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Risk groups and their relatives - advice and information

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Advice and information about COVID-19 for risk groups and their relatives

Advice and information about COVID-19 for risk groups and their relatives


Most people who are infected with coronavirus, will have mild respiratory symptoms that pass. Some groups are at particular risk of developing more severe disease, but even the majority of people in risk groups will experience mild symptoms. Here you will find information about who is at particular risk, and guidance on how these groups can avoid transmission of infection. Information on this page may change as more knowledge becomes available.

Everyone should follow the general infection control measures, keeping good hand hygiene and cough etiquette, limiting the number of close contacts and keeping a safe distance to others. This is particularly important for people in risk groups and their relatives.

The risk of a severe disease course increases with higher age and underlying medical conditions, with men having a higher risk than women. Younger people without known risk factors may also experience a severe course. The probability is increased among people with underlying medical conditions.

Currently, there is little transmission in Norway. If transmission increases in society, people in risk groups should take everyday precautions and keep social distance.

Advice for risk groups

The tables below provides advice and guidance for risk groups in a situation of low and widespread transmission in their communities:

Low-level spread (Current general situation in Norway*)

Slightly increased risk

Moderate to high risk  

Live like others 

You can generally live like the rest of the population, travel, work and attend events. But be particularly careful to follow the general infection control measures:

  • Keep the recommended distance to people, apart from your closest family and friends
  • Remember hand hygiene and cough etiquette.
  • Stay home when you are ill

Consider whether you will be able to follow these measures before travelling or participating in social activities.

Increase social distancing

You can maintain a normal level of contact with your closest family and friends, travel and socialise with others as long as:

  • You and your closest circle are particularly careful to follow general advice, keeping a safe distance and good hand hygiene and cough etiquette.
  • You limit your number of close contacts
  • You avoid crowded places (e.g. public transport, shopping malls) or only go to such places when they are quieter

Workplace planning and adjustment may be appropriate.

Widespread transmission or outbreaks in your community

Slightly increased risk

Moderate to high risk  

Increase social distancing

You can maintain a normal level of contact with your closest family and friends, travel and socialise with others as long as:

  • You and your closest circle are particularly careful to follow general advice, keeping a safe distance and good hand hygiene and cough etiquette.
  • You limit your number of close contacts
  • You avoid crowded places (e.g. public transport, shopping malls) or only go to such places when they are quieter

Workplace planning and adjustment may be appropriate.

Social shielding

To avoid infection, you should keep to yourself during this period. You can go outside and maintain normal contact with your closest circle as long as they also practice social distancing and are healthy. Pay particular attention to hand hygiene and cough etiquette.

In addition, you should

  • Keep a greater distance from others (preferably 2 metres) than your closest circle.
  • Ask others to help you with necessary purchases.
  • If your closest contacts and household members have many other social contacts, you should keep a safe distance to them. If this is not possible, it might be necessary to consider other temporary housing arrangements.

If workplace adjustment or remote working is impossible, sick leave should be considered 

*Rate of transmission in Norway: The Municipal Health Care Services in collaboration with NIPH assess the epidemic.  The transmission of the virus is currently low in all counties in Norway.  There may be local clusters of transmission e.g. workplaces, regions or municipalities.  

Slightly increased or moderate/increased risk? 

Risk assessment is performed at group level, not per individual. There are considerable individual differences in risk within the distinctive risk groups. If necessary, speak to your doctor about your degree of risk of severe disease.

People at slightly increased risk:  

  • Age 65–80 years (especially over 70) 
  • Age 50–65 years with one of the following chronic diseases:  
    • cardiovascular disease (other than well-regulated high blood pressure) 
    • morbid obesity (BMI ≥ 35 kg/m2) in combination with weight-related diseases or BMI ≥ 40 kg/m2)
    • diabetes  
    • chronic kidney disease and kidney failure
    • chronic lung disease (other than well-regulated asthma)
    • chronic liver disease
    • in immunosuppressive therapy such as chemotherapy, radiation therapy and immunosuppressive therapy in autoimmune diseases

People under 50 years of age have a lower risk of developing severe COVID-19 disease. However, some people with poorly-regulated chronic conditions or a combination of several chronic diseases might be at increased risk.

People at moderate (clinically vulnerable) / high risk (clinically extremely vulnerable)

  • Over 80 years of age 
  • Residents of nursing homes
  • Age 66–80 years with one of the following chronic diseases, OR age 50–65 years with two or more of the following chronic diseases: 
    • cardiovascular disease (other than well-regulated high blood pressure) 
    • morbid obesity (BMI ≥ 35 kg/m2 in combination with weight-related diseases or BMI ≥ 40 kg/m2)
    • diabetes  
    • chronic kidney disease and kidney failure
    • chronic lung disease (other than well-regulated asthma)
    • chronic liver disease
    • in immunosuppressive therapy such as chemotherapy, radiation therapy and immunosuppressive therapy in autoimmune diseases
  • Severe health condition, regardless of age *:   
    • people with active cancer, ongoing or recently discontinued treatment for cancer (especially immunosuppressive therapy, radiation therapy to the lungs or chemotherapy). Leukaemia has a higher risk than other types of cancer
    • neurological or muscular disease with impaired coughing strength or lung function (e.g. ALS)
    • congenital immunodeficiency in an unstable phase that carries the risk of severe respiratory tract infections
    • blood disorders that include cells or organs that are important for the immune system
    • bone marrow transplant or organ transplant
    • HIV infection with low CD4 counts  
    • significant renal impairment or significantly impaired liver function
    • other, assessed by physician 

*We have included some serious health conditions in this list of a precautionary principle, although at present there are no studies indicating a higher risk of severe progression for the diseases.

Assessment of risk factors as of May 2020:  

NIPH’s assessments may change as more knowledge becomes available. An overview of the main risk factors follows:

Age  

Age appears to be the clearest risk factor for a severe course of disease for COVID-19, and the risk increases with advanced age. With advanced age, the incidence of chronic diseases also increases. It may be difficult to distinguish risk related to age from the risk related to disease, but analyses that adjust for several risk factors show that age is an independent risk factor.

Weekly reports from NIPH show that the number of hospitalisations and deaths per 100,000 rises with increasing age, and mortality increases significantly from age 70 years onwards. In Norway, as of May 12, 2020, 15 deaths were reported under the age of 70, representing 7 per cent of deaths (NIPH daily report of May 12, 2020). For the time being, NIPH still considers people over 65 years of age as a risk group, in particular, those over 70 years. The risk increases with increasing age.

It is nevertheless important that the assessment of a person’s risk should not be based solely on age, but also on an individual assessment of the person's general health.

Cardiovascular disease

Cardiovascular diseases include a range of diseases that may increase the risk of COVID-19. There is reason to believe that the risk increases with the severity of the underlying disease. High blood pressure without other risk factors does not appear to increase the risk of hospitalisation or death from COVID-19.

Diabetes

Diabetes is one of the most common underlying diseases in patients with severe COVID-19, internationally. The incidence of diabetes increases with increasing age. In studies that adjusted for age and other risk factors, patients with diabetes are at higher risk of severe COVID-19 progression. Some studies indicate that people with well-regulated diabetes have a lower risk of severe disease compared to people who have poorly-regulated diabetes.

Obesity

People with morbid obesity have an increased risk of hospitalization, intensive care and death, and the risk increases with increasing body mass index (BMI).

Chronic lung disease

It appears that the risk of severe COVID-19 disease is increased in people with chronic lung disease. In the largest study to date from the United Kingdom, data shows that chronic lung disease increases the risk of severe COVID-19 progression more than asthma, when adjusted for age and other risk factors. However, in the same study, well-regulated asthma showed no evidence of increased risk.

Other chronic diseases

People with chronic renal impairment or impaired liver function are at increased risk of severe course of COVID-19 when adjusted for age and other risk factors. The same applies to certain diseases that require immunosuppressive treatment.

For a number of diseases, there are insufficient data, but they are included in the list of serious underlying conditions because they are considered likely to increase the risk of severe COVID-19 progression. This applies to congenital immunodeficiency and HIV infection with low CD4 counts.

People who have been treated for hematologic cancer during the past five years or who have had an organ transplant are at higher risk of severe course of COVID-19.

Residents of nursing homes

Residents of nursing homes are considered to be at increased risk of a severe course of COVID-19, based on a combination of high age, multiple chronic diseases, impaired functions and low activity level.

Rationale for the updated assessment of groups at particular risk of May 15, 2020:

Some people are at increased risk of developing more serious disease from COVID-19 than the general population. We distinguish between people with known risk factors for COVID-19 and people with lung diseases or people with underlying diseases that may increase the general risk of infectious diseases, and who are more susceptible of a severe course of COVID-19. It is emphasised that for most people, even for those at risk, COVID-19 will not result in hospitalisation. Available evidence suggests that men with low socioeconomic status as well as people with minority backgrounds are over-represented among those with severe COVID-19, both in Norway and internationally.

We distinguish between groups with slightly increased risk and groups with moderate to high risk. We have included some serious health conditions in this list of a precautionary principle, although at present, there are still no studies indicating a higher risk of severe progression of COVID-19 for the diseases. There are considerable individual differences in risk within the distinctive risk groups. If necessary, speak to your doctor for your individualised assessment of risk and possible vulnerability.

Advanced age, chronic conditions, or a combination of both appears to increase the risk of severe disease, and how careful you should be. The guidelines apply to everyone who has an increased risk of severe COVID-19 progression, including those at increased general risk of infectious disease. Well-regulated chronic illnesses reduce the risk of serious illness.

Children and adolescents in risk groups

Children and adolescents appear to have mild symptoms. This also applies to children with chronic conditions and so far, there is nothing to suggest that they have a more severe COVID-19 disease course than other children. Some groups may be more vulnerable and teaching adjustment should be considered as a precaution when schools and childcare centres reopen. For more information about these groups:

Employees in risk groups

Employees in risk groups should talk to their employer about the possibility for remote working and workplace adjustment based on individual risk. Currently, this only applies for people at moderate or higher risk. With widespread transmission in the community, this will also apply to people with slightly increased risk. With widespread transmission, sick leave should be considered for people at moderate or higher risk if workplace adjustment or remote working is not possible.

The Norwegian Directorate of Health has prepared its own recommendations for employers in the health sector. 

Should people in risk groups change ongoing treatment?

No, there is no reason to advise against starting or stopping ongoing immunosuppressant treatment. If people who use immunosuppressants become sick, they should contact their doctor for advice about medication, testing and examination.

What should you do if you become ill?

Contact the healthcare service early if you feel ill and suspect that you may have been infected with the coronavirus. If you develop symptoms such as fever, cough, shortness of breath and reduced condition, contact your own doctor or emergency out-of-hours clinic (tel. 116117) as soon as possible. If you develop severe symptoms call 113.

If you develop other acute symptoms that you would normally seek medical attention for, contact the healthcare service, regardless of whether or not you may be infected with coronavirus.

Advice to people in risk groups:

  • Ensure you have all necessary medication available. Continue with your regular medication and only make changes in consultation with your doctor.
  • You should attend planned check-ups and appointments unless you hear otherwise from the healthcare institution. If you are unsure, contact the healthcare institution.
  • Remember good hand hygiene and cough etiquette. This also applies to persons you live with and to visitors. Clean your home frequently, paying particular attention to surfaces that are touched frequently. See Hand hygiene, cough etiquette, face masks, cleaning and laundry
  • Avoid shaking hands, as well as kissing and hugging of people who are not your closest contacts or are not your regular partner.
  • Keep a safe distance from others, at work, outside and other places you go to. 
  • You can go for walks, but choose places where there are few people.
  • Avoid contact with people with respiratory tract infections.
  • Limit use of public transport if possible, particularly during rush hour.
  • See advice when you or your closest contacts have acute respiratory infections
  • Keep up-to-date about the situation and follow the local media, NIPH's website and/or helsenorge.no.

Advice for relatives of people at particular risk:

  • Keep in touch with people at risk 
  • Follow the advice about hygiene and other measures to reduce the risk of getting infected
  • Do not visit people in risk groups if you have symptoms of respiratory tract infection or do not feel completely healthy.
  • Offer to help with necessary errands
  • If you live with someone who is at risk and you have symptoms of a respiratory tract infection or do not feel well, limit time spent together. If possible, stay and sleep in separate rooms and have your own bathroom / toilet. If this is not possible, try to keep your distance and have a separate towel in the bathroom / toilet and your own toiletries. See advice when you or your closest contacts have acute respiratory infections.

Vaccines

Currently, there is no vaccine against COVID-19 but several research groups are working hard to develop a vaccine.

The Norwegian Institute of Public Health recommends that people in risk groups should take the influenza vaccine every year and the pneumococcal vaccine (against a bacterium that can cause pneumonia) every 10th year. These recommendations apply regardless of the coronavirus situation, but people in risk groups are asked to ensure that they are updated with these vaccinations.

Due to limited availability of vaccine, those at highest risk will be prioritised. These vaccines do not prevent coronavirus infection.

Earlier assessment of groups at particular risk:

Based on evidence available from the outbreak in China, NIPH originally considered the following groups of people to be at increased risk of developing severe COVID-19 (10.03.2020):

  • Older people (> 65 år)
  • Peoples with underlying chronic diseases like cardiovascular disease, diabetes, significantly impaired lung function, cancer and hypertension. People who smoke may be at higher risk of a severe development of COVID-19.

In the early reports from China, smoking was considered to be a risk factor for severe development of COVID-19. With new information emerging from different countries, the NIPH reviewed available literature, and smoking was no longer a distinct risk factor for severe COVID-19 progression and was therefore removed. Diseases related to smoking are still considered risk factors. In the systematic review about risk groups from 17.04.2020, the conclusion was that high age was the clearest risk factor, and it seems to increase with advancing age, especially if the person also has underlying diseases.

The NIPH chose to distinguish between groups at increased risk of severe course of COVID-19 (age over 65 years, people with cardiovascular disease (including high blood pressure) or diabetes, and groups that may be at increased risk of severe course of covid-19 (morbidly obese, significantly impaired lung function, neurological or muscle diseases that cause coughing or lung dysfunction, congenital immune failure in unstable phase that carries the risk of serious respiratory tract infections, blood disorders that include cells or organs important for immune defense, bone marrow transplantation, bone marrow transplantation, chemotherapy, radiation therapy and immunosuppressive therapy in autoimmune diseases, HIV infection with low CD4 counts and significant renal or hepatic impairment). Advice was prepared for people at particular risk and for their closest contacts.

References

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Facts

Coronavirus

SARS-CoV-2 is the name of the virus that is causing the outbreak of COVID-19 disease.

The virus is related to another coronavirus that caused the SARS outbreak in 2002/2003 but is not the same virus.