Health Commissioner Jan Malcolm on the recent rise in COVID levels, next steps in the pandemic

On April 4, the federal government stopped requiring labs to publish negative COVID-19 tests and the Minnesota Department of Health soon followed. With concerns over the usefulness of positive test cases and the rise of underreported at-home testing, wastewater data has provided the inside scoop for monitoring case load.

Jan Malcolm, the commissioner for the Minnesota Department of Health, discussed how Minnesotans can stay safe without looking toward positivity rates and the individual choices that many residents may soon have to make.

The following transcript has been lightly edited for length and clarity.

How would you characterize the rise in COVID levels?

We have seen an uptick in cases over the last couple of weeks, but I'm happy to say those increases have been fairly moderate. We're not seeing the kind of rapid, almost vertical increase in cases that we saw in December. We're watching it very closely but so far, we're feeling a little more comfortable with what's going on.

How long until we may see COVID levels in wastewater translate to case counts?

The science is still really coming together on how close of a correlation there is between wastewater levels, cases and the timing. Sometimes there are spikes in wastewater data that don't translate into additional cases but by and large, we do look to see the wastewater levels predicting five or so days ahead of where cases may spike and we have seen some increases in those wastewater levels but the absolute numbers are still quite low compared to where they were.

The federal government stopped requiring labs to report negative test results back on April 4 and the State Health Department's stopped publishing positivity rates. What does it mean for tracking this current rise?

We’ve known for a while that we were not getting all the test results that were out there because over the counter tests, which are now by far the most popular, have never been reported to public health authorities. So we always knew that our picture was incomplete at best.

What we're doing now is using a whole bunch of other indicators like data from emergency rooms, urgent cares, clinics, and hospitals. The wastewater data is another really valuable sign.

For folks who still want to protect themselves, how can they determine if they're in an area of concern?

I hope folks are aware of the community level indicators that the CDC came out with a month or so ago. We really think that is a big improvement in the way that we look at community level risk. You can see where every county in the state is and it's updated once a week on the CDC website — we link to it on the MDH website as well. And we do still get, all the positive cases are still reported to us when they come through a test.

So we've got case data, but even more critically, I think in terms of knowing how severe are those cases, is looking at how many people are hospitalized for COVID. And what percentage of our hospital beds are in use for COVID care specifically. Put those three things together, come up with a community level risk indicator, and we think that's a really good way for people to know locally what's going on.

As of last week, we had three southern border counties that were in the moderate community level range, but the rest of the state was in low risk.

So hospitalizations are still pretty low across the state?

Yeah, happily so. Our health care workers have obviously been so incredibly stressed for over two years now. We're just really grateful to see a little respite there. The numbers have ticked up a little bit in the last week or so. But again, at a moderate rate. So we're watching those numbers very closely as well.

There is a sub-variant of delta and omicron said to be more transmissible than measles. What does that mean long term?

As our good colleague Dr. Michael Osterholm, keeps saying, this really should keep us very humble because the virus has thrown one surprise after another.

With so much transmission still happening around the world and over a million cases a day globally, it’s a lot of opportunity for the virus to spin off these variants. We are tracking and looking for all of those sub-variants and we do not see any evidence of that yet here in Minnesota.

And with each new variant, we have to look carefully at how well the vaccines protect against infection, but even more importantly, against severe disease.

So far, vaccines are holding up well against severe outcomes, even from BA.2. Unknown about new future variants. One of the things to really celebrate is the pace of scientific advancements that happened over the last couple of years and the degree to which people all over the world are sharing intelligence and analysis to try to stay on top of these things as quickly as we can. 

Are you concerned about long-COVID and the impacts it could have on our society and economy?

Absolutely, we've been saying for some time, that long-COVID could be one of the most significant public health issues that we'll be confronting for who knows how long. We don't know enough yet about long-COVID.

The governor has a budget proposal in front of the Legislature right now, to start really working on long-COVID and better supporting folks who are suffering with it and their health care providers.

And at the federal level there's a lot of research ramping up to understand the characteristics of long-COVID And what might predict it and what might help it. So far, it does look like vaccination also helps against long-COVID in terms of the the severity of that impact — so another reason to encourage folks to get vaccinated and boosted when they're eligible.

Do you think that the general public thinks the pandemic is over? What does that mean for public health messaging?

It’s pretty clear now that COVID or SARS-CoV-2 is not going to go away, we're going to be dealing with it as a recurring virus. The way to keep it manageable is to keep it from causing such huge disruption and damage to health is to get vaccinated, staying up to date. And also making sure testing is robust so that people know their status and can take appropriate preventive actions; paying attention to those community levels that I mentioned so that we can take community level action when we need to when we see the risk growing.

I hope that all of us can be our best Minnesota selves and recognize that even though for many of us things are returning to a state of normal, a lot of our fellow citizens are still at high risk. We really need to respect that and when folks want to keep masking, that's a good thing.

I think people are going to be making more individual decisions about their comfort level and measures that they can take to protect themselves or family members who may be at a higher risk.

A while back Republicans threated to oust you from your position. What was the agreement or understanding that's kept you in office?

Well, we had a very nice conversation with Senate Majority Leader Jeremy Miller, and I'm proud of the work that we've been able to do with with many folks in the Senate as well as the House. We're working hard on the budget right now, and so I'm hopeful that we'll have a productive few weeks here.

And you still plan to stay on the job even after session?

That's my intent. Yes, I'm grateful that I'm still in the job. It's been an enormous privilege as well as some real challenges for me and all of my colleagues in public health.

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