A downstate health care region reached a “warning level” Monday after seeing seven consecutive days of coronavirus positivity rate increases, according to the Illinois Department of Public Health.

Region Four, which includes Belleville, Carlyle, Greenville, Madison, Monroe, Randolph and St. Clair counties, has four counties that border Missouri.

Some residents who live in those counties, state health officials said, travel frequently to the other side of the state border, where less stringent mitigation measures have been put in place.

Public health officials have expressed concern after hearing reports of large gatherings without social distancing that took place in the southern Illinois region. Specifically, Hidden Lake Winery in Aviston is reported to have hosted several large events, contrary to public health guidance, according to IDPH.

Under a mitigation plan announced last week by state health leaders, additional measures will be reinstated in a region following a sustained rise in the positivity rate along with either a sustained increase in COVID-19 hospital admissions or a critical reduction in hospital bed capacity.

A sustained rise in the positivity rate is defined as an increase in the 7-day rolling average for 7 days out of a 10-day period. In addition, if a region hits three consecutive days of an 8 percent average positivity rate, automatic action will be required, state health officials said.

The first tier of mitigation steps can include suspending indoor bar service, reducing indoor dining capacity, reducing elective surgeries and procedures, placing additional limits on gatherings and room capacity, expanding remote work, as well as potential further mitigation steps relating to recreational activities, retail, and salon and personal care based on data received.