At the head of state Health Department, Jan Malcolm is 'Minnesota's Dr. Fauci'

It was two months into the national crisis, and Jan Malcolm was calm, sitting with a pen and paper, fielding questions on quarantines, testing capacity and the spread of infectious diseases.

As head of Minnesota's Department of Health, Malcolm reflexively kept coming back to the "public" part of the public health crisis, emphasizing the little things people can do to seize control of their lives at a time when it feels like they have none: Don't smoke. Get plenty of rest. Wash your hands.

"We can't be certain what's ahead of us," she said, "but the best way to fight back is to take charge of things that are in our control."

That was nearly 20 years ago, shortly after the Sept. 11 terrorist attacks. Fear of a second bioterrorism attack permeated American homes. Malcolm addressed the public on a live broadcast on Twin Cities Public Television, just moments after her then boss, former Independence Party Gov. Jesse Ventura, gave a statewide address.

It could have been yesterday.

Malcolm is now leading the health department's response to a new threat: the coronavirus pandemic. Her days are long, filled with press briefings and conference calls where she fields many of the same questions she did in 2001. Even now — as the death toll from the virus rises almost daily — Malcolm retains her frank, calm delivery, one that often veers into her wonky reservoir of knowledge.

"She's wise, she's sound in her thinking, she's calm and she carries on," said Penny Wheeler, president and CEO at Allina Health, where she worked with Malcolm. "If everybody could have a booster shot of Jan Malcolm right now, that would be OK."

Her contemporaries have started calling her "Minnesota's Dr. Fauci," likening her to Anthony Fauci, director of the National Institutes of Allergy and Infectious Diseases, who has advised six administrations in public health crises. He has risen to new prominence for his matter-of-fact style in briefings on the coronavirus. Like Fauci, Malcolm has delivered the same pragmatic counsel under three administrations, regardless of their party affiliation.

"It's a real shock to the system to get our heads around the magnitude of this challenge," Malcolm said in an interview, during a short break between calls. "Everybody is just kind of reeling with, what does this mean? How big is this? How long is it going to last? And what kind of changes will be left in its wake?"

Growing up, Malcolm didn't picture herself managing catastrophes. A Minnetonka High School graduate, Malcolm was pre-med at Dartmouth, an Ivy League college in Hanover, N.H. She was on track to be a physician when she decided to take a few elective classes on medical economics and the sociology of medicine. "It was for fun," she said. "It opened my eyes to this whole realm of health policy."

Out of college, Malcolm dived into health policy research and worked for health maintenance organizations (HMOs) before she was tapped by Ventura to lead his health department in 1999. Her appointment raised eyebrows, charged with regulating the very industries she used to represent.

But she adapted to the new role quickly, convincing a skeptical Ventura to raise taxes on cigarettes and launch a major anti-smoking ad campaign. She was dogged in highlighting Minnesota's health disparities.

After Ventura, she led the Courage Center, a rehabilitation center for people with disabilities, and its eventual merger with Sister Kenny Rehabilitation Institute and Allina Health. But former Gov. Mark Dayton called her back in 2018, after a backlog of elder abuse complaints led health commissioner Ed Ehlinger to resign. Malcolm returned to her old job and eliminated the excess of complaints within eight months.

"She's often the smartest person in the room, but you never feel like she's making you feel like she's the smartest person in the room," said Emily Piper, who served as Dayton's commissioner of human services.

At the time, Malcolm planned only to help for the remainder of Dayton's term, but she continued on into Gov. Tim Walz's administration when he took over in 2019. A year later, the coronavirus happened.

On daily press calls, Malcolm speaks directly after Walz and is tasked with the grim situation update: relaying the numbers of positive COVID-19 cases and confirmed deaths in Minnesota, numbers that keep rising.

To slow the spread of the virus, the administration has closed schools, bars and restaurants. Minnesotans were asked to stay home unless absolutely necessary. Malcolm's department initially took heat for not disclosing the names of long-term care facilities where residents and caregivers had tested positive for COVID-19, a decision she reversed.

Walz's team has been praised by some for decisive decisionmaking and criticized by others for the impact it's had on the economy. Sen. Jim Abeler, R-Anoka, chairs a health and human services committee and is effusive in his praise for Malcolm. But he's worried the administration's executive orders have been applied unevenly, with businesses like small salons and golf courses ordered to close.

"The public health people by nature err on the side of caution; that's how they are trained," he said. "There is great need for caution, and there is great need for distancing, but I'm concerned they're closing places that are perfectly safe."

Colleagues say they're on calls with Malcolm at 10 a.m. and then again at 10 p.m., constantly updating business leaders, schools and hospitals. The toll rarely weighs publicly on Malcolm, who lost her partner to cancer in January.

"She's a shock absorber, and that takes a strong person," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "There are groups, there are organizations, there are different political persuasions and it's all coming into one place, and that's her."

But the pandemic has cast its own uncertainty over her life. Public health crises are usually episodic, but then they're over. Not this one.

Malcolm takes solace in looking ahead. The pandemic has emphasized frailties in society she hopes will sharpen people's values on the other side. Amid uncertainty, the public health wonk often taps that simple advice she delivered long ago: Wash your hands, take control of the things you can.

After decades in the field, those little things are instinctual for her. When Vice President Mike Pence toured Minnesota mask-maker 3M in March, he reached toward Malcolm to shake her hand.

She offered her elbow instead.