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The state has seen a steep rise in infections this month: Its seven-day average rose to 4,077 on Thursday, more than doubling since Oct. 1.

Four of Illinois’ 11 regions are now under heightened virus-related restrictions.

And Gov. J.B. Pritzker, at a briefing Thursday at the St. Clair County Health Department , said that the Metro East — no longer under restrictions — is once again moving in a “concerning direction.�

“It’s time to step up and mask up. The work is not yet over,� Pritzker told Metro East residents. “Nobody wants to go back to tightened and heightened mitigations.�

The Metro East had an average positivity rate of 7.8% on Thursday. A region can see tighter restrictions if its positivity rate is 8% or higher for three consecutive days, or if it sees a decrease in hospital capacity.

Dr. Omer Badahman, director of infectious disease and infection prevention at Memorial Hospital in Belleville, said the facility has seen a noticeable uptick in COVID-19 patients over the past few weeks.

“It’s not over,� Badahman said. “We have more fighting to do.�

The Illinois Department of Public Health reported 4,942 new cases of COVID-19 on Thursday, the second-highest number ever throughout the pandemic. The record was 5,368 on Sept. 4, when the state health department processed a backlog of tests. The numbers pushed Illinois past 360,000 total cases since the beginning of the pandemic.

Statewide, Illinois reported 2,463 patients hospitalized with COVID-19, the highest level since June 8. The state reported 44 more deaths, bringing the total to 9,387.

Pritzker announced on Thursday additional restrictions for Region 1, which consists of nine counties in northwestern Illinois. The new measures include a reduction of the number of people who can gather in a bar or restaurant, to six people from 10, and a ban on meetings and social gatherings of more than 10 people.

Other Midwestern states, including Missouri, have seen rising COVID-19 rates in recent weeks. Missouri reported 1,854 new cases of COVID-19 on Thursday, well above the seven-day average of 1,522. The state also added 16 deaths, reaching a total of 2,657.

Dr. Elvin Geng, a professor of infectious diseases at Washington University, said the recent colder weather may be playing a role in the Midwest’s rising case numbers. Some residents may also be fatigued by the long-term precautions. He cautioned that while it is understandable, the virus, if allowed, will continue to spread.

“We don’t get credit for being exhausted from this,� Geng said. “If it’s allowed to, the virus will exploit us.�