Risk groups for severe coronavirus disease

Age is the most significant risk factor for severe coronavirus disease. The risk of severe coronavirus disease increases significantly after the 70th year of life, even if the person has no underlying illnesses.
Certain underlying illnesses increase the risk of contracting severe coronavirus disease, leading to hospitalisation and intensive care, or death from the disease.
Based on a medical evaluation of risk, THL has produced a list of illnesses and conditions that can expose a person to severe coronavirus disease. 

• Risk groups of those aged 12 and over
• Risk groups of those aged 6 months to 11 years

Risk groups of those aged 12 and over

Organ transplant or stem cell transplant

The group comprises persons 

• waiting for organ transplantation or who have had organ transplantation 
• who have had transplantation of stem cells within a maximum of three years 
• who uses anti-rejection medication due to stem cell transplantation, regardless of the time of the stem cell transplantation. 

Cancer that weakens the immune system, people undergoing active cancer treatment or follow-up

The group includes those with a cancer that strongly impairs the function of the immune system. These include some types of leukaemia and lymphoma. The group also includes those whose cancer is treated in a way that strongly weakens their immune defence.

In addition, the group includes persons receiving cancer therapy or follow-up care for any cancer.

Severe and moderate disorders of the immune system 

This group includes 

• people with severe inherited immunodeficiency or lowered resistance due to another reason
• persons who have had their spleen removed
• HIV-positive persons with a CD4 helper cell level of less than 0.350 x 109 cells/l
• persons whose rare diseases affect immune defence.

In this risk group, the condition itself causes an abnormal immune response. 

The group does not include mild abnormalities common in general population, such as IgA deficiency, deficiency of mannose-binding lectin or partial deficiency of complement factor C4. 

Immunosuppressive drug therapy for autoimmune disease

This group includes, for example, ankylosing spondylitis, rheumatoid arthritis, ulcerative colitis, Crohn disease and psoriasis, if the disease is treated with 

• glucocorticoid tablets taken by mouth
• biological drugs or other immunosuppressants
• chemotherapy.

Severe chronic renal disease 

This group includes, for example, people with 

• renal disease requiring dialysis
• glomerular disease
• renal failure related to hypertension or diabetes,
• other chronic renal failure. 

Severe chronic pulmonary disease, asthma requiring continuous medication 

This group includes, for example, chronic obstructive pulmonary disease (COPD), pulmonary emphysema, bronchial dilatation, chronic bronchitis and cystic fibrosis.

This group also includes asthma patients on continuous medication and people with asthma who have taken corticosteroid tablets by mouth during the past year.

The group also includes people with clearly decreased lung capacity (e.g. people with one lung).  

Neurological illness or condition that affects breathing

The group includes, for example, patients with stroke, cerebral hemorrhage, respiratory paralysis, Parkinson disease, multiple sclerosis (MS), cerebral palsy (CP) and other stroke syndromes that affect breathing.

Epilepsy

This group includes all people with epilepsy.

Down syndrome

This group includes people with Down syndrome. 

Type 1 diabetes or adrenal insufficiency, type 2 diabetes with medication 

This group includes insulin-treated type 1 diabetes and adrenal insufficiency. 
This group also includes type 2 diabetes requiring medication. High blood glucose is known to increase susceptibility to infection. Type 2 diabetes is often associated with obesity, which in turn also increases the risk of severe coronavirus disease.

Severe heart disease

The diseases of this group include heart failure, pulmonary heart disease, pulmonary circulation diseases, cardiomyopathy and coronary artery disease. 

This group also includes atrial fibrillation, valvular heart disease and Marfan syndrome.
However, the group does not include people with only hypertension or a cardiac pacemaker.

Severe chronic liver disease

The diseases in this group include for example liver failure, fibrosis and cirrhosis of the liver. 

Other chronic metabolic disease

The group includes, for example, chronic alpha-antitrypsin deficiency or hereditary angioedema.

Sleep apnoea  

The group includes persons diagnosed with a moderate to severe sleep apnoea disease. A person has moderate sleep apnoea when there are over 15 pauses in breathing or episodes of hypopnea per hour. A person has severe sleep apnoea when there are over 30 pauses in breathing or episodes of hypopnea per hour.  
Sleep apnoea (Terveyskirjasto, in Finnish)

Psychosis 

This group includes schizophrenia, schizotypal disorder and delusional disorders. The group also includes people who have any type of mental disorder treated with clozapine.

Morbid obesity 

The group comprises persons aged 16 or over with a BMI of 40 or higher and persons aged 12 to 15 with an ISO-BMI of 35 or higher. 
Children's body mass index (ISO-BMI) calculator (Terveyskirjasto, in Finnish)

Pregnancy

The group includes all who are pregnant. 
Covid vaccinations while pregnant or breastfeeding (in Finnish)

Other illness or condition that is predisposing to severe COVID-19 as assessed by a physician

According to an assessment by the treating physician, some other condition or illness can also make one more predisposed to severe COVID-19. These may include for example long-term physical inactivity or poor nutritional condition, which impair the functional capacity of the body.

Risk groups of those aged 6 months to 11 years

The at-risk group listing of those aged 6 months to 11 years differs somewhat from the at-risk group listing for those aged 12 and over.

For children, the risk of a severe case of coronavirus disease is low. However, there are children whose illness or state of health can enhance the risk of a severe disease. A coronavirus infection can also exacerbate the symptoms of underlying illnesses.

Most of the illnesses or conditions listed below are very rare, and in such a case, the child will be under supervision of specialised health care. The attending specialist physician can best evaluate, whether the child benefits from the vaccination.

The list is exemplary. Other similar, serious chronic diseases may also predispose them to severe coronavirus disease. Vaccinations may also be offered to other severely ill children after individual evaluation.

Some conditions, such as transplantation, cause severe immune deficiency, in which case the child belongs to this group.
Coronavirus vaccines for severely immunocompromised persons (in Finnish)

Moderate immunosuppressive treatment and immunodeficiency

This group may include children receiving treatment that suppresses their immune system. Such treatments include some of the treatments for juvenile arthritis, bowel or neurological diseases, such as cortisone therapy, biological medicines and other immunosuppressants.

In addition, the group includes HIV-positive children with a CD4 helper cell level of less than 350 x 10E6 cells /l. 

Obesity

This group includes children with an ISO-BMI of 30 or higher.
The body mass index for children (ISO-BMI) takes into account the proportions of a child's body and the changes that they undergo with growth and age. Calculating the ISO-BMI index is based on age, height, and weight:
Children's body mass index (ISO-BMI) calculator (in Finnish)

Rare diseases

The group includes children with a rare metabolic disease or other rare disease that affects immune defences or that an attending specialist physician has for some other reason estimated to increase the risk of a severe disease or its complications.

Children in this group fall within specialised health care. The attending specialist physician can best evaluate if the child belongs to a high-risk group.

Severe chronic pulmonary diseases

The group includes the following illnesses:

• rare severe pulmonary diseases 
• children's pulmonary and muscle diseases requiring ventilation support or supplementary oxygen treatment
• a pulmonary disease linked with an elevated pulmonary vascular resistance (pulmonary hypertension) 
• a significantly lowered expulsion of mucus from the lungs (severe bronchiectasis or primary ciliary dyskinesia)

Children in this group fall within specialised health care.

This group does not include for example children with asthma.

Severe cardiac illnesses 

The group includes the following illnesses:

• heart failure 
• pulmonary hypertension 
• cyanotic tetralogy of Fallot (TOF) not treated by surgery.

This group also includes children whose pulmonary circulation is dependent on a shunt (BT-shunt, RV-PA shunt).

Mild valvular defects and heart murmurs requiring observation, which have not caused heart failure or pulmonary hypertension, are examples of conditions not included in this group.

Children in this group fall within specialised health care. The attending specialist physician can best evaluate if the child belongs to a high-risk group. 

Chronic renal disease 

The group includes, but is not limited to, children who have 

• renal disease requiring dialysis
• glomerular disease
• renal damage related to hypertension or diabetes
• other prolonged renal insufficiency. 

Children in this group fall within specialised health care. The attending specialist physician can best evaluate if the child belongs to a high-risk group. 

Severe renal disease and dialysis treatment count as conditions causing severe immunodeficiency.

Severe chronic liver disease

The group includes the following illnesses:

• heart failure 
• pulmonary hypertension 
• cyanotic tetralogy of Fallot (TOF) not treated by surgery.

This group also includes children whose pulmonary circulation is dependent on a shunt (BT-shunt, RV-PA shunt).

Children in this group fall within specialised health care. The attending specialist physician can best evaluate if the child belongs to a high-risk group. 

Mild valvular defects and heart murmurs requiring observation, which have not caused heart failure or pulmonary hypertension, are examples of conditions not included in this group.

Chronic renal disease 

The group includes, but is not limited to, children who have 

• renal disease requiring dialysis
• glomerular disease
• renal failure related to hypertension or diabetes
• other chronic renal insufficiency. 

Children in this group fall within specialised health care. The attending specialist physician can best evaluate if the child belongs to a high-risk group. 

Severe chronic liver disease

The illnesses in this group include for example

• hepatic failure
• hepatic fibrosis 
• cirrhosis of the liver. 

Children in this group fall within specialised health care. The attending specialist physician can best evaluate if the child belongs to a high-risk group. 

Neurological diseases causing respiratory insufficiency or increased susceptibility to infection

The group includes paediatric neurology patients with respiratory insufficiency, and/or increased sensitivity to infections. 

All children cared for in institutions for the developmentally disabled are part of this risk group.

The group does not include other paediatric neurology patients, such as those suffering from headaches, epilepsy, or ADD/ADHD.

The children in this group usually fall within specialised health care. The attending specialist physician can best evaluate if the child belongs to a high-risk group. 

Down's syndrome

The group includes children who have Down's syndrome.

References

Cariou B, Hadjadj S, Wargny, ym. Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study. Diabetologia 2020.

Clift AK, Coupland CAC, Keogh RH, ym. COVID-19 Mortality Risk in Down Syndrome: Results From a Cohort Study Of 8 Million Adults. Ann Intern Med . 2020 Oct 21;(October):M20-4986. Available from: 

Goodall JW, Reed TAN, Ardissino M, ym. Risk factors for severe disease in patients admitted with COVID-19 to a hospital in London, England: a retrospective cohort study. Epidemiol Infect. 2020 Oct 13;148:e251. doi: 10.1017/S0950268820002472.

Gianfrancesco M, Hyrich KL, Al-Adely S, ym. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2020;79:859–866.

Petrilli CM, Jones SA, Yang J,ym.  Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020 May 22;369:m1966. doi: 10.1136/bmj.m1966. 

Reilev M, Kristensen KB, Pottegård A, ym. Characteristics and predictors of hospitalization and death in the first 11 122 cases with a positive RT-PCR test for SARS-CoV-2 in Denmark: a nationwide cohort. Int J Epidemiol. 2020 Sep 5:dyaa140. doi: 10.1093/ije/dyaa140.

Williamson EJ, Walker AJ, Bhaskaran K,ym.  Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020 Aug;584(7821):430-436. doi: 10.1038/s41586-020-2521-4. Epub 2020 Jul 8.