It looks "highly likely" Norfolk will go into a higher tier of coronavirus restrictions, the county's public health director has said, amid record rates of the virus.
Norfolk and Suffolk are currently covered by Tier 2 restrictions, but rising rates suggest they could go into Tier 3 or even 4 when the government next reviews the rates - scheduled for December 30.
In the seven days up to December 17, the rate in Norfolk had reached a record high of just under 180 cases per 100,000 people - and Dr Louise Smith, Norfolk County Council's director of public health said she expected that to rise further.
There is particular concern about West Norfolk, where the rate of 208.7 cases per 100,000 has hit a record high - and where the Queen Elizabeth Hospital is under particular pressure, prompting a plea from its chief executive.
North Norfolk recorded a new high of 124 cases per 100,000 people, while Norwich's rate of 203.5 cases per 100,000 was a new high for the city.
Broadland's rate increased from 123.1 cases per 100,000 people in the seven days up to December 10 to 208 in the seven days up to December 17.
Great Yarmouth was at just below 200 cases per 100,000, having gone up from 153, Breckland went up from 88.6 to 149.3 and South Norfolk went from 98 to 153.3.
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Dr Smith said: "Looking at the trends, the case rate is rising more rapidly and my expectation is that in the next week or so, the numbers will keep going up.
"When we came out of lockdown, they had levelled out, but over the past few days we have seen a step change.
"I think that is a significant concern and it suggests the current Tier 2 restrictions are not containing and controlling the virus.
"If our cases stayed the same as they had been then we would be likely to stay in Tier 2.
"But if our cases keep going up, then the discussion becomes about escalation of the tiers.
"When I put together that cases have been going up and my prediction that they will continue to go up in the coming days, it seems highly likely we could be thinking about when we will be going up into a higher tier."
She said Norfolk had generally been about two weeks behind other areas and that was likely to be the case again now.
Tier 3 restrictions would mean restaurants and pubs would have to close, except for takeaways, while hotels, accommodation and indoor entertainment such as cinemas would have to shut. Mixing of households outdoors would also be more limited.
But there is also the possibility that the even more restrictive Tier 4, which London was placed under, could be extended to other areas - under which all non-essential businesses would have to close and individuals would only be allowed to meet one other person outside.
Pressure on hospitals and care homes
There are currently 366 people with coronavirus being treated in the county's hospitals.
And Dr Smith said the Queen Elizabeth Hospital in King's Lynn had the highest proportion of patients using its beds, at a time when a number of staff were needing to isolate, having come into contact with somebody in the community who had been infected.
She said: "We know they are facing a particular challenge. The healthcare system is offering help and support, with some staff from other hospitals being redeployed there."
On the plus side, she said the proportion of people on ventilators had come down.
There are currently 16 and Dr Smith said the experience of the first wave and better treatments were reducing the number of people who end up in intensive care.
She said there were about 50 outbreaks in care homes, which was fairly evenly split between infections among staff and residents.
She said: "We have been seeing that the outbreaks in care homes are getting bigger. When we have been managing them, we have seen that the number of people infected is higher than it was."
The new variant
The new Covid-19 variant, which chief medical officer Chris Whitty says is 70pc more transmissible, was identified in Norfolk in November.
Scientists at The Quadrum Institute in Norwich said the surge in cases in Wymondham last month was attributable to the virus.
Dr Smith said there was not yet enough data to know if the recent increase in cases in Norfolk was due to that variant - but it was clear it was present in the county.
She said: "The Quadrum Institute is telling me that they have found more than 100 samples, both in community tests and in testing being done by the NHS.
"Norfolk does seem to be tracking more of it than other counties outside London, but it's difficult to say whether that's because we actually have more of it or because the sequencing being done by the institute means it's being better recorded here."
She said there was no evidence yet that it caused more serious illness, but that it should make people behave more cautiously.
She urged people to remember to stay two metres apart, to wear face coverings, to keep washing hands and for people with symptoms to get tested and isolate.
And she reiterated that, just because up to three households are permitted to mix in Christmas bubbles on Christmas Day, it doesn't mean they should.
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