Rapid review of public health guidance on protective measures for vulnerable groups in the context of COVID-19 [v56.0]

 A variety of protective measures are being taken to protect vulnerable groups who are at high risk of severe illness from COVID-19 in all countries included in this review. In general, people who are considered vulnerable to more severe illness are those that are of an older age, with chronic conditions if not well-managed or are in receipt of therapies that weaken the immune system. \n Belgium, Canada, Finland, Germany, Sweden, England, Switzerland, and Wales have a single grouping for vulnerable people. Australia, Northern Ireland, Norway and Scotland distinguish between those considered at ‘highest risk’ and those at ‘increased risk’. Denmark stratifies according to age groups and the US stratifies according to the certainty in the evidence underpinning each risk group. \n Some countries have published additional risk factors that increase risk, although these do not always necessitate inclusion in the vulnerable group category. These risk factors include ethnicity, smoking, high BMI and pregnancy in conjunction with another condition. \n Since 1 April, Switzerland has added adults with Trisomy 21 to the high risk groups while cancer was removed. \n Advice for vulnerable groups typically includes stay at home, practice hand hygiene, physical distancing and avoid contact with others. Northern Ireland and Scotland have joined England and Wales in advising those previously shielding that it is safe to return to the workplace and educational institutions in-person. \n Advice in England, Northern Ireland, Norway, Scotland and Wales for those who are fully vaccinated is to continue to follow public health guidance, however advice for those fully vaccinated is being eased by the CDC and in Ireland, Denmark and Switzerland. \n Ireland advises those who are fully vaccinated that they may visit indoors with one other household who also has full protection. While in Denmark, people at higher risk and fully vaccinated can have physical contact with close friends and family, participate in activities with several people and use public transport outside of off-peak times. In addition, HCWs who are medically vulnerable will need to continue to avoid work related tasks which may put them at risk regardless of vaccination status. Switzerland has announced that those at high risk and fully vaccinated are advised that their employer is no longer obliged to take steps to provide additional protection in the workplace. The CDC advises grandparents who are fully vaccinated that they can have contact with their family even if they are not fully vaccinated provided none of the unvaccinated family members are at risk of severe COVID-19. \n The updated ECDC rapid risk assessment on 15 February 2021 reported that the risk associated with further spread of the SARS-CoV-2 variants of concern (VOCs) in the EU/EEA are currently assessed as high to very high for the overall population and very high for vulnerable individuals.

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