It’s a milestone that Jan Malcolm hoped to never reach: 10,000 confirmed deaths in Minnesota from COVID-19.
“I can remember when things were looking better in the spring and in the summer, and we hoped we would never see 7,000 deaths or 8,000 deaths, and we’ve just kept going,” said Malcolm, commissioner of the Minnesota Department of Health.
The state reached 10,000 deaths on Wednesday, two days after Malcolm sat down with the Pioneer Press to talk about COVID-19, the political battle she is facing at the Capitol and her racehorse.
“Every death is a tragedy, especially at this point in the pandemic, when it’s so very preventable,” Malcolm said. “I think everybody has gotten kind of desensitized. Ten thousand deaths; we’re coming up on a million total cases — people have lost context, literally.”
Malcolm, 66, of Minneapolis, has been under intense pressure the past few months, with the Republican-controlled state Senate threatening to reject her confirmation in Gov. Tim Walz’s administration. Malcolm, who served as commissioner of health under Gov. Jesse Ventura, has never been confirmed by the Senate since Walz appointed her three years ago.
Malcolm has been targeted because of decisions on vaccines, mask mandates, and business and school closures.
“A lot of the criticism has been about, ‘Boy, this seems like a disproportionate response to shut down business or to shut down schools,’ or ‘The solution is worse than the problem,’ ” she said. “It’s very hard to argue proportionality when there is so much you don’t know about the virus.
“People have to remember what those early months were like – or what last year at this time was like: without vaccines, with the hospitals starting to get massively stressed. The community mitigation was something that we could do that we knew had an effect. In hindsight, you might say, ‘Well, you went too far on that one or that one … or your timing was off by a month.’ ”
Health department officials are “learning all the time,” she said.
“It’s the nature of science. That’s how things happen. Things change as you learn more, but I think people have interpreted that to mean, ‘You guys don’t know what you are talking about because you keep changing the guidance,’ as opposed to ‘That is the natural progress of how science works.’ ”
LEADER IN A CRISIS
Malcolm’s leadership during the pandemic has been “absolutely critical,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy.
“It’s like having the Rock of Gibraltar in your back yard,” he said. “Jan is a brilliant public-health professional with a heart and a soul. To have someone with the breadth of capacity that she has, has really helped instill confidence in the staff and respect in the community. She’s done a really, really remarkable job. I mean, she has an impossible job — it’s like having a shock absorber come at you from five different directions.”
Malcolm and other state Health Department officials got word about the first confirmed case of COVID in Minnesota at 12:40 p.m. March 6, 2020. Within a few hours, Walz, Malcolm and other state officials were holding a news conference in the Governor’s Reception Room at the state Capitol.
Key leaders in state government spent that weekend “working around the clock” to develop plans, said Chris Schmitter, Walz’s chief of staff. “Jan was the backbone of that critical time. She was concerned, but she never gave up her calm focus on moving forward. She knew how many people — in and out of government — were looking to her, and she just kept working, providing guidance and analysis, and modeling how to lead.”
Malcolm soon became one of the most recognized government officials in the state, participating in hundreds of media calls and dozens of news conferences to update Minnesotans on the fight against COVID-19.
Her calm voice during the briefings reassured many, including longtime friend Ann Bancroft.
“That calm is like a salve,” Bancroft said. “I think that’s her secret sauce. I’m not actually interested in the minutiae of COVID, but I enjoy listening to the briefings. The way she presents the information, it’s factual, it’s calm, and you know she’s not messing with you. She’s not playing politics. You just know she’s a straight shooter.”
A TUMOR’S IMPACT
Malcolm grew up in Bloomington and Minnetonka and graduated from Minnetonka High School. When she was 8, doctors found a benign tumor in her right leg. The tumor returned when she was 13, and it was malignant.
“I had to have a very big chunk of my leg taken out,” she said. “My mother almost fainted when she saw the size of the scar. I started crying.”
The surgeon looked at Malcolm and said: “ ‘Well, young lady, you’ll never be Miss America, but you should be grateful you still have your leg,’ ” she said. “Maybe that’s another reason why I wanted to become a doctor: to be nicer than him. He was probably a great surgeon, but his bedside manner left quite a bit to be desired.”
Malcolm went to Dartmouth College in Hanover, N.H., graduating in 1977 — one of the first full graduating classes to include women. Pre-med students were allowed to audit courses at the Geisel School of Medicine at Dartmouth their senior year, and Malcolm said she took full advantage.
“I took Sociology of Medicine, History of Medicine, Biomedical Ethics, Health Policy,” she said. “It was like, ‘Wow, that’s what I’m really interested in.’ ”
After she graduated, Malcolm returned to Minnesota and began working for health-maintenance organizations, including Allina Health System and HealthPartners. She also served on various state commissions.
In 1999, Ventura picked Malcolm to be commissioner of health.
THE ROLE OF PUBLIC HEALTH
“I didn’t know beans about maternal and child health or environmental health or infectious disease, but I fell completely in love with the whole spectrum of public health,” Malcolm said. “Governmental public health has a responsibility that nobody else has: to look at the health of the whole population and to try to do things to improve that … and to attend especially to the inequities in health outcomes. What are the levers that we have to address some of those?”
Pam Wheelock, who served with Malcolm in the Ventura administration, remembers meeting Malcolm for the first time in the Governor’s Reception Room at the beginning of the Ventura administration. Budget talks were underway, and Malcolm, who had not yet officially started her new role, came to make the case for a cigarette-tax increase.
“She came to talk about how wrongheaded we might be to believe that anti-smoking efforts were not effective,” Wheelock said. “She wanted us to invest heavily in anti-smoking measures. (Ventura) was skeptical, and I was generally skeptical of everything, and she knocked my socks off. She was so impressive, so thoughtful, so knowledgeable, so articulate. I just thought, ‘I am going to love working with her,’ and I did.”
After her stint as health commissioner ended, Malcolm went to work as a senior program officer for the Robert Wood Johnson Foundation, where she helped develop initiatives to strengthen the nation’s public-health system. From 2005 to 2013, she served as CEO of Courage Center in Golden Valley and oversaw its merger with Sister Kenny Rehabilitation Institute, which was part of Allina Health System.
Malcolm was working as vice president of public affairs and philanthropy at Allina Health when Gov. Mark Dayton asked her in early 2018 to again lead the health department. She replaced Dr. Ed Ehlinger, who resigned amid the fallout of the state’s failure to address maltreatment complaints.
In 2019, Walz asked her to continue in her role.
If not for the pandemic, Malcolm said she might have considered retiring this year. “But I very much hope to continue serving,” she said. “It’s not all up to me, obviously.”
IN THE CROSSHAIRS
During a rally against vaccine and mask mandates in August at the Minnesota Capitol, Sen. Jim Abeler, R-Anoka, said Senate Republicans should oust Malcolm as commissioner. Abeler, who along with other Republicans has been critical of Walz’s emergency powers and public health restrictions during the coronavirus pandemic, said it “seems the only language the governor understands is the removal of another commissioner.”
Senate Republicans, citing various motivations, have previously derailed three of Walz’s Cabinet members: Commerce Commissioner Steve Kelley; Nancy Leppink, the commissioner of the Department of Labor and Industry; and Minnesota Pollution Control Agency Commissioner Laura Bishop.
Abeler on Wednesday called that old news and explained that Senate Republicans simply wanted the administration to “find out the truth” about whether the COVID-19 vaccines are “safe and effective.”
He said he and his fellow Republicans are “not brainstorming to see Jan go … I admire her.” But he said he wants health department officials and especially Walz to respond to their questions about the administration’s pandemic policies.
“It’s on him,” Abeler said. “He has failed to engage with us. I’m not anti-vaccination; I’m pro-informed consent.”
A ‘SURPRISING’ ROADBLOCK
Malcolm said the “level of hesitancy” around COVID vaccinations has been “surprising and distressing.”
“There is just something different about COVID,” she said. “It’s just got this dimension to it that is really concerning, especially from our perspective, when the data are so abundantly clear on how effective and overwhelmingly safe they are. That doesn’t mean there aren’t adverse reactions, but the odds are so disproportionate that you would think that people would not want to take the risk of getting really sick.”
Combatting vaccine “misinformation and disinformation” on social media has been especially difficult, she said.
“There is no agreed-upon source of truth,” she said. “We don’t have (news anchor) Walter Cronkite saying, ‘That’s the way it is.’ It’s just so easy to find something that looks like a credible validation for anything that you are inclined to believe. The fact that we just don’t even have a common set of facts that we agree upon makes it hard to talk to each other or try to respond effectively to those beliefs that, from my point of view, are just not at all credible, but they are credible to those people, so how do you bridge that gap? I don’t know.”
Health officials are used to saying, “these are the health facts, and this is the health guidance, and people have understood that and believed that and generally followed that public-health guidance to a great degree,” she said. “This has just been such a different experience.”
Malcolm said it makes her “blood absolutely boil” when she hears stories about how health care providers have been treated by their patients or their patients’ families “who still don’t believe they have COVID,” she said. “It’s tragic the stuff that people are getting subjected to — our public-health staff around the state included.”
The doctors and nurses around the state “really are heroes,” she said. “We’ll never be able to thank them enough. What keeps them going is a commitment to service. Most people don’t have a clue how hard they have been working.
“We know it’s been hard for everybody,” she said. “It’s been hard for parents and teachers and businesses and everyone. We’re not saying anyone has had a cake-walk of it, but that daily pressure is something that I think has been experienced by some parts of our community more than others.”
LIFE TOUCHED BY GRIEF
Pre-pandemic, Malcolm’s hobbies included gardening, playing golf and boating. She has a tawny rescue cat named Leo, whom she inherited after her mother died last fall. She also is part-owner, along with her sister, of a racehorse named Big Boy McCoy.
“I have never been on a horse I haven’t fallen off of, or almost,” Malcolm said. “His name is Big Boy McCoy because he’s a big boy. He has yet to win a race, but he’s sweet.”
Malcolm met her wife, Kris Carlton, in 1983 when their two employers merged. After 29 years as partners, the couple got married in the fall of 2013, just months after the Minnesota Legislature passed a same-sex-marriage bill in May 2013, which Dayton signed. Carlton died of complications related to pancreatic cancer on Jan. 4, 2020, right before the coronavirus began to spread worldwide.
The timing meant Malcolm didn’t have a chance to truly mourn Carlton’s death. “Quite honestly, I think I have a lot of grieving yet to do,” she said. “This has been pretty all-consuming — and not in a healthy way, for sure. I was forced to keep moving. There was no time.”
Friends like Bancroft, the polar explorer, and Alice Johnson, Malcolm’s CFO at Courage Center, started a meal train to keep her fed during the first year of the pandemic.
MEET THE CHEAP NYLONS
Bancroft said she met Malcolm in 1981 when she was “cajoled” into coaching a city league women’s basketball team that included Malcolm. “They were really softball players, but they wanted to keep hanging out once a week, so they decided to form this team,” Bancroft said. “They were horrible.”
Bancroft, who had just graduated from college, was teaching and coaching in St. Paul, but she agreed to coach Malcolm’s team.
At 5 feet 10 inches, Malcolm was the tallest player, and Bancroft put her at center. “She’s a better first-base woman, let me just put it that way,” Bancroft said. “She is really competitive when she is on the softball pitch. She can keep a toe on first base and stretch almost halfway to second, and still catch our wild throws.”
Malcolm and the softball players made Bancroft try out for their team before offering her a position — a fact that still chafes, she said.
“They didn’t just say, ‘You can come play,’ which I was very incensed by,” Bancroft said. “They were very serious. We had uniforms and the whole deal. We were the Cheap Nylons. Our motto was: ‘Runs are our business.’ ”
Bancroft and Malcolm were on their way to Malcolm’s cabin in northern Wisconsin in March 2020 when the commissioner received word about the first confirmed case of COVID-19 in Minnesota. “I had to take over driving because her phone was off the hook,” Bancroft said.
Her friend has worked almost nonstop since then, she said.
“She has always been work-identified and just fully engaged with whatever work she is doing,” Bancroft said. “She’s not a person who will abandon ship. She’s a workhorse. Public service is her thing, and there is sacrifice involved in public service, and she does it with great grace.”
Malcolm said she and her staff have done “the very best that they could with a really challenging set of circumstances.”
“It’s just an enormous honor to be in public service,” she said. “It’s just been the greatest job I could have ever asked for.”
Staff writer Bill Salisbury contributed to this report.
