Should Gov. Ivey Loosen COVID-19 Restrictions? Not Yet, Retired UAB Public Health Professor Says

Dr. Frank Franklin is a retired epidemiologist and pediatrician, now a professor emeritus of public health at UAB. (Source: UAB)

If Dr. Frank Franklin had the opportunity to tell Gov. Kay Ivey what she should do about loosening restrictions on businesses and other public places, his advice would be simple: Don’t, at least not quite yet.

The retired epidemiologist and pediatrician, now a professor emeritus of public health at UAB, is not convinced that the spread of the COVID-19 virus is under control in Alabama or neighboring states — three of which are already relaxing restrictions on reopening businesses and public spaces — and doesn’t want to see the progress made so far reversed.

Instead, Franklin is hoping that Ivey will announce on Tuesday that the state will stay the course for now but revisit the situation on a weekly basis, keeping transparency in the process at the forefront.

“I think Ivey could be a very straight communicator if she could do those few things of saying, ‘This is what we need to do, this is where we stand on doing it, we want to move in that direction as quickly as possible, and we don’t want to be the state that infects the entire United States,’” Franklin told BirminghamWatch on Monday.

“There’s going to be intense pressure because Florida is opening, Georgia is open, Tennessee is open. So every one of our business people is whispering in her ear that at every one of those borders, we’re going to lose money, like we do for the lottery,” Franklin said. “Every business in Phenix City, in Ardmore, … in Huntsville, and in Dothan is going to say, ‘Why should we stay closed when people are going over to Georgia or Tennessee or Florida to go to dinner, and they’re coming back over here?’ And that puts us in a very challenging position.”

Alabamians may become susceptible to increased COVID-19 infection by traveling to those states. as well, especially because of health issues that many of the state’s poor suffer from more than most other states. Franklin cites data presented in The Economist, the London-based weekly newspaper that focuses on international business.

“The South, because we have so many poor people, and so many poor African Americans, with so much chronic disease … probably one out of every seven adults has diabetes in this state,” Franklin said. “Even though we generally don’t have many metro areas … we’re going to have a higher case fatality rate than anywhere else in the country. So not only is it (COVID-19) going to come back if Georgia falls apart, it’s going to wipe out a lot of people … who have a lot of other conditions and don’t have access to good health care.”

Franklin said that the main thing Alabama health officials need straight away is more testing for COVID-19. That opinion is shared by virtually all business stakeholders, government officials and the medical community in the state.

“In Alabama, we’re doing about a third of the testing that needs to be done. The people who need to get it done are clinical cases, people in health care who have patient contact, obviously, and people who work in service industries, where they really are confronting the public all the time,” he added.

When someone in one of those fields tests positive, public health officials face the challenging task of contract tracing — finding out who the positive subject had contact with in the previous few days. “Each has contact with 10 people on average, so then you have to test the contacts,” Franklin said. “At a minimum, we’re short on the testing of those coming back to work. And we’re far away from being able to find out what the rate (of infection) is in the general public.”

An additional problem lies in the quality those performing and processing the two kinds of tests: the common initial PCR test that checks for the presence of the coronavirus, and the second that checks for COVID-19 antibodies that indicate a test subject had the virus in the past. That test may also indicate whether the subject has built an immunity to COVID-19, but it’s not 100% certain. The antibody test is more commonly given to those returning to workplaces.)

“I wouldn’t swear by it. But if it’s right 90% of the time, though, that’s pretty damn good,” Franklin said. “The challenge for people is that you have no idea of the quality of the antibody test you’re getting done. Some of them are terrible. And as far as which lab is doing the test and where, it’s impossible to find out.”

Franklin is critical of the Alabama Small Business Commission, which has pushed for reopening restaurants, personal care providers and similar businesses sooner rather than later.

“The recommendations by the Small Business Commission about two weeks ago were absurd. They were saying we could have restaurants reopen and could have social distancing six feet between the table, but as many as six people at the table. And then they said you could put up a physical barrier between tables. … There was no plan other than checking for a fever, and no plan to test employees. I wouldn’t go to any sit-down restaurant in Alabama until they start doing that,” he said.

Franklin believes Ivey has a good shot at finding support for her decision Tuesday, whichever direction it takes.

“I think Ivey is good. I think she’s speaking the right things. There’s all those pressures on her, but I think if she’s a good communicator, she’ll keep everybody at bay. She’s not going to be saying we’re going to close until July 1 or June 15. We’re going to go week by week, and then we’re going to react by what the day shows us.”

Franklin’s career has included research and teaching stints at Johns Hopkins University (which is the de facto worldwide statistician for the COVID-19 pandemic) and Harvard as well as UAB. He was awarded his Ph.D. from MIT and his M.D. from the University of Maryland.