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Risk groups and their relatives - advice and information

Published Updated

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 (admission to hospital, intensive care or death), but even the majority of people in risk groups will experience mild symptoms.

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

Everyone should follow the general infection control measures, with 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.

If transmission increases in society, people in risk groups should live more secluded. This advice applies for adults over 18 years. 

Advice for 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 in doubt, 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, cleaning and laundry
  • Avoid shaking hands, as well as kissing and hugging of people who are not household members or your regular partner.
  • Keep a safe distance from others, both inside and outside. 
  • It is better to meet others outside where the risk of transmission is lower, but avoid places with crowds.
  • Avoid contact with people with respiratory tract infections.
  • Limit use of public transport if possible, particularly during rush hour. See When you suspect that you have COVID-19 disease
  • Keep up-to-date about the situation and follow the local media, NIPH's website and/or helsenorge.no.

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

Low-level spread in society*

Slightly/ moderately increased risk

High risk  

Live like others 

You can generally live like the rest of the population, but be particularly careful to follow the general advice:

  • Keep the recommended distance to people, apart from those you live with.
  • Remember hand hygiene and cough etiquette.
  • Stay home when you are ill.

 

Increase social distancing

You can be with the people you live with as normal and socialise with others as long as:

  • You and the people you live with are particularly careful to follow general advice about 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 there when they are less busy.

Workplace planning and adjustment may be appropriate.

Widespread transmission in society*

Slightly/moderately increased risk

High risk  

Live more secluded

You can be with the people you live with as normal and socialise with others as long as:

  • You and the people you live with are particularly careful to follow general advice about 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 there when they are less busy.

Workplace planning and adjustment may be appropriate.

Social shielding

To avoid infection, you should withdraw during this period. You can go for walks and have normal contact with those you live with as long if you follow the advice in the yellow box and in addition: 

  • Keep a greater distance (preferably 2 metres) to others than those you live with.
  • Ask for help with shopping.
  • Those you live with should also live more secluded. If not, you should keep an increased distance to them. If this is not possible, it might be necessary to consider other temporary housing arrangements.

Patients with a risk of severe COVID-19 may be put on sick leave under certain circumstances. More information about assessing sick leave for patients in risk groups can be found at nav.no

*Rate of transmission in society: Assessed by the Municipal Medical Officer in collaboration with NIPH.  There may be local outbreaks e.g. workplaces, regions or municipalities.  

You define who is in your closest (physical) circle. They will normally be the people you live with.

Assessment of risk

Risk assessment applies at a group level, not for the individual person. There are considerable individual differences in risk within each risk group. If necessary, speak to your doctor about your degree of risk of severe disease course.

Younger people have a low risk of severe disease course, but people with poorly managed diseases/conditions, or combinations of several underlying conditions may have a higher risk.  

Groups with slightly/ moderately increased risk:  

  • Age 65–79 years  
  • Age 50–64 years with one of the following chronic diseases:  
    • chronic liver disease
    • immunosuppressive therapy, e.g. with autoimmune diseases
    • diabetes  
    • chronic lung disease, including cystic fibrosis and severe asthma that have required the use of high dosage inhalation steroids or steroid tablets during the last year 
    • obesity with body mass index (BMI) of 35 kg/m2 or higher 
    • dementia
    • cardiovascular disease (except high blood pressure) 
    • stroke

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.

Groups with high risk 

  • Residents of nursing homes
  • Over 80 years of age 
  • Severe health conditions, regardless of age *:   
    • solid organ transplant
    • immunodeficiency
    • hematologic (blood) cancer in the last 5 years
    • people with active cancer, ongoing or recently finished treatment for cancer (especially immunosuppressive therapy, radiation therapy to the lungs or chemotherapy). 
    • neurological or muscular disease with impaired coughing strength or lung function (e.g. ALS, Downs Syndrome)
    • chronic kidney disease and renal failure

Other serious and / or chronic diseases that are not mentioned may also increase the risk of serious illness and death from COVID-19. This is assessed individually by a doctor.

* These diseases/ conditions can give a high risk for severe disease course and death, also among younger people. 

Assessment 

NIPH’s assessments may change as more knowledge becomes available. Here is an overview of the main risk factors. This assessment applies for people aged over 18 years.

Age  

The risk of severe COVID-19 increases significantly with age and it seems to be the dominant risk factor for a severe disease course and death. With advanced age, the incidence of chronic diseases also increases. It may be difficult to distinguish the risk caused by age from the risk caused by disease, but analyses that adjust for several risk factors show that age is an independent risk factor.

A person's risk should not just be based solely on age, but also on an individual assessment of their 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 medical conditions in patients with severe COVID-19. 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 a severe disease course, 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, for example Chronic Obstructive Pulmonary Disease (COPD). Asthma is considered to be a chronic lung disease among people who regularly use inhaled steroids or cortisone tablets. People who occasionally use fast-acting reliever inhalers are not considered to have a chronic lung disease.

Chronic renal and liver disease

Both chronic renal and liver disease give an increased risk of severe course of COVID-19 when adjusted for age and other risk factors. This applies in particular to people with severely impaired renal function.

Cancer

People with active cancer, ongoing or recently discontinued treatment for cancer (especially immunosuppressive therapy, radiation therapy for the lungs or chemotherapy) have an increased risk of severe COVID-19. A large study from the UK indicates that people with blood cancer have a particularly high risk in the first five years after their diagnosis.

Other chronic diseases

Certain diseases and conditions that cause immunodeficiency, or require immunosuppressive therapy, such as organ transplantation, increase the risk of severe COVID-19.

Several studies suggest that dementia is an independent risk factor for severe COVID-19. The same applies to cerebral palsy and some motor neurone diseases. A UK study also suggests that Down's syndrome increases the risk of severe COVID-19 among people over 18 years of age. Since people with Down's syndrome are a heterogeneous group, the risk probably varies considerably within the group.

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, frailty, multiple chronic diseases, impaired functions and low activity level.

Children and adolescents in risk groups

Children and adolescents appear to have mild symptoms, even those with chronic conditions. 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

In some situations, workplace adjustment should be considered for employees who are at increased risk for a severe disease course. 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 sick?

Anyone who has symptoms of COVID-19 or have been exposed to infection should be tested. 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 for relatives of people at particular risk:

  • Keep in touch with people at risk 
  • Follow the current 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 well.
  • Young people and adults who have been with friends and in other situations where they have not kept a distance of one metre, should keep a distance of two metres to people in risk groups.
  • 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

Vaccination is one of the most effective forms of prevention of infectious diseases. The purpose of vaccination is to prevent disease or to make the course of the disease milder. The main goal of the coronavirus vaccine is to protect the lives and health of those most at risk for COVID-19 disease. Vaccination began in December 2020 in Norway. When you are fully vaccinated, it is likely that you will have a lower risk of serious illness and thus be able to live less secluded.

Advice about vaccination will be regularly updated here:

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 vaccines do not prevent coronavirus infection.

Coronavirus

The Norwegian Institute of Public Health receives an immense amount of enquiries about the coronavirus pandemic. Unfortunately, we do not have the capacity to reply individually to members of the public. 

Our advisory service is primarily intended for Norwegian government agencies, the healthcare service and municipalities. 

General public

You will find general advice about coronavirus on this website and on helsenorge.no

If you do not find the answer your to your question, you can ring the information helpline 815 55 015 that is open on weekdays from 08:00-15:30.

The Norwegian Directorate of Immigration has answers to many frequently asked questions about travelling to Norway, and a helpline 23351600 that is open on weekdays from 10:00-14:00. 

The Ministry of Foreign Affairs also has answers to many frequently asked questions.

If you need acute medical attention, contact your doctor. If you cannot reach your doctor, contact the emergency out-of-hours clinic on 116117. If life is in danger, call 113.

For questions about the Smittestopp app, ring Helsenorge on 23 32 70 00.

For healthcare personnel

You will find information on these pages and at helsedirektoratet.no

If you are a healthcare professional who is responsible for infection control at their institution can ring Smittevernvakta.

For questions about whether or not you should attend work if you are a healthcare worker, contact the person who is responsible for infection control at your institution. 

Contact your doctor or emergency out-of-hours clinic for questions about your personal health.

References

Himmels JPW, Borge TC, Brurberg KG, Gravningen KM, Feruglio SL, Berild JD. COVID-19: COVID-19 and risk factors for hospital admission, severe disease and death, 3rd Update  Oslo: Norwegian Institute of Public Health, 2020.

Norwegian Institute of Public Health. Weekly reports about coronavirus and COVID-19.

History

13.01.2021 Changed definition of asthma. Added link to "Who can get the vaccine"

05.01.2021 Updated section about vaccination, including:When you are fully vaccinated, it is likely that you will have a lower risk of serious illness and thus be able to live less secluded.

23.12.2020 Text and content have been harmonised with chapters on vaccination. Clarified that the advice applies to people 18 years and older. New text on assessment of spread of infection / risk level. Changed order of diseases / conditions according to order in another text dealing with vaccination against COVID-19. Inserted a new definition of asthma as a chronic disease. The term "well-regulated asthma" has been removed. It is specified that the increased risk of a severe course of Down's syndrome applies to adults 18+ years of age.

01.12.2020 Linguistic changes. Risk groups updated and changed according to the latest rapid review about COVID-19 and risk factors for hospitalisation, severe disease course and death. Changed heading from moderate / high risk to high risk, and moved several groups from this category to the category slightly increased risk. Dementia and stroke are included in the list of slightly increased risk. Updated section on vaccination.

25.09.2020 Removed sentence that there is little transmission in Norway.

14.08.2020 Removed sentence about a lack of vaccine for pneumococcal disease and prioritisation for those at highest risk for the disease.

19.06.2020
Replaced information about workplace adjustment in the red box in the matrix about advice for risk groups with information about sick leave and links to nav.no.

05.06.2020
Changed BMI from 35 to 30 according to systematic review, vn 2. Minor linguistic updates according to Norwegian version.
Removed reference to Mehra et al. Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19 because study is withdrawn from New England Journal of Medicine.

03.06.2020
Updated link to Directorate of Health

21.05.2020
General updates throughout the article, as per Norwegian text.

22.04.2020
Added "People over 65 years are advised to keep a distance from people outside their household, including children. This can also apply to people under 65 years with chronic conditions. People under 65 years who are healthy do not have the same risk and can be with others according to the recommendations given.  New knowledge shows that children become ill to a lesser extent and have few symptoms. It is mainly people with symptoms who are most contagious."

20.04.2020
Moved paragraph about work, as per Norwegian version. No changes to advice.

16.04.2020
Updated according to Norwegian article. Changes in groups with increased risk. Smoking removed as risk factor. Added paragraph about evaluation points in a work setting.

05.04.2020 
General updates throughout the article, as per Norwegian text.

01.04.2020
Clarification of text - people who smoke and people with overweight/obesity can have an increased risk, as per Norwegian text.

29.03.2020
Updated text according to Norwegian version

24.03.2020
Figure 55 000 is changed back to 44 000 as per an earlier version of this article.

20.03.2020
Updated text according to changes in Norwegian text. Added paragraph about children and healthcare personnel in risk groups

18.03.2020
Updated text according to changes in Norwegian text - user organisations

15.03.2020
Updated text according to changes in Norwegian text

14.03.2020
Updated text according to changes in Norwegian text

10.03.2020
Added paragraph about attending appointments. Updated advice about avoiding infection.

09.03.2020
Changes according to Norwegian text - added sentence about events and consider the need for travel.

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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.