With a back-to-school shuffle like none before, students and their families should be extra vigilant on their health, said Lincoln Medical Partners pediatrician Dr. Melissa Keeport. Attention to masks and vaccines for the youngest students will be especially important in school and for the entire community, said Keeport.

“Younger kids are having higher viral loads … and they often have no symptoms. If they were distanced outside without a mask, that's fine, but indoors? Considering kids are not naturally good at staying six feet apart, it's definitely a risk to everyone.”

Keeport said pediatricians know it will be no small task to get kids in the habit of keeping a mask on and socially distancing. Teachers, parents and older students will have to model the right behaviors: Wearing the mask, helping students and gently reminding them when they forget or take their masks off.

“There are also such a wide range of masks available and there are some that work way better and ones that don't work well at all. So, getting an appropriately fitting one … and something with a cool fabric that they choose themselves really makes a difference.”

Modeling will be especially important for special needs students. For example, many nonverbal kids will not be able to report symptoms as often as a typically developing child and many special needs students will be considered high risk, said Keeport. Often, a rewards system and constant positive reinforcement will be the best tools for helping these students mask up and distance themselves.

Comorbidities associated with COVID-19 related deaths are respiratory disease, obesity, cardiovascular disease, hypertension, kidney disease, sickle cell disease, cancer, COPD, liver disease, cystic fibrosis and general neurological and immunocompromised conditions.

“I worry about these kids more because they may not be able to report symptoms … (and) some of them may not understand why they have to have this on their face. But I think a lot of kids really do respond … if they see other kids wearing it and their teachers wearing it.”

Because some people are high risk, it will be especially important for students to be caught up on their vaccinations, Keeport said. Most COVID-19 related deaths are associated with a comorbidity, an underlying health issue exacerbated by the virus. For example, the elder population has suffered far more than other age groups because older people generally have more health issues, she said.

Keeport said vaccinated children are far less likely to catch and spread diseases. Exposure to commonly vaccinated diseases puts high risk people in peril even without considering COVID-19, said Keeport. It is unthinkable what a high risk person exposed to nearly eradicated viruses and COVID-19 would face, Keeport added.

The Centers for Disease Control recommend and Maine law requires the following vaccines before the first year of school: chickenpox (varicella); diphtheria, tetanus and pertussis (DtaP or TDaP); measles, mumps and rubella (MMR); and poliomyelitis (polio). Learn more at: https://www.cdc.gov/vaccines/growing/school-vaccinations.html

“The risk (by not vaccinating) really is that you're putting yourself and your community at risk. We recommend everyone follow CDC guidelines on vaccines. We’ve always encouraged flu vaccination. Distinguishing between COVID-19 and the flu is going to be difficult because the only way to ... before acute symptoms are presented is to test for both, said Keeport. However, she said she has reason to believe that due to isolation and decreased travel, the flu is being reported far less than the medical community would expect.

“By this time of year, we're already seeing the flu in the southern hemisphere, but there's been so little travel that it might not be spreading up here as much as it traditionally has.”

Resurgence of typical maladies like common cold, norovirus or viral gastroenteritis are not any likelier due to the last six months of quarantining because they are not something we vaccinate for, said Keeport. She added quarantining in general should not affect the immune system and children will likely not get as sick as often due the precautions being taken at school for COVID-19.

“… Once we have a COVID vaccine and (an infection rate) of around 1%, I think there's definitely something to be learned about hygiene and mask wearing … Going back to school, we can't eliminate risk, but we can mitigate it as much as possible. We are being flexible as we follow the science. As things evolve we need to respond ... All that being said, kids will adapt and they are super resilient, so they will do well with all of this.”