, to exercise “extreme caution” before considering moving any part of the country to a lower tier.
He wrote: “We are now seeing a worrying increase in infection rates across a wide range of areas.
“It is particularly concerning that these increases come at the tail end of a second national lockdown.
“Trust leaders are worried that if infection rates remain as high as they are at the moment, relaxing the restrictions will trigger a third wave."
London Essex, Somerset, Bath and North East Somerset, Gloucestershire plus Wiltshire and Swindon are all teetering on the edge of Tier 3.
The areas have seen a surge in Covid cases with any changes due to be announced on Wednesday.
London has now emerged as the coronavirus capital of England with extra cops and Covid marshals being scrambled to police the streets.
Under the toughest Tier 3 restrictions, pubs and hospitality venues would be forced to close and people would no longer be allowed to meet friends in gardens.
The rules on gathering with people from other households would then be relaxed from December 23 for five days to allow families to get together over Christmas, but other restrictions would remain in place.
The UK Government and devolved administrations have agreed a temporary easing of measures which will allow three households to mix in a bubble from December 23 to 27.
Social distancing will be relaxed within the bubbles, giving people the chance to hug friends and family for the first time in months.
Each bubble can meet at home, at a place of worship or an outdoor public location but not inside a restaurant or pub.
Ministers have also slashed the self-isolation period from two weeks to 10 days to help reunite families for Christmas.
But Boris Johnson warned families must make a "personal judgement" about the risk to vulnerable loved ones when forming a Christmas bubble.
And the PM urged the public to "think carefully" over the festive period.
Professor Linda Bauld, of the University of Edinburgh, has also warned that relaxing Covid restrictions for five days over the Christmas period is a "mistake".
She told BBC Breakfast yesterday: "From a public health perspective, I have to be perfectly honest, I think this is a mistake.
"I think people have to think very carefully whether they can see loved ones outside, or do it in a very modest way.
"I'm also concerned about the travel, people going from high to low-prevalence areas.
"I think it's going to have consequences."
Two week self-isolation slashed to 10 days to help reunite families for Christmas