Briefing – people at high and special risk of infection

infection

This briefing looks at the risks associated with Covid infection, the conditions (both physical and environmental) which may place some groups of people more at risk, and what can be done to reduce that risk. Download the briefing here.

What are the risks associated with a SARS-CoV-2 Infection?

SARS-CoV-2 is the virus which causes Covid-19 disease and on entering the body it can infect, affect and persist in multiple systems within the body (the cardio-vascular system, the brain, and immune systems). Research is discovering more about how this disease can negatively impact the human body.

As we saw early in the pandemic, Covid-19 is a disease that can cause severe respiratory illness, but even in milder initial infections it has been found to cause long-term illness and a higher risk of subsequent ill health and death. Repeated infections increase the risk of ill health and negative outcomes. 

Subsequent and persisting conditions can include:

  • Fatigue
  • Respiratory problems (shortness of breath)
  • Neurological or mental health conditions (such as loss of smell and taste, poor concentration, sleep problems, headaches, dizziness, pin and needles, depression and anxiety) 
  • Digestive and menstrual problems
  • Joint or muscle pain
  • Heart symptoms or conditions (such as chest pain or racing heartbeat)
  • Blood clots and blood vessel (vascular) issues (which can lead to pulmonary embolism, heart attacks and strokes)

Who is at higher risk?

The risk of death and long-term illness has been seen from the statistics to often increase with age, but there are other factors that may also place someone at higher risk from infection than another.

Ethnicity

It has been found that ethnic minority groups have suffered higher rates of death from Covid-19 compared with the white British population. This has been highest in the Bangladeshi ethnic group followed by Pakistani and the Black Caribbean and Black African ethnic groups. 
Updating ethnic contrasts in deaths involving the coronavirus (COVID-19), England: 10 January 2022 to 16 February 2022

A number of factors could contribute to this such as lower vaccination take-up in some groups, occupation type and socio-economic factors. Ethnic groups are more likely to work in occupations with a higher risk of virus exposure: Bangladeshi and Pakistani groups are more likely to work in retail and hospitality, and Black African and Black Caribbean groups often work in health and social care roles. However, even when these factors were taken into account and adjusted for, statistically ethnic groups still appear to have higher rates of death involving Covid-19. 

Existing health conditions

Existing health conditions which impair the immune system or organ function can place someone at higher risk of becoming more seriously ill from Covid-19. This can include people receiving treatment for cancer, transplant patients, people suffering from conditions affecting brain or nerves (e.g. multiple sclerosis), and those with autoimmune or inflammatory conditions (e.g. rheumatoid arthritis or inflammatory bowel disease)

NHS Guidance: People who are still at high risk

Other conditions can also increase the risk of developing a more serious illness with Covid-19 such as cardiovascular disease, hypertension, diabetes, obesity, and chronic renal disease. 

Other common diseases such as periodontitis (gum disease) have also been found to be associated with increased Covid-19 complications, though it’s not yet clear whether this association is causal. British Dental Journal/Journal of Dental Research

Pregnancy also increases the risk of a more serious illness from Covid -19 and can cause low birthweight in the baby or premature birth. (NHS: Pregnancy and coronavirus)

So there are many underlying conditions which can increase the risk of a more negative impact from a Covid-19 infection.

Higher risk occupations


The occupations in which people spend more time in close proximity to others and those who are regularly exposed to the virus are at higher risk of infection. Unsurprisingly, occupations most at risk are in dental and medical services, but many other occupations bring people into close contact with others such as education, beauty services, retail, waiting and bar staff (and many others).  Covid-19 is a risk to the employees within these occupations and also a risk to the users of those services.

What measures can help protect people of higher risk and reduce risk? 

There are a range of measures which can be put in place to reduce risk. These can be public health and government-led measures, measures which employers put in place to reduce risk to their staff, and individual measures that we can take to protect ourselves and others. 

Public health measures 

Throughout the Pandemic we have seen a range of public health measures used to control the spread SARS-CoV-2, such as free testing, contact tracing, social distancing requirements, lockdowns, vaccine programmes, financial support for businesses, mask mandates etc. The current Scottish Government advice can be found here: Coronavirus in Scotland

Government and public health policy will determine the measures in place as we move forward through this pandemic and adapt our way of life to be more resilient to current and future viruses. 

There must be continued government and public health action to reduce the risk and impact of Covid-19 within the population. Governments must include in their policies measures which reduce the risk of Covid-19 infection, particularly for those at higher risk.   

The availability of regular vaccine boosters, safer indoor environments and access to antivirals can help make life less dangerous and stressful for those who are at higher risk of an adverse outcome if infected by Covid-19. Antivirals such as Evusheld can provide additional protection for people who are at higher clinical risk and have impaired immunity, and the government is encouraged to make this available.

See our briefing on the public health service we need

Employers and businesses

Employers and business owners are encouraged to take steps to reduce the risk of Covid-19 transmission in their workplaces and venues. This can help reduce staff absences and reduce the risk to others in the wider community. 
Coronavirus (COVID-19): safer workplaces and public settings (as updated 28 September 2022)

Steps can include adaptations and safe management of buildings or vehicles (for transport operators) such as maximising ventilation, regular monitoring of air quality, awareness of occupancy levels, and taking action to improve ventilation and reduce occupancy levels where required (Scottish government guidance on ventilation). In 2021 the Scottish government funded a wide range of businesses to make adaptations to improve ventilation in their buildings, to protect staff and customers and improve their business resilience to the current and future pandemics. This Business Ventilation Fund supported the purchase of CO2 monitors, HEPA air purifiers, adjustments to windows etc.

Employees should be aware of the measures that their employers can put in place to make their workplaces safer.

Measures to improve air quality can help make a venue a safer and more accessible place for those who are at higher clinical risk, many of whom now feel excluded from accessing indoor environments where the occupancy level, lack of masking, and poor air quality would put them at considerably more risk. Adopting a clean air strategy creates a more inclusive environment which improves safety and benefits all.
Dr Sally Witcher Towards an inclusive New Normal

Coronavirus (COVID-19) Adaptations Expert Advisory Group has now been set up with the aim of improving Scotland’s resilience to COVID-19 and other infections by providing recommendations and advice on the adaptations that can be made to our buildings, homes and the spaces around them. This group will also consider the equity and priority of adaptations given what is known about risk factors and the disproportionate impact of Covid-19 on certain groups.

The Scottish Government is due to publish a new set of guidance this year for both building managers and individuals which will advise on the importance of good ventilation and air quality to reduce transmission of disease and for wider health, and will advise on the ways that ventilation and air quality can be improved. 

See our briefing on the importance of clean air in preventing Covid-19

Individual actions

Individuals can take a number of steps to reduce their risk of contracting Covid-19 or passing it on to others, some of which may be limited to an extent by their occupations. 

  • Limiting time in risky environments (indoor environments with high occupancy and poor air quality).  
  • When in risk environments wearing face masks which offer protection to the wearer (such as FFP2 or FFP3 masks). See our briefing on masks
  • Taking up Covid-19 vaccines and boosters. 
  • Supporting our own health and wellbeing (to help the body fight infection). 
  • When meeting others (especially the more vulnerable) carry out a lateral flow test beforehand. Wear a mask if possible. 
  • If you feel at risk, ask for understanding and supportive action from others (friends and family, carers, health professionals etc)
  • Encourage the venues and businesses you access to make clean air adaptations in their buildings. 
  • Demand that governments include within their policies actions which reduce the risks from Covid-19 and other viruses.

Outlook

Covid-19 has claimed over 200,000 lives in the UK since the start of the pandemic (where Covid-19 was mentioned on the death certificate) and infections and re-infections still continue. BBC, Covid-19 in the UK

An estimated 2.3 million people in the UK have experienced long-term symptoms following a Covid-19 infection. Long COVID can be more common in women, people working in social care, those living in deprived areas and those with other health conditions or disability. Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 6 October 2022

For further information on Long Covid see our Long Covid briefing.

In the last week (as at 9 Oct 2022) the virus had caused 274 deaths in the UK and 45 in Scotland, with the number of people admitted to hospital due to Covid-19 infection also increasing over the past week. We saw a rise of cases over the summer months and another wave is expected as we head into winter. Covid-19 is unfortunately not over (the Scottish government has estimated that we are halfway through this pandemic). 

The SARS-CoV-2 virus continues to mutate. There are a number of variants and sub-variants of the virus currently in circulation. Some variants, due to their infectiousness, become more dominant and may cause different symptoms and levels of disease. Some variants are better at vaccine escape. Due to the virus’s ability to rapidly mutate, by the time a new vaccine booster is developed and released newer variants can be in circulation with mutations which enable the virus to escape some of the protection offered by the vaccine. See our briefing on vaccines and variants

We need to ensure that we use all the tools available to us to avoid repeated transmission of Covid-19 and keep ourselves and others safe. For those at higher or special risk accessing services in the community should not be a matter of life or death. We need to avoid Covid ableism. We may all be at higher risk at certain points in our lives or have loved ones we need to protect.

This briefing published under a Creative Commons CC-BY-SA-NC License by Zero Covid Scotland

16 October 2022

Download the briefing here.

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