Ending the press conference, Boris Johnson says: "We're walking a narrow path here today, because we don't want to go back into a national lockdown, with all the damage, social and economic that that can do, unless we absolutely have to.

"We think the local approach is the reasonable one given the way the virus is dispersed."

"And, just to sort of give everybody some hope, If you look at what is actually happening with the universities, for instance, they have done a great job of getting their virus under control."

He adds: "The R is currently above one but it's not that much above one, so if we all follow the guidance together... then I have no doubt that we can drive it down, particularly in those badly affected areas."

Jennifer Williams of the Manchester Evening News has the last question. She asks if the prime minister owes Manchester an apology. She also asks how much support business in the region will get.

Boris Johnson says he is "deeply sorry it is necessary to put these measures in place".

"We want to give Manchester the proper levels of support," he adds.

"Our door remains open to Andy [Burnham] to discuss that, although we've got to keep it in line with deals already done."

Jennifer Williams also asks if a localised test and trace system would have been better.

Prof Van-Tam replies that you need both. He says a local back-up system is need to track the "complex hard-to-reach" cases.

Prof Van-Tam is asked whether the argument for a short national "circuit-break" lockdown is stronger or weaker now than when Sage recommended it on 21 September.

"It is a kind of scientific feature of the effect of a lockdown that, if disease levels are higher when you effect the lockdown, the effect will be less, overall, than if the lockdown is inflicted at a point when disease level is much lower," he says.

"I wouldn't expect the same magnitude of effect if it were done now as if it were done early in September or mid-September."

He stresses again that he thinks a national lockdown would be "inappropriate" and "very difficult to justify for some communities".

Reality Check

Cases across Greater Manchester have been increasing since early September.

For the week ending 1 September, there were around 44 cases per 100,000 people across the 10 local authorities that make up the city-region.

Jump forward to the week ending 16 October, and this case rate had increased to around 384 cases per 100,000.

The national average in England is around 96 cases per 100,000.

However, in the past 10 days the case rate appears to have stabilised somewhat. To what extent this is influenced by the amount of testing is unclear.

The pressure these increases are having on hospitals is often mentioned but the data available to the public is patchy.

We do know that coronavirus admissions and diagnoses in major Greater Manchester hospitals are increasing – in the week ending 11 October (the latest week we have data for), an average of 60 people were being admitted. This is about double the previous week’s average.

Localised data on whether hospitals or intensive care beds are reaching capacity is not publicly available. However, slides used in today’s press conference do show that occupancy is still increasing in Greater Manchester.

Quizzed further on the support package offered to Greater Manchester, the PM says: "The £22m that you mention, that's separate and additional to any other support that we were trying to agree with Manchester for business support."

He adds: "Our door is open to continue that particular conversation."

Jason Groves from the Daily Mail asks if Manchester will be receiving the £66m (a figure that was mentioned earlier in the day).

Boris Johnson says "for the sake of fairness" the financial package offered to Greater Manchester had to be in line with deals reached with Lancashire and Merseyside.

He reiterates that he chose to act on Greater Manchester today "because of the surge in cases".

Jason Groves also asks if today's death toll of 241 people is a blip or part of a trend

Prof Van-Tam says figures tend to be higher on a Monday or Tuesday due to a delay in reporting deaths over the weekend but adds that he expects the rise in deaths to continue.

The PM is asked by Times Radio why he has decided to take a different course to Wales and Northern Ireland - which both have lower infection rates than England but stricter rules.

"In the areas which are experiencing a particular surge of the virus that are now in tier three or going into tier three, we rule nothing out," he replies.

"If we have to take tougher measures then of course we will."

He adds: "We think that the local regional approach is right. The way to make this work with tier three is for everybody to comply."

Prof Jonathan Van-Tam defends the restrictions.

"We just can't afford just to let our elderly die," he says. "And we can't afford to allow our NHS to be completely consumed by looking after Covid so it can't do its other business-as-usual work.

"So we'll have to take as tough measures as necessary to stop that."

He says the typical "lag time" between doing something and beginning to see a discernible effect is two to three weeks.

"We can't take the brake off on this and we may have to push on the pedal a little harder to get it back under control."

According to the latest government figures, external, the rates of Covid-19 infection per 100,000 people in each Greater Manchester area on 17 October were as follows:

• Rochdale 480.2
• Salford 452
• Wigan 451.2
• Oldham 439
• Bolton 429.8
• Manchester 420.4

• Bury 409.4
• Tameside 363.8
• Trafford 318.5
• Stockport 293.8

Those rates mostly reflected a rise in the rate compared to the figures from seven days before - although Manchester and Trafford have all seen a drop in the rate in the last week.

The average rate for England on the same day was 168.8.

Jessica Parker
BBC political correspondent

I'm hearing from Downing Street sources that "conversations will continue" about support for businesses in Greater Manchester.

It would be politically very risky for the government to offer up nothing - given the row that there’s been and having given extra cash to other tier-three areas.

Ministers just clearly can’t, or won’t, give a figure right now.

Carl Dinnen of ITV asks if Manchester is being made an example of.

Boris Johnson says he wanted a deal but had to take action because of the urgency of the situation.

He adds that he is grateful to Manchester leaders for "getting behind the measures in place".

Carl Dinnen also asks if tier-three measures are enough to make a difference and whether the 10-day negotiation will be damaging.

Prof Jonathan Van-Tam says tier-three measures are "the minimum national standard for hard measures" and adds there are other things local authorities can do.

"What is really important is compliance," he adds.

Prof Stephen Powis says it will be up to two weeks before the new measures have an effect.

Prof Van-Tam says he does not think a national "firebreak" would be right.

"It is clear that in the areas where it is out of control... hard measures are needed," he says.

But, in some parts of the country, levels of the disease are "very, very much lower" than they are in the north of England.

"I don't think [a firebreak] is consistent with the epidemiological picture we're seeing, or indeed consistent with the pressures that are being seen in different parts of the health service across the country," he says.

Jessica Parker
BBC political correspondent

Key question from BBC’s Vicki Young: what’s happened to the tens of millions of pounds to help Greater Manchester businesses and workers? It isn’t clear.

And remember that’s what leaders and government have been haggling over all day.

Yes the area gets £22m but that’s a baseline per head figure, for tier-three areas, to help with things like testing and enforcement.

Boris Johnson says he couldn’t do a deal with Greater Manchester that would have been out of kilter with agreements already reached with tier-three areas Merseyside and Lancashire.

So at the moment it’s just not clear whether that support for businesses is gone for Greater Manchester, or still up for negotiation.

The PM tells the BBC's Vicki Young that he "bitterly regrets" restrictions that lead to damage to businesses and to people's lives.

"Frankly, Andy Burnham is right in what he says about the length of endurance that Greater Manchester has shown, and I've simply got to look at the data - alas the number of deaths, the hospital admissions - and we have to act."

He says £22m of help for the Greater Manchester area is "additional to other support" and that the area will have access to funds including help with contact tracing and enforcement.

"The funds are there, they're massive," he says.

But he adds: "What we couldn't' do... was do a deal with Greater Manchester that really would have been out of kilter with the agreements we'd already reached with Merseyside and with Lancashire."

The next question to the PM from a member of the public is on care homes - is there an opportunity for the restrictions on care homes to be reviewed? She says she has only visited her relative in a care home once since March.

Mr Johnson says "everybody sympathises deeply with you and your family" - and the situation is "tragically being replicated" across the country.

He says the government is "certainly looking at what we can do to review the circumstances that might allow people to visit elderly relatives in extreme circumstances".

He says he can see how "absolutely wretched it is".

England's deputy chief medical officer, Jonathan Van-Tam, says "it's really extremely distressing" for relatives and residents.

"The unfortunate and horrible truth about this virus is that when it gets into care homes it can inflict really massive mortality very quickly."

He says there is a "constant tension" between wanting to see relatives and not wanting to cause "catastrophic mortality" in homes.

Prof Van-Tam says he is hoping that there might be a "breakthrough" in rapid testing so that relatives can visit care home residents in a safer way.

Current guidance says in tier one (medium) Covid risk areas there should be individualised assessments of the safety of visits to care homes. But in tiers two and three, where the risk is high or very high, “visiting should be limited to exceptional circumstances only such as end of life.”

Boris Johnson has just confirmed what was suggested in Andy Burnham's news conference earlier - that tier-three measures will come into place in Greater Manchester on Friday just after midnight, and that the region will get £22m in extra financial support.

Mr Burnham described the offer as "brutal".

"This is no way to run the country in a national crisis," he added.

Boris Johnson says the government is offering a "comprehensive package of support".

He says the Job Support Scheme means those affected by business closure will still be paid.

With Universal Credit they will receive 80% of their full income, he says.

And he says that Greater Manchester will receive £22m "on top of the £1bn we're providing in funding for local authorities across the whole country he says.

Mr Johnson is asked by a member of the public how many regions will be put under tier three until the government announces a national lockdown.

"What we're trying to avoid is a national lockdown at all," Mr Johnson says.

"We don't rule anything out," he says - but the prevalence of the virus is "very uneven" across the UK.

Jessica Parker
BBC political correspondent

We’ve heard the case made for further restrictions in Greater Manchester before and we’ve heard it again today.

Jonathan Van-Tam was asked to present a specific "heat map" for the area.

It’s part of a rolling the pitch for the prime minister as Boris Johnson confirms that Greater Manchester will go into Tier 3 on Friday at midnight.

Boris Johnson now takes over.

He says Greater Manchester will move to the very high alert level -tier three.

He says this mean pubs and bars will close unless they are serving substantial meals and he strongly advises people against travel into and out of the area.

These new measures will come into force on Friday just after midnight, he says

Prof Van-Tam says the rate of new cases is "a contrasting game of two halves".

While the weekly case rate among younger age groups has declined, he says there is "continuing increase" among older age groups.

"This really shows us now that the infections which have ceded in the younger age groups are now penetrating those older age groups as we go forwards in time," he says.

Image source, Downing St