Hopp til innhold

Get alerts of updates about «Risk groups and their relatives»

How often would you like to receive alerts from fhi.no? (This affects all your alerts)
Do you also want alerts about:

The email address you register will only be used to send you these alerts. You can cancel your alerts and delete your email address at any time by following the link in the alerts you receive.
Read more about the privacy policy for fhi.no

You have subscribed to alerts about:

  • Risk groups and their relatives

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.


Skip to content on this page

Most people who become infected with coronavirus (SARS-CoV-2) will experience mild respiratory symptoms that pass. Some groups are at particular risk of developing more severe illness (resulting in hospital admission, intensive care or even death), but even the majority of people in risk groups will experience mild symptoms.

The risk of a severe COVID-19 disease course rises with age and underlying medical conditions, with men being at greater risk than women. In rare cases, younger people without known risk factors may also experience severe illness.

Everyone should follow the general infection control measures, including 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 the infection rate increases in society, people in risk groups should live in a more secluded way. This advice applies for adults over 18 years.

Vaccination against COVID-19

Vaccination is effective in preventing infectious diseases. The purpose of vaccination against COVID-19 is to prevent disease or to make the course of the disease milder.

As of 1 June 2021, the majority of people in the risk groups had been vaccinated.

Advice for people in the risk group who have been vaccinated or have undergone COVID-19 can be found at the bottom of this page.

Advice for people in risk groups who are not vaccinated or have had COVID-19

Make sure you have the medicines you need to hand. Continue taking your regular medication, and only make changes in consultation with your GP.

  • 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 concerned.
  • 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
  • It is better to meet others outside where the risk of transmission is lower, but avoid places with crowds.
  • Limit your use of public transport if possible, especially during the rush hour. See When you are sick or suspect that you have COVID-19 disease
  • Keep up to date with the situation by following your local media, the Norwegian Institute of Public Health's website and/or helsenorge.no

The table below provides advice and guidance for risk groups who have not been vaccinated or have not had COVID-19:

Low-level spread in society*

Slightly/ moderately increased risk

Moderate/ 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 away from other people, apart from those you live with.
  • Remember hand hygiene and cough etiquette.
  • Stay at home when you are ill.

 

Live in a more secluded way

You can be with people you live with as normal and socialise with others provided you follow the advice in the green box, and:

  • 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 centres) or only go there when they are not very busy.

Workplace planning and adjustment may be appropriate.

Widespread transmission in society*

Slightly/moderately increased risk

Moderate/ high risk  

Live in a more secluded way

You can be with the people you live with as normal and socialise with others provided you follow the advice in the green box, and:

  • 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 centres) or only go there when they are not very busy.

Workplace planning and adjustment may be appropriate.

Live in a secluded way

To avoid infection, you should live in a more secluded way during this period. You can go for walks and have normal contact with those you live with provided you follow the advice in the yellow box, and also:

  • 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 in a more secluded way. If not, you should maintain a greater distance away from them. If this is not possible, it may 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 for people who are not vaccinated or have not had COVID-19

Risk assessment applies at a group level, not to the individual. There will be considerable individual variations within each risk group.  If necessary, speak to your doctor about your risk of a severe COVID-19 disease course

Younger people are at a low risk of a severe COVID-19 disease course, but those with poorly managed diseases/conditions, or combinations of several underlying conditions, may be at greater risk.  

Advice for people in the risk group who have been fully vaccinated or had COVID-19 can be found at the bottom of this page.

Groups with slightly/ moderately increased risk:  

  • Age 65–69 years  
  • Age 50–64 years with one of the following chronic diseases:  
    • chronic liver disease
    • immunosuppressive therapy with autoimmune diseases
    • diabetes  
    • chronic lung disease, including severe asthma that has 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 are at lower risk of developing severe COVID-19 illness. However, some people with poorly-regulated chronic conditions or a combination of several chronic diseases might be at increased risk.

Groups with moderate/ high risk 

  • Residents of nursing homes
  • Over 70 years of ageα 
  • Severe health conditions, regardless of age *:   
    • solid organ transplant
    • immunodeficiency
    • hematologic cancer in the last five years
    • other active cancer, ongoing or recently completed treatment for cancer (especially immunosuppressive therapy, radiotherapy targeted at the lungs or chemotherapy).
    • neurological or muscular disease with impaired coughing strength or lung function (e.g. ALS and cerebral palsy)
    • Down's Syndrome
    • chronic kidney disease and renal failure

α  There is an exponential (sliding) increase in risk from 70 years and over. Age is the most important independent risk factor.

* 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 result in a high risk of severe illness and even death, including amongst younger people.

Further information about risk groups

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

Age  

The risk of developing severe COVID-19 illness rises significantly with age, and age appears to be the dominant risk factor regarding the development of severe illness 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 be based solely on age, but also on an individual assessment of their general health.

Organ transplantation

Several studies show that people who have undergone organ transplantation have a significantly increased risk of a severe COVID-19 disease course. People on the waiting list for organ transplantation should preferably be vaccinated before transplantation. Organ transplantation shall not be postponed due to vaccination.

Immune deficiency

This includes severe congenital or acquired immune deficiency conditions that can lead to significant immune deficiency, and are more severe and rare conditions than the autoimmune diseases. People in this group may be at high risk for severe COVID-19 disease course. The conditions include severe combined immunodeficiency, immunodeficiency associated with major defects (e.g., Wiskott-Aldrich syndrome), common variable immunodeficiency, immunodeficiency with predominant antibody deficiency (e.g., hypogammaglobulinemia) and some other types of severe immunodeficiency conditions. The group also includes HIV patients with low CD4 counts who should be considered for vaccination by their doctor.

People with sickle cell anemia also have an increased risk of a severe disease course.

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 a severe COVID-19 disease course. Active cancer is defined as a cancer that has not been radically treated and assumed to be cured. Recently completed cancer treatment is defined as completed within the last 6 months.

When planning the start of cancer treatment, it should be considered whether patients can be vaccinated before starting. Vaccination should not delay the start of treatment. A large study from England indicates that people with blood cancer have a particularly high risk in the first five years after the diagnosis is made.

Neurological diseases or muscle diseases that cause impaired coughing or lung function

In this group we find people with cerebral palsy (CP), mental retardation, severe muscle diseases, spina bifida, as well as diseases that affect the brain in adults and the elderly (e.g., Parkinson's and ALS). In general for these diseases, people may have physical immobility (e.g., use a wheelchair) and / or reduced lung function and coughing power, risk of food or drink entering the respiratory tract, or they have a genetic condition that increases morbidity.

The risk of a severe disease course in people with CP depends on how severe their CP is, see text above. Milder degrees of CP will not pose any risk in themselves.

Down's syndrome

Several studies show that adults with Down's syndrome have a higher risk of a severe COVID-19 disease course. The risk increases with age. Down's syndrome can lead to an increased incidence of autoimmune diseases, diabetes, low metabolism, obesity, dementia and congenital heart disease. Some of these conditions can contribute to the severe course of COVID-19.

Furthermore, people with Down's syndrome may have inappropriate immune responses in COVID-19, which further increases the risk of a severe course. All people with Down's syndrome who are 16 years and older are therefore given priority for vaccination.

Chronic kidney disease

Chronic kidney disease increases the risk of a severe COVID-19 disease course when you adjust for age and other risk factors. This is especially true for people with significantly impaired renal function. People with moderate / severe kidney failure are considered to have a significantly increased risk.

Chronic liver disease

Chronic liver disease also carries an increased risk, especially with significantly impaired liver function.

Immunosuppressive therapy in autoimmune diseases

Patients using immunosuppressive drugs may have an increased risk of severe disease course. It is probably the drugs themselves, and not the underlying disease, that increase the risk. Immunosuppressive drugs include TNF-alpha inhibitors, interleukin inhibitors, methotrexate, and more (see Felleskatalog). These drugs are used, among other things, for multiple sclerosis (MS), inflammatory joint diseases and inflammatory bowel diseases.

Diabetes

Diabetes has been reported as one of the most common underlying diseases in patients with a severe disease course. In studies that have been adjusted for age and other risk factors, patients with diabetes have a higher risk of severe COVID-19. 

The duration of the diabetes disease and the incidence of late diabetic complications seem to increase the risk. Poor blood sugar control is a risk factor for a severe course, but diabetic patients with well-regulated blood sugar levels are also recommended to be vaccinated. All people with diabetes who are 18 years and older are therefore given priority for vaccination.

Chronic lung disease

It appears that the risk of a severe COVID-19 disease course is increased in people with chronic lung disease, including severe asthma, defined as asthma that has resulted in the use of high-dose inhaled steroids or steroid tablets during the past year.

Obesity

People with obesity have an increased risk of a severe disease course, and the risk increases with increasing body mass index (BMI).

Cardiovascular disease

Cardiovascular diseases include a range of diseases that may increase the risk of a severe COVID-19 disease course. There is evidence to suggest that the risk increases with the severity of the underlying disease. In studies that adjust for age and other risk conditions, including other cardiovascular diseases, high blood pressure does not appear to be an independent risk factor for hospitalisation or death from COVID-19.

Other chronic diseases

A number of studies suggest that dementia and stroke are independent risk factors for a severe COVID-19 disease course

Nursing home residents

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

Children and adolescents in risk groups

Children and adolescents appear to develop mild illness, even those with chronic conditions. As vaccination coverage increases in the adult population, transmission among children and adolescents will become less common because there will be less infection in circulation. This has already been seen in countries that have come further in the vaccination rollout, such as the UK, the USA and Israel. 

For children and adolescents in the 12-17 year age group, there may be some groups where with an indication for a vaccine against COVID-19 when it becomes available. It has not yet been opened up for vaccination of healthy children and young people who are close contacts with people in risk groups.

For more information about these groups and about COVID-19 in children and adolescents, see:

Pregnant and breastfeeding women

Most pregnant women will get a mild disease course. Pregnant women with COVID-19 who develop symptoms still have a slightly higher risk of needing treatment in hospital, intensive care unit and with a respirator compared with non-pregnant women with COVID-19 of the same age.

The risk of severe COVID-19 progression increases if the pregnant woman has underlying diseases such as diabetes, cardiovascular disease and / or obesity.

Employees in risk groups who are not vaccinated or have not had COVID-19

In some situations, workplace adjustment should be considered for employees who are at greater risk of a severe COVID-19 disease course. With widespread transmission in the community, this will also apply to people with a moderately increased risk. With widespread transmission, sick leave should be considered for people at moderate or high 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 ill, they should contact their doctor for advice about medication, testing and examination.

What should you do if you become ill?

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 general condition, contact your GP 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.

General advice for relatives

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.
  • If you live with someone who is at risk and you have symptoms of a respiratory tract infection or do not feel well, limit the time you spend together and arrange to be tested for SARS-CoV-2. If possible, you should live and sleep in separate rooms, and use a separate bathroom/toilet. If this is not possible, it is important to keep your distance from them and to use separate towels in the bathroom/toilet and separate toiletries. See When you are sick or suspect that you have COVID-19 disease.

Advice for people in risk groups who are vaccinated or have had COVID-19

When people in risk groups have been vaccinated, they will be at lower risk of SARS-CoV-2 disease and a severe disease course and will be able to live as other people and follow the general infection control advice. The full effect of the vaccine is achieved 1 week after full vaccination. So far it has been shown that protection lasts for at least half a year, but it probably lasts much longer. If the protection decreases over time, booster doses may be necessary. Since the COVID-19 vaccine prevents disease, it will also prevent transmission. 

Vaccination advice will be updated on an ongoing basis, see:

The Norwegian Institute of Public Health has recommended that people in risk groups should be given an influenza vaccine every year and a pneumococcal vaccine (against a bacterium which can cause pneumonia, among other things) every ten years. It is important to stress that these vaccines will not prevent infection with SARS-CoV-2.

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

26.07.2021: Added sentence about "It has not been opened up for vaccination of healthy children and young people who are close contacts with people in risk groups".

02.06.2021: Changed age limit for which groups of children / adolescents should be offered vaccination. Updated advice and links for vaccinated people in the risk group.

02.06.2021: Updated section about children and vaccines.

12.05.2021: Updated and clarified prioritisation of people with diabetes for vaccination.

04.05.2021: Added further information about the risk of severe COVID-19 in adults with Down's syndrome

29.04.2021: Down's syndrome has now been changed to a separate group under Groups with moderate / high risk. An in-depth description of Neurological diseases or muscle diseases that cause impaired coughing power or lung function. Inserted a new section about pregnant and breastfeeding women.

19.03.2021: Removed cystic fibrosis as an example under chronic lung diseases.

10.03.2021 New text about active cancer, cerebral palsy, Down's syndrome and vaccination 

17.02.2021 Changed age for groups with light/moderate risk from 65-79 to 65-69 years. Changed age for groups with moderate/high risk from 80 years and over to 70 years and over. Added footnote about exponential increase in risk from 70 years and over.

01.02.2021 Changed name from Assessment to further information about risk groups. New text about organ transplants, immune deficiency, including people with sickle cell anemia, cancer, immunosuppressive therapy for autoimmune diseases, and clarification that the risk of Down's syndrome applies to adults (> 18 years)

26.01.2021 Linguistic changes and updated links. Given differentiated advice to fully vaccinated vs. unvaccinated persons in risk groups. Updated definition of asthma: severe asthma that has resulted in the use of high-dose inhaled steroids or steroid tablets in the past year.

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.