5 years after the pandemic, Jan Malcolm says we are not better prepared for the next one

Thursday marks five years since Gov. Tim Walz declared a “peacetime emergency” and the state went into lockdown for the COVID-19 pandemic. Schools moved to remote learning, bars and restaurants were shuttered and people were told to stay home. Nearly 17,000 Minnesotans have lost their lives to the virus.

Former Minnesota Department of Health Commissioner Jan Malcolm led the state through the first two years of the pandemic. She frequently hosted the state’s daily COVID press conferences. She joins MPR News host Nina Moini to reflect on the early days of the pandemic and her role in the Minnesota’s COVID-19 response.

Editor’s note: This conversation has been edited for length and clarity.

What was it like to serve as health commissioner during that time?

It was certainly different. I’ve had the privilege of serving as commissioner a couple of different times, including right after 9/11, so that had some similarities to the uncertainty and the fear that was going around then, like Anthrax, if you remember that.

But this was something of a scale and a duration that was unimaginable for most of us. Public health is usually behind the scenes, quietly doing work to try to prevent problems from ever happening or containing problems at a very low level.

It’s highly effective, but not usually right in the spotlight. Rather, we’re quietly saving truly millions of lives globally, and extending the quantity and quality of people’s lives in ways they don't even know.

Suddenly we were not only in the spotlight, but perceived by some to be the enemy. It was really disheartening and such a different thing for us to feel. Our motives were being called into question, and our competency was being called into question. There were some really difficult things about the division and the politicization that occurred around it.

Are there things you wish could have done differently?

I think the retrospectives are really important to do. And actually, I wish we were having more of a community-wide conversation about it and sharing perspectives. Because the conversations are tending to happen in separate circles, and certainly with hindsight, we can see things that we didn’t know at the time. The information was changing so fast, hence the daily calls, and then we ramped down to weekly, and then as needed.

But for three years, we were doing very regular public outreach. And yes, we learned a lot along the way. Some of what we first thought was the case, wasn't the case. It took a while to understand that the virus could be transmitted from person to person without the transmitter having any symptoms at all. So many, many people passed the virus along to others and never knew it.

There was a lot of debate: Is it airborne? Are the masks effective? Is there anything magic about six feet? All of that was the product of not knowing what was going on with this novel virus. In retrospect, it’s really good to look back now and say: What can we learn? Which measures were most helpful? And which weren’t? Could we have taken a more surgical approach to lockdowns or one thing or another, or the length thereof?

Minnesotans might not remember that we actually opened up earlier than a lot of states did, and that, I think, was to Gov. Walz’s credit. He wasn’t only looking at public health data. But he was also weighing the impact on the economy and on social cohesion. I think he made some difficult choices about how to balance that, and I think our state looks pretty good in retrospect.

Do I wish we had had more precise tools, especially early on? Yes. I think once we had treatments and vaccines, our approach shifted, appropriately so, to giving individuals information to make their own choices.

I do wish that we had had a way of managing the school situation better. I think early on, it seemed a prudent course to go to distance learning, but certainly, we're well aware of the long-term negatives of that. So what could we have done to make school settings safer? I think there are some things without maybe being closed for as long as we were. But again, that's learning that I hope we will apply to future challenges.

Do you feel that the state would be better prepared now than it was in 2020 for something like a pandemic?

I’m really sorry to say I think the answer is no — because of what has happened and what is happening federally, rather than investing in modernizing information systems and building up the workforce. This epidemic landed after decades of underfunding of public health and we saw the results of that.

The same is true with our health care workforce. We’ve lost a lot of folks to the burnout and the damage that was done in the pandemic. And instead of investing and building those systems up, we're going in the other direction. That worries me a lot. I know there are policy debates about if the governor should be able to use executive orders in the future or not.

And just the whole federal budget situation and the direction that appears to be going: more cuts rather than more investment. That worries me a lot. Certainly, we learned a lot of important lessons. We figured out how to do some things, develop deeper partnerships, so we could be better prepared, but we won’t be, unless we really learn those lessons and apply them and invest to build up the systems where we know they are weak.

What do you think needs to happen in order to maintain the integrity of the public health system?

I think we need to take seriously, we in public health, how it is we’re going to rebuild an understanding of what public health does, what vaccines do, why they’re important and how we demonstrate accountability. As part of rebuilding that trust, I think we need to engage with the people who had questions and worries about vaccine safety and other things.

I think the data are very clear, but we also have to say that we invest a lot of care and effort in making sure that the vaccines are safe.

But just to approach all of it with a spirit of compassion rather than dismissing people’s concerns. Or rather than people accusing public health of being incompetent or somehow trying to manipulate the data. To what end? I don’t know.

But I think we need a little compassion on both sides and to have a conversation about what are the concerns and how can we address them so we can rebuild that trust.

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