The Liverpool City Region will be on the “very high” Covid alert level from Wednesday, Boris Johnson has announced.
Confirming new three-tier restrictions, the PM said pubs, bars and betting shops would close on Merseyside.
Most areas of England will be on “medium” alert, with measures such as the rule of six, but areas with local restrictions on household mixing are automatically on “high” alert.
The PM said all retail outlets, schools and universities would remain open.
Speaking at a Downing Street press conference Mr Johnson and Chancellor Rishi Sunak, England’s chief medical officer Prof Chris Whitty said he was not confident the new measures “would be enough to get on top of [the virus]”.
However, Mr Johnson said he did not want to go down the “extreme route” of a national lockdown “right now”.
It came after England’s deputy chief medical officer, Prof Jonathan Van-Tam, said growth in Covid cases was a “nationwide phenomenon” and that “things are heating up” in areas beyond northern England.
The new system is split into three alert levels: medium, high and very high. Most areas in England are in the medium alert level – meaning current restrictions continue, including the 10pm hospitality curfew.
Areas already under additional local restrictions are automatically in the high alert level – meaning bans on household mixing indoors are extended to include hospitality venues.
Nottinghamshire, East and West Cheshire and a small area of High Peak now come into this category, as well as Greater Manchester, parts of South Yorkshire, and north-east England. Around 4.4 million people will be in high alert areas.
The Liverpool City Region – home to 1.5 million people – becomes the first area to enter the very high alert level, with the closure of pubs and bars. Betting shops, gyms, leisure centres and casinos will also close in the region.
Household mixing will be banned anywhere indoors, and in outdoor gardens and hospitality. The rule of six will continue to apply in outdoor public spaces like parks, according to government guidance.
Restaurants can continue to trade in very high alert areas – including pubs and bars that serve “substantial meals” – while people will also be advised against travelling to and from these zones.
Go further or gone too far?
Some will say ministers should have gone further, while others argue they have already gone too far.
But the problem with the restrictions that are being discussed is that no one really knows what impact they will have.
Closing Covid-secure pubs, for example, could just drive people to gather more in homes, where the risk of transmission is even greater.
The other factor, which is not grabbing the headlines at the moment but is just as important, is whether the test and trace system is up to the job.
Test results are taking too long to return, contact tracers are failing to reach enough of the close contacts of infected individuals and even when they do most people do not follow the isolation guidelines to the letter.
Infections, hospitalisations and deaths are certainly going to rise. By how much and for how long is the big unknown.
Certainly with better treatments in place and the UK in a stronger position to protect care homes – four in 10 deaths were among their residents in the first wave – many believe the toll should not be as great as it was in the spring.
Mr Johnson told the Downing Street news conference the increasing number of coronavirus cases was “flashing at us like dashboard warnings in a passenger jet”, adding: “We have to act now.”
Speaking earlier in the House of Commons, he said: “This is not how we want to live our lives but this is the narrow path we have to tread between the social and economic trauma of a full lockdown and the massive human, and indeed, economic cost of an uncontained epidemic.”
The PM said around £1bn of “new financial support” would be provided to local authorities in England with further financial support for local test and trace and local enforcement in very high alert areas.
A postcode search will launch on the government website in due course enabling residents to determine which rules apply to them, Mr Johnson said at the news conference.
Labour leader Sir Keir Starmer said: “The question today is whether the restrictions announced by the prime minister can bring the country back from the brink.”
Prof Calum Semple, an infectious disease expert and adviser to the government, told BBC Radio 4’s PM programme the new restrictions had come too late and a short national lockdown could be needed in weeks.
The British Medical Association, which represents doctors, said new local measures are “treating the ‘symptom’ not the cause” of increasing infections and called for a national prevention plan.
By Ellie Price, political correspondent
As he introduced the new three-tier system for England, questions and criticisms came at Boris Johnson from all sides and highlight his challenge.
Since March, Labour leader Sir Keir Starmer has lent his broad support to government restrictions. But in the Commons he accused the PM of being “several steps behind the curve” and questioned whether the measures “can bring the country back from the brink.”
There were numerous questions on whether the government could be more generous in its financial support for businesses affected.
And from Conservative MPs, some said individuals should be left to make their own decisions, while others said tougher measures needed to be imposed now.
Labour mayor of Liverpool Joe Anderson told the BBC “we agree with the government having to impose tougher restrictions” but he added that an argument for a stronger financial package for the city “wasn’t listened to”.
Liverpool City Region metro mayor Steve Rotheram said the area’s restrictions were “comparable” to the national lockdown in March – but without the same level of financial support.
Some areas of northern England have had additional restrictions on household gatherings since the end of July.
Meanwhile, London Mayor Sadiq Khan said despite the capital being on the medium alert level, its status could “change very quickly – potentially even this week” and move into a higher level.
The three-tier alert system applies only to England, with the devolved administrations in Scotland, Wales and Northern Ireland in charge of designing and implementing their own coronavirus restrictions.
A further 13,972 confirmed coronavirus cases were reported on Monday, with 50 more deaths within 28 days of a positive test recorded.
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