Paul Harvey on the radio in the mornings was not something I appreciated as a child.

We lived on a farm outside of town. My mom, a reporter, always had to be at work early, and the long, crack-of-dawn car rides to school often included tales from “The Rest of the Story.”

Living on the outskirts also meant we didn’t have cable TV. I always felt out of touch with what was cool, never was able to talk about the latest videos on MTV, and really, really wanted to, at a minimum, catch the latest hit on the radio.

But, no, it was NPR and Paul, every morning.

2021 is a new year. I wonder what Harvey would have to say about the rest of OUR story as caregivers post 2020. 

I imagine him starting a tale in his steady and calm voice, always accentuating key words with precision and at just the right time, moving into his classic almost run-on intensity. 

I hear him now …

He would open with thanks. Appreciation to all the hard-working and dedicated caregivers, loved ones and families. 

He would give emphasis to remembering those we have lost and provide encouragement to all who have recovered.

Then his tone would shift.

The story is not over. His intensity and rate of speech would increase. 

During the Rest of the Story, he would remind of the importance for which we continue to care for those recovering from COVID-19. 

Recovery not simply being admission to a SNF. 

Recovery not being a negative test.

Recovery not even being admission home. 

COVID-19, we now know, is not a transient event. The residual impacts are real, and they may be long-standing.

Perhaps Harvey would review a January 4 JAMA original investigation titled, “Risk Factors Associated With All-Cause 30-Day Mortality in Nursing Home Residents With COVID-19,” which directly spoke to mortality risks for those.

The results are as follows:

  • The study included 5,256 nursing home residents (3,185 women; median age, 79 years; and 3,741 White residents, 909 Black residents, and 586 individuals of other races/ethnicities) with COVID-19.
  • Compared with residents aged 75 to 79 years, the odds of death were 1.46 (95%CI, 1.14-1.86) times higher for residents aged 80 to 84 years, 1.59 (95%CI, 1.25-2.03) times higher for residents aged 85 to 89 years, and 2.14 (95%CI, 1.70-2.69) times higher for residents aged 90 years or older.
  • Women had lower risk for 30-day mortality than men (odds ratio (OR) 0.69 [95%CI, 0.60-0.80]). 
  • Two comorbidities were associated with mortality: diabetes (OR,1.21 [95%CI, 1.05-1.40]) and chronic kidney disease (OR, 1.33 [95%, 1.11-1.61]). 
  • Fever (OR, 1.66 [95%CI, 1.41-1.96]), shortness of breath (OR, 2.52 [95%CI, 2.00-3.16]), tachycardia (OR, 1.31 [95%CI, 1.04-1.64]), and hypoxia (OR, 2.05 [95%CI, 1.68-2.50]) were also associated with increased risk of 30-day mortality. 
  • Compared with cognitively intact residents, the odds of death among residents with moderate cognitive impairment were 2.09 (95%CI, 1.68-2.59) times higher, and the odds of death among residents with severe cognitive impairment were 2.79 (95%CI, 2.14-3.66) times higher. 
  • Compared with residents with no or limited impairment in physical function, the odds of death among residents with moderate impairment were 1.49 (95%CI, 1.18-1.88) times higher, and the odds of death among residents with severe impairment were 1.64 (95%CI, 1.30-2.08) times higher.

The overall conclusions of the study were that in nursing home residents with COVID-19, increased age, male sex and impaired cognitive and physical function were independently associated with mortality. Understanding these risk factors can aid in the development of clinical prediction models of mortality in this population.

At the end of the review Harvey’s voice would calm again. Perhaps he would add a classic pause …

I didn’t appreciate his artistry and skilled closings as a child but, oh, how I appreciate him now. 

Always the best endings. Literally, as a writer, the hardest part of the story.

How we would close our COVID-19 story?

The rest of the story, the 2021 story … this one is on us. 

Renee Kinder, MS, CCC-SLP, RAC-CT, is Executive Vice President of Clinical Services for Broad River Rehab and a 2019 APEX Award of Excellence winner in the Writing–Regular Departments & Columns category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty, and is an advisor to the American Medical Association’s Relative Value Update Committee (RUC) Health Care Professionals Advisory Committee (HCPAC).