock, began late last night and the decisions will be reported to Parliament today.
Any changes will take effect from Saturday.
It comes as UK Covid cases continue to rise. Yesterday, 25,161 people were diagnosed – the highest number since November 14, when England was in full lockdown, and a 51 per cent jump on this time last week.
Politicians' decision on the tier system comes just hours after London and much of the South East went into Tier 3 amid rocketing Covid rates.
Pubs, restaurants and theatres have all been shut down across the capital and its neighbouring regions.
There are now around 34 million people in England living under the toughest rules.
Downing Street is expected to take a hyper cautious approach as they battle to dampen down Covid infection rates before the Christmas lockdown amnesty.
The PM yesterday announced a series of five strict rules ahead of relaxing restrictions for the festive season – including that people must quarantine for five days before seeing loved ones.
But politicians in Manchester and Birmingham have been pressing Boris Johnson to move them from Tier 3 to Tier 2.
Greater Manchester Mayor Andy Burnham said there was a “clear case” for his region to see rules loosened as infection rates are now lower than the English average.
But he suggested he would be happy with Greater Manchester being carved up, with parts moved down into Tier 2 while the worst hit spots remaining in the harshest lockdown.
He said he would understand if the Government wanted to “err on the side of caution”.
Mr Burnham added: “We have seen steady decreases across all of our boroughs pretty much ever since the last tiering decision, to the point where we are now essentially below the England average across the 10 boroughs – we are at 150 cases on average per 100,000 people, England averages 180.
“We are below London and below Liverpool when they went into Tier 2 originally.
“I accept the national mood has changed since those decisions were taken and I can also understand if the Government were wanting to err on the side of caution.
“There is a clear case for Greater Manchester, or a large part of Greater Manchester, to be placed in Tier 2.”
Public Health England (PHE) data showed that more than two-thirds of areas across England are seeing a rise in Covid-19 case rates.
According to data from the ZOE Covid Symptom Study App, run by researchers at King's College London, Oxfordshire, East and West Sussex, Brighton and Hove and Northamptonshire have all seen an uptick in infections.
Oxfordshire is currently in Tier 2 and data from the app shows that the area has 188 cases per 100,000 and 50 cases per 100,000 people in the over 60s.
The app has also predicted that East and West Sussex, Brighton and Hove could be moved into Tier 3.
The data suggests that the area has 232 cases per 100,000 people and 63 cases per 100,000 in those over the age of 60.
Earlier this week it was revealed that some schools in Brighton were forced to close due to outbreaks of the virus.
Northamptonshire has also seen a rise with 344 cases per 100,000 and 61 cases per 100,000 in the over 60s.
And in an address to the nation yesterday, the PM said Kent was still seeing a "worrying" rise in infections.
"I must be frank with you – we are already seeing worrying rises in some parts of the country," he said.
"Kent is still seeing rising infections and the number of cases in London is at 270 per 100,000 people.
"And that’s why we acted quickly by moving London into Tier 3."
Moving into the "very high alert" level would force the hospitality sector to shut down, other than for takeaway service.
It would also mean people can't meet friends and family inside or outdoors, except in public places such as parks.
Data from King's College London is separate from data published by Public Health England (PHE) revealed that more than two thirds of local areas across England are seeing a rise in Covid-19 case rates.
Data from PHE states that seven days ago, 126 out of a total of 315 local authority areas had recorded a week-on-week jump in rates. That figure now stands at 222.
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