Sunderland, Gateshead, Newcastle and South Tyneside on Coronavirus watchlist
Getty ImagesSunderland, Gateshead, South Tyneside and Newcastle have been added to Public Health England's Coronavirus watchlist.
Sunderland Council said there were 244 new cases in seven days; 75 cases per 100,000 people which is three times higher than the national rate.
Council leader Graeme Miller said there would be "enhanced support" rather than restrictions.
A local lockdown was "close" if there was not a "rapid and drastic reduction in the number of cases", he said.
"The virus is spreading across Sunderland and we need to work together to stop it."
Areas on the "enhanced support" watchlist are given additional resources by the government, such as greater levels of testing.
Gateshead said cases had more than trebled in the past seven days with 113 new ones in the first week of September, equating to about 55 cases per 100,000 people.
Newcastle City Council said there had been 145 new cases in the past seven days, equating to 48 cases per 100,000 people.
The authority's director of public health, Eugene Milne, said almost 60% of people in the city who tested positive in the past two weeks were from the 18 to 30 age group.
Enhanced support is the second of three tiers on the watchlist, with the highest level resulting in government intervention in a bid to help slow the spread of the virus.
Middlesbrough and Hartlepool are on the lowest tier as areas of "concern".
- SOCIAL DISTANCING: What are the rules now?
- SUPPORT BUBBLES: What are they and who can be in yours?
- FACE MASKS: When do I need to wear one?
- SCHOOLS: What will happen if children catch coronavirus?
- TESTING: What tests are available?
Gateshead's director of public health has warned the town could see direct government intervention in one or two weeks if cases keep rising.
Alice Wiseman said the borough doesn't "have much time, we have to move fast".
"Unless we can get a hold on this there will be more restrictions on people's lives."
Low Fell businesswoman Julie Oxley said another lockdown would "kill" the economy.
"We just survived one lockdown, if there is another lockdown how on earth are we supposed to pay the bills that still have to be paid?" she said.
Maureen Bowe said it would force her to close her hair salon.
"If people stick to common sense things like wearing masks, washing their hands and social distancing it would be fine," she said.
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