Deeper Dive - Group 4

Group 4 – Adults at High Risk for Exposure and Increased Risk of Severe Illness

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COVID-19 Vaccinations: Your best shot at stopping COVID-19

A tested, safe and effective vaccine will be available to all who want it, but supplies will be limited at first. To save lives and slow the spread of COVID-19, independent state and federal public health advisory committees recommend first protecting health care workers caring for patients with COVID-19, people who are at the highest risk of being hospitalized or dying and those at high risk of exposure to COVID-19. Our goal is to vaccinate as many people as possible given the limited supply of vaccines.

Keep practicing the 3 Ws— wear a mask, wait six feet apart, wash your hands—until everyone has a chance to get vaccinated.


4. Adults at High Risk for Exposure and Increased Risk of Severe Illness


Group 4: The goal is to protect those at increased risk of being hospitalized or dying from COVID-19, those at increased risk of exposure and those in essential roles during the pandemic.

Group 4 includes anyone 16-64 years old with one or more high-risk medical conditions for severe disease from COVID-19, people living in close group settings and essential workers. (Please note these are different from Group 3 frontline essential workers.)



This population includes anyone with conditions that have been identified by the CDC as increasing risk for severe COVID-19 illness. The CDC may update the list of high-risk conditions as scientists learn more about COVID-19. NCDHHS will update the list accordingly:

  • Asthma (moderate to severe)
  • Cancer
  • Cerebrovascular disease or history of stroke 
  • Chronic kidney disease 
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Cystic fibrosis
  • Dementia or other neurologic condition 
  • Diabetes type 1 or 2 
  • Down Syndrome 
  • A heart condition such as heart failure, coronary artery disease, cardiomyopathy
  • Hypertension or high blood pressure 
  • Immunocompromised state (weakened immune system) from: immune deficiencies, HIV, taking chronic steroids or other immune weakening medicines, history of solid organ blood or bone marrow transplant
  • Liver disease, including hepatitis 
  • Pulmonary fibrosis
  • Overweight or obesity  
  • Pregnancy 
  • Sickle cell disease (not including sickle cell trait) or thalassemia 
  • Smoking (current or former, defined as having smoked at least 100 cigarettes in their lifetime)



This population includes anyone who is living in congregate or close group living settings who is not already vaccinated due to age, medical condition or job function, including:

  • Homeless shelter
  • Correctional facility, such as jail or prison



Essential workers include:

  • Those working in the essential sectors identified in Group 3 who did not meet the criteria for frontline. Essential sectors identified in Group 3 include critical manufacturing, education, essential goods, food and agriculture, government and community services, health care and public health, public safety and transportation. See Deeper Dive Group 3.
    • Those working in additional essential sectors as defined below.
    • Chemical (including workers in petrochemical plants, agricultural chemicals, pharmaceutical facilities, consumer products)
    • Commercial facilities (including retail workers, hotel workers)
    • Communications and information technology (including news reporters and staff, service repair dispatchers, data center operators)
    • Defense industrial base (including workers supporting essential services to meet national security commitments)
    • Energy (including electric, petroleum, natural and propane gas workers)
    • Financial services (including workers who maintain systems for processing financial transactions, workers needed to provide consumer access to banking and lending services)
    • Hazardous materials (including nuclear facilities workers, workers managing medical waste)
    • Hygiene products and services (including laundromats, sanitation workers)
    • Public works and infrastructure support services (including plumbers, electricians, exterminators, workers supporting parks)
    • Residential facilities, housing and real estate
    • Water and wastewater (including staff at water authorities, wastewater treatment facilities, water sampling and monitoring)


The essential sectors and workers, as categorized by Cybersecurity and Infrastructure Security Agency (CISA), align with federal prioritization guidance from the Centers for Disease Control and Preventions’ Advisory Committee on Immunization Practices (ACIP) recommendations.

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