A Pediatric Infectious Disease Specialist on Back to School and COVID-19

Dr. Bishara Freij discusses masking, vaccines, and other ways to protect students
back to school - COVID-19 pandemic
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In just a few weeks, many Michigan students will return to completely in-person schooling for the first time since March of 2020. The Michigan Department of Health and Human Services announced its updated guidance for schools on Aug. 2, indicating that while the state will recommend vaccines and masking, it will stop short of mandating either measure.

We spoke with Dr. Bishara Freij, a pediatric infectious disease specialist with Beaumont Health System, to get his recommendations as kids and teens head back to school.

Hour Detroit: As of last week, more than 30 Michigan counties, including Oakland and Wayne, reported substantial COVID-19 transmission rates. In light of this, do you think moving forward with a return to in-person schooling is a mistake?

Dr. Bishara Freij: No, I don’t. Last year created a lot of problems for students. There [were] much higher incidences of depression…around the country. A lot of students suffered in terms of their education — a lot of children don’t do well with virtual schooling. Last year was almost like an educational loss across the country, and we can’t keep perpetuating this since we have means of preventing and minimizing infections. I think that people should proceed [with in-person schooling] and then manage the risk accordingly.

Should students be wearing masks while in school even if they’re fully vaccinated?

Yes, absolutely. I think we know that vaccination primarily prevents severe disease; it reduces your risk of getting infected quite dramatically, but it doesn’t protect you 100 percent from infection. So [if a vaccinated person contracts COVID], they may not get very sick. However, they can actually do harm in two ways: by possibly spreading it to some contacts who are unimmunized…and by allowing the virus to infect and replicate, potentially setting the stage for new variants to emerge.

The 12-15 age group has the lowest vaccination rate of any eligible group in Michigan — fewer than 30 percent of kids in this demographic are fully vaccinated. Why are parents so hesitant to vaccinate their kids and teens, and are their reasons justified?

The perception that it’s not as bad of a disease in that age group is one reason [for vaccine hesitancy]. [Parents think] ‘Why should I vaccinate my kids who are not going to get that sick?’ This idea really permeates a lot of parents’ decisions, and it’s a faulty one, because they forget that we’re all in this together. If some of us are not protected, then most of us are not protected.

The other thing [that’s causing hesitancy] is this issue with vaccine-associated heart and muscle inflammation, myocarditis, which is quite rare but has received a lot of attention. Unfortunately, people forget that it’s rare, it’s transient, and it’s mild. All [affected children] need is time and Motrin, and they’re fine. But this has led a lot of parents to kind of back off and a lot of pediatricians have backed off [from promoting the vaccine].

Would you support a vaccine mandate for all eligible Michigan students?

Absolutely. I think we are in a situation where personal choice cannot trump public health. People talk about personal freedom — and yes, we have a lot more personal freedoms here than in many parts of the world — however, you don’t have the personal freedom, for example, to not pay your federal taxes. You don’t have the personal freedom to drive 100 miles per hour on Woodward and not face consequences. There are a lot of restrictions on us, and we follow them, whether we like them or not. This is a situation where the roots of destruction are around us, and we can prevent it. So, I would absolutely support a vaccine mandate in schools.

Are you concerned that young kids, who are not able to get vaccinated yet, may not be capable of keeping masks on and wearing them properly while they’re at school?

From seeing kids in my office, I am amazed — and I’m talking about young kids here, even under 5 — at how good they are about wearing the mask and keeping it on. They can be taught, and I’ve seen ample examples of this. The parents have to teach them the importance of wearing a mask to school, and also, they need to model that with their kids themselves. [Parents need to be] wearing masks when they are out and about, going to Kroger, or whatever they’re doing, so the kids can learn this.

What other preventative behaviors can parents teach their kids to minimize the risk of infection?

Simple behaviors like hand washing and sneezing etiquette. They can learn these things quite well, but [parents] need to model them. At school, practice social distance whenever feasible. There’s no one measure that’s going to solve the problem — it’s got to be a combination of things all together. Each intervention helps a little.

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