Elders of Color Face Major Hurdles Getting COVID Vaccine

by Carolyn Bick

Every day, Lynda Greene and her fellow staffers at the SouthEast Seattle Senior Center field about 30—45 phone calls from community elders trying to schedule an appointment to get vaccinated against the novel coronavirus.

Most of these callers are crying. Most of them are Black.

"We've got folks calling here, they are in tears, because they are so frustrated that they can't get an appointment, and that's what they want to do," Greene told the Emerald in a Feb. 19 phone call. "They are scared. They are absolutely scared. … As they are sharing their story, sometimes I just have to stop talking. It just makes you want to cry, because I can only imagine if it were my mother or my father. It's just terrible."

Greene is the director of the SouthEast Seattle Senior Center (SESSC). She and her staff, as well as a small cohort of volunteers, have been on the front lines of the novel coronavirus pandemic since the virus was first discovered in the United States in Washington State in January 2020. Even though the center is physically shut down, its staff have been working to stay connected with the people they serve, while keeping them from contracting the virus and developing COVID-19, the virus's associated disease. The center's staff and volunteers have been delivering hot meals to elders since last March and have kept in touch with many elders who frequented its community space via a phone tree. It has also worked to keep its elders informed about the novel coronavirus with newsletters and webinars.

But now that it's time to get vaccinated, Greene and other outreach organizers say south King County elders are facing still more challenges. Even though elders make up a large portion of the vaccine-eligible population in Washington State, many in south King County still face a web of difficulties in scheduling vaccines. These difficulties — which local health agencies, in partnership with community organizations, are still trying to iron out — have the potential to become exhausting obstacles, particularly if these elders come from communities of color. Though community organizations and government entities have tried to mitigate these problems, they persist, leaving many of these elders at the bottom of long vaccine waiting lists — or, sometimes, not on them at all.

Greene had initially been excited to start the week of her interview with the Emerald. On Friday, Feb. 12, nearly 30 of the center's elders had gotten their first doses of the vaccine at the Rainier Beach Safeway, in a new coordinated effort to get elders from the SESSC vaccinated. The effort removed many of the hurdles the elders faced in getting a vaccine, because the center scheduled and coordinated everything for these elders and the vaccinations took place in what many viewed as a familiar, safe community space, rather than a mass vaccination site in a place some had never been. A week later, on Feb. 19, 40 more elders were supposed to have gotten vaccinated at a different South Seattle Safeway. On Feb. 22 and 23, 100 more elders were supposed to get vaccinated.

But the winter storms that swept through the Pacific Northwest in mid-February threw a wrench into those plans. The weeklong delay in vaccine shipment arrival didn't just translate into a weeklong delay for these elders. It meant a delay of an untold number of weeks.

Though Greene and her staff have since been able to reschedule these appointments for early March, in her initial interview with the Emerald in February, Greene didn't know when they would be able to reschedule, which meant she had to deliver bad news to elders who had already been waiting for weeks to get their vaccine and who were all the while fearful of contracting the novel coronavirus and developing COVID-19. Just a week or so before, she had been delivering good news.

"You could almost feel the weight leaving their bodies during the conversation," Green said of delivering the good news, "because, 'Oh, finally I have an appointment.'" She said that the hardest part was "recognizing now that, well, we committed, but the dose is not here."

The "weight" Greene is referring to largely comes from websites offering vaccine locations but no guaranteed appointments. The State's Phase Finder, for example, has applicants answer a series of questions, before determining whether they are eligible for a vaccine and offering a list of locations. But this doesn't mean elders who go through the Phase Finder are automatically signed up for an appointment at one of the State's or County's mass vaccination sites — and that's if they even want to go, or can even get to, a large vaccination site. Some vaccination sites may be far from home and in a place they have never been before, and they must go there to be given a shot by people they have never met.

Even the Washington State Department of Health's (DOH) dedicated vaccine locations page, while full of helpful information, may be overwhelming. The dots on the provider map and print on the page are small and difficult to read, which means it may be difficult for elders — particularly those with vision problems — to find vaccine providers or figure out how to narrow down the list of locations closest to them.

And if elders go through a private provider, Greene said, they have to fill out information online before they can schedule an appointment. Swedish Medical Center's chief equity officer, Dr. Nwando Anyaoku, said that such technology hurdles — which can be challenging for any senior, regardless of race — can become amplified for elders who come from communities of color. These elders, who are also more vulnerable to COVID-19, often have less access to technology or technology literacy from the get-go, even if they come from multigenerational households, because they are more likely to live in poverty.

Anyaoku said that the difficulties elders face from technological hurdles cannot be overestimated. On top of trying to understand Phase Finder — "you can tell them they are in the right phase, but to understand is challenging" — if elders keep hearing the message that they are more vulnerable because of their race, socioeconomic status, or a combination of the two, "it makes it harder for them to do the things that other people could do."

"If you are sitting as an African American elder, for example, or Native American, and people are telling you on the news that you are at higher risk for this disease, then you … hunker down and you don't necessarily [have people] who are coming in who can help you, who can explain; and you can't get out to go get the support you need," said Anyaoku. "So, they get more and more isolated in that way."

Even if they have access to technology and help from a more tech-savvy person to navigate these sites, elders may still run into difficulties getting an appointment. Oftentimes, Greene said, by the time elders reach the end of filling out information for a vaccination appointment, chances are they will be told the appointment they had selected is no longer available, because of the current scramble to get an appointment for what is currently a limited number of vaccines. The appointment time chosen at the start of the process is not held indefinitely for the user filling out the necessary information to complete the process.

International Community Health Services' (ICHS) strategic initiative administrator, Ian Munar, said that another major obstacle he sees facing a number of the community elders ICHS serves is a lack of schedule flexibility. Throw high demand for vaccines, language barriers, and limited access to technology during work hours into the mix, and getting a vaccine becomes a difficult obstacle to surmount.

Many of those ICHS serves are People of Color who work in what are considered essential jobs, such as grocery store workers or restaurant workers, Munar said. This includes community elders, many of whom still work in the essential service industry past age 65. This means they don't have the flexibility to constantly check and refresh appointment webpages or have time to wait around for a phone call from one of ICHS's staff who can provide language assistance and make an appointment for them, since they need to be working.

"And then the other thing, too, is the flexibility they have for when the appointments are scheduled. For instance, even if they end up being able to get through the online scheduling tool to see what's available, the other part is the flexibility of being able to get one of those appointments and being available when those appointments are available," Munar said. "So, if there is an appointment available tomorrow, they have to be flexible enough to make it to that appointment."

Public Health — Seattle & King County (PHSKC) has been working with 20 different community organizations, many of them serving south King County's senior population. Maureen Linehan, who serves as PHSKC's program manager for COVID response for older adults, said that representatives from these community organizations have been doing hands-on appointment-making for community elders. These organizations often have early access to vaccination slots, which means they don't have to race against the clock to get elders in for an appointment, and they work directly with elders or elders' families to make those appointments.

"They serve seniors and they have social workers who are helping seniors schedule appointments. They might have a client list of … people [who] come to their senior meal program, or they come to a family caregiver support group," Linehan said. "They have been proactively outreaching to those seniors. … The social worker can sit down and help the person make the appointment — either by helping the family member make the appointment, or the social worker will make the appointment themselves, while the elder is on the phone. So, there is no waiting … or needing to go through a web link. There is specific outreach done."

Though she didn't know specifically how many BIPOC elders have been able to get appointments this way, Linehan shared that at a not-publicly-advertised Kaiser Permanente vaccination site on Feb. 21, more than 800 elders were able to get vaccinated, with many appointments made via this hands-on community outreach method.

But organizations that are not affiliated with PHSKC's outreach do not necessarily have this kind of priority vaccine access. Munar said that another problem is that ICHS — which is not one of the 20 organizations working with PHSKC — has not been guaranteed a specific number of vaccines from the DOH from week to week for its vaccination sites in the Chinatown-International District and New Holly or at its full-service medical and dental clinics in Shoreline and Bellevue. If it were to be graphed, ICHS's vaccine supply from DOH would look like a roller coaster. This translates into a great deal of uncertainty that ultimately means few elders who work in the essential service industry can get a vaccine appointment. Fortunately, ICHS was chosen for the federal Health Center COVID-19 Vaccine Program, ensuring an additional weekly supply of vaccine is delivered and added to their inventory as of Feb. 22. Still, appointment scheduling is challenging and the landscape is changing constantly.

"For us, we have no choice but to release our appointments last-minute, once we have actually received the supplies — once we know that we can give those vaccines out. We can't just start setting up appointments without knowing that we have those vaccines in hand," Munar said. "That makes it difficult, because even though we are trying to reach out to our community and People of Color, they have to respond pretty quickly, too, and have to be available last-minute. But some of them have work and can't just take off work all of a sudden."

This means that ICHS staff have to also think about individuals' schedules and know ahead of time whether their employers will allow them to take off work to get vaccinated.

Munar said that ICHS has tried to make vaccination scheduling easier by stratifying its patient lists. ICHS has identified which patients are eligible for the current phase of vaccinations, as well as identified those who are most at-risk based on chronic conditions. ICHS staff have been able to make phone appointments with these patients, which has helped with the barrier to online scheduling — but it has only primarily helped those patients who are able to be near a phone when ICHS staff calls. Moreover, as stated above, many of these patients have to have schedule flexibility to get to the appointment. This effort also takes a lot of staff hours, Munar said.

"That takes away from the work we are already doing," Munar said. "We have to redeploy and repurpose our staff to make those calls."

Munar said that in an effort to reach as many people as possible, like PHSKC, ICHS is working with other non-medical community partners and organizations, such as the Seattle-Chinatown International District Preservation and Development Authority (SCIDpda) and El Centro de la Raza. ICHS relies on these organizations to coordinate with area businesses at the ground level in a way ICHS does not have the resources to do.

"That helps, because they work with some of the businesses in the area that have elderly [employees], and so most people, like I had mentioned, would have a hard time getting onto a computer, because they are doing work then that is not in front of a computer," Munar said. "SCIDpda was able to mobilize with those local businesses to work with business owners to make the time to let their staff come in and get vaccinations."

But all of this has involved a lot of coordination and last-minute juggling, Munar said, "because we didn't know what supplies we had until we received them."

"It was a lot of, 'Can you get your people ready?' and 'If it comes, we will do it on this day.' There was just a lot of really trying to work with the people as best we can and just hoping they are flexible enough to get those vaccine appointments," Munar said.

ICHS staff also have to take transportation options into consideration. Even if an elder does not work and lives in a multigenerational home, they may rely on one of their younger family members to provide transportation for them.

"Some of their family caregivers have jobs outside of their homes," Munar said, so "… even if [the elders] are available to go to that appointment, they might not have a family caregiver who can bring them to that appointment last-minute."

Munar said ICHS is not coordinating transportation options for elders at this time.

Transportation equity isn't a new problem and isn't exclusive to Seattle. A 2013 comprehensive report from the publication J Community Health on multiple studies regarding transportation equity found that, overall, "the evidence supports that transportation barriers are an important barrier to healthcare access, particularly for those with lower incomes or the under/uninsured." The report drew on 61 peer-reviewed studies in PubMed's database that focused on different areas of healthcare but that all had to do with transportation and ease of access across the United States. Of these 61 studies, six specifically related to race and transportation equity. The comprehensive report's authors concluded that these studies "suggested that [transportation] access is superior" for whites compared with People of Color.

Eight years later, it appears little has changed: a piece published in The Washington Post on Feb. 13 specifically discussed the fact that a large number of public health experts, doctors, and civil rights leaders see transportation as one of the major barriers to healthcare equity, in general, and to vaccinations, specifically.

These inequities fall, as they always have, on the shoulders of People of Color, particularly on Black and Latino people. According to limited data from the Centers for Disease Control and Prevention (CDC), the Post article says, just 15% of the 13 million people who were vaccinated the first month a vaccine became available were Black and that people from the Latino community were also underrepresented in getting the vaccine. The disparities are driven in part by both a lack of healthcare providers and transportation.

Greene said she has had recent conversations with folks at the City level about looking at vaccination efforts from the perspective of the aging community. Some of these conversations have been about transportation, particularly for those she terms "older seniors," those who are at least 80 years old. For instance, if an older senior is no longer able to drive themselves anywhere but does not have a caregiver or anyone to call on, how will they get the vaccine? If they don't live in a group home, they won't get a visit from one of King County's 17 mobile vaccination teams or one of the City's four vaccination teams.

"Senior centers … don't have the volunteer capacity to drive every single person that might need a ride," Greene said.

But even if good-hearted community volunteers offer to drive elders from the SESSC or another senior center to their vaccination appointment, senior centers can't just let anyone drive elders to their appointments. The centers need to perform a background check on the driver and figure out the admittedly grim logistics of who assumes responsibility if there's a car accident on the way. "Who assumes responsibility? The driver or the senior center?" Greene said.

PHSKC spokesperson Kate Cole said that Uber and Lyft are specifically in the process of setting up vaccination ride services for older adults in King County. It's unclear if this specific effort is part of the two companies' recent announcements regarding vaccine ride services, but Greene said she is skeptical about the possibility that this would help a substantial number of elders. For one, Greene said, most elders just aren't that tech-savvy. What's the likelihood they will have smartphones — or smartphones with either ride-sharing app installed? And even if someone helps them coordinate a ride to a vaccine appointment, it is unlikely these elders will want to take this option.

"Number one, seniors are not too willing to get into a car with someone they don't know. Number two, are the drivers willing to help those seniors who need help? For instance, if they are on a walker, are you willing to help them open the door? Help them hold their walker? Get them in the car?" Greene said. "All those things are things that are associated with seniors that need some help. And are [the drivers] going to be trained to assist in that manner — that a caregiver, in essence, would be doing." This does not even factor in the close quarters an elder would be in with a stranger in a ride-share — in a vehicle that other strangers are presumably getting in and out of throughout the day, which would put them at increased risk of exposure to the novel coronavirus.

It's also worth noting that Lyft and Uber don't appear to have the most sound of background checks, either. Several drivers from both companies have been accused of assaulting people. A series of lawsuits filed in December 2020 against Lyft alleges that the California-based ride-sharing company has done little to protect passengers against sexual assault. In December 2019, NPR reported that Uber had received nearly 6,000 sexual assault claims in the two years prior.

PHSKC spokesperson Gabriel Spitzer told the Emerald in a March 2 email that on-demand transportation is also available for door-to-door travel to the Kent site via Metro Access and Hyde Shuttle.

"Another option for people who are Medicaid recipients is to call Hopelink, the Medicaid transportation broker, who can arrange a ride to vaccine sites (typically through Lyft, Uber, or a taxi)," Spitzer said.

The Auburn site, though, is a different matter, Spitzer said. Because it is a drive-through site, it "is not set up to receive people arriving by the vans described above, due to the wait time involved and the need to complete other rides. My understanding is that the rides arranged by Hopelink can bring people to Auburn and drive the person into the site so they can be vaccinated in the car. (And then they drive the person back home)."

As the Post article also discusses — and as Greene well knows herself — a large part of the discrepancy between the number of eligible people and the number of people who get the vaccine in communities of color, particularly Black communities, is fueled by systemic racism.

In her February interview with the Emerald, Greene said that Black communities have historically been wary of the medical community, given everything they have suffered at its hands. This wariness stems not only from historical atrocities in the medical community, like the Tuskegee Study, but also from individuals' one-on-one visits with providers. Because of this racist legacy and its persistent echoes, Greene said she didn't even want to get the vaccine herself, at first.

"I was one who said, 'Mmm-mmm, nope, not going to do it. Not going to do it,'" Greene recalled. "But I quickly changed my mind, as I also had more information. So, I am totally in support of it, and I recommend it to everybody, and my family members, as well."

Information is critical to surmounting some of the mistrust stemming from systemic racism. Greene said that she had a lengthy discussion regarding the lack of information about the vaccine within communities of color with Dr. John Vassall III, a Black doctor with Swedish who Greene said "has been doing quite a bit of outreach into the Black community."

"What he has found … is that it needs to be a two-way conversation — that they are asking questions and would like to have answers. So, that is something that we need to do a better job of: getting more information out about the safety of the vaccine," Greene said.

Vassall did not respond to requests for comment on this issue or on his conversation with Greene.

Anyaoku said that Swedish has found that it is the lack of information, rather than vaccine hesitancy, that is a bigger problem for elders of color overall. They have questions, Anyaoku said — "Can I take it if I have diabetes? Can I take it if I take high blood pressure medication?" — but they don't necessarily have easy relationships with healthcare providers or know whom they can ask.

"Just to ask those questions is a challenge to those who don't have ready access to healthcare providers and are not able to get their answers from people that they trust easily," Anyaoku said.

To that end, Swedish has been inviting community leaders to hold advance language-appropriate webinars for communities of color for which Swedish will hold pop-up vaccination clinics. For instance, Anyaoku said, Swedish recently held a pop-up clinic in partnership with the Ethiopian Community in Seattle. A week ahead of time, the Ethiopian Community Center held a webinar in which they and Swedish were able to answer Ethiopian elders' questions and sign them up for vaccinations. Since then, Swedish has invited other organizations serving communities of color with which it has partnered to do the same.

"That really helped to bridge the knowledge gap, and when you are thinking about serving BIPOC and other vulnerable communities, that sort of collaboration is critical, because it helps to close a lot of challenges people otherwise would face," Anyaoku said. "They know these organizations, they trust them, they speak their language. Even on the day of our clinic [with the Ethiopian community center], they had volunteers come out to help elders fill out their forms, help translate for them what was going on, and help translate the questions that [the elders] had to us as providers."

Though technology-based translation services were available, "it certainly worked better when we were able to get volunteers in language to help us at the community level," Anyaoku said.

PHSKC has also been working with community navigators to identify places of trust and safety within the community to expand vaccination site options. For instance, Linehan said, a vaccination site could be a church identified specifically by the community via these community navigators. Such a site would be a more comfortable environment than a mass vaccination site and would be much simpler to access for those community elders who may not drive or have easy access to transportation. Though public transit exists, it becomes sparser the further south one travels in King County — and with a pandemic on, getting onto a bus with other people is not the safest option for elders.

"It's understanding the local community. And … making sure to get education out there about vaccines and side effects, so there is that part of it — having local spokespeople talk about their own experience of being vaccinated," Linehan said. "It's bringing [all of] that to people where they are comfortable gathering."

Linehan said that she isn't aware of any current webinar efforts aimed specifically at elders to answer their questions. She said that PHSKC's primary method is by going through community navigators and working with trusted organizations within BIPOC communities.

Munar said that to his knowledge, ICHS hasn't faced any hesitancy from elders to get vaccinated. There simply isn't enough vaccination supply at ICHS to outstrip demand at the moment. While he can't speak for other community organizations, Munar said that it has "been very difficult for us to obtain supplies."

"One of the things the State and City have to take a look at is where the supplies are going, and are they going to people that are actually working with the People of Color," Munar said. "I don't have data to show that they aren't getting to providers. It's just from our experience, as an organization that works with People of Color, we have had challenges in getting supplies and have had to really advocate for our organization to get access to the supplies."

ICHS spokesperson Angela Toda said that ICHS's vaccine supplies have allowed them to administer about 7,800 first and second doses since the health center started receiving supplies in December.

Linehan also said that her team is working with data gathered and categorized by ZIP code and race. With this data, she said, PHSKC can figure out which communities lack access to or information about the vaccine, allowing PHSKC to better focus its outreach and access efforts on those communities.

Though it should be noted that this data is only up-to-date as of March 1, it shows that inequities persist within south King County ZIP codes, where communities of color tend to live. As of this writing, none of the top 10 ZIP codes with documented first doses among people aged 65 and older are in south King County. This changes slightly when looking at first doses among residents aged 75 and older, but even then, only four south King County ZIP codes appear in the top 10 ZIP codes with documented first doses.

Separately, the University of Washington Department of Environmental & Occupational Health Sciences (DEOHS) has developed a tool that the City of Seattle said in a Feb. 23 press release will help it target underserved communities by showing which areas have the least access to the vaccine. DEOHS alumna and research consultant Esther Min is leading development of the tool, which the DEOHS' website on the tool's announcement says "combines census tract information and data from the Social Vulnerability Index developed by the U.S. Centers for Disease Control and Prevention."

"The index examines factors such as socioeconomic status, household composition, and minority status to assess community capacity to respond to and recover from disasters," the page says, and explains that "Min said a key takeaway from her research is the opportunity for the City to partner with community groups to set up pop-up vaccine clinics and do neighborhood-level outreach in areas identified on the map as being the hardest to reach."

Min is also drawing on her UW Population Health Initiative-funded work that found poorer neighborhoods in King County that have higher levels of air pollution usually also have higher rates of COVID-19 cases and lower testing rates.

DEOHS' Dr. Edmund Seto said that the tool can even help officials create targeted outreach that's as broad as ZIP code alone or as granular as door-to-door.

Greene, of SouthEast Seattle Senior Center, also told the Emerald that she had managed to secure about 100 or 125 doses of the vaccine for the center's elders with the City of Seattle at the City's new vaccination location at the Atlantic City Boat Ramp in Rainier Beach. Many of these appointments are for those elders whose February appointments had to be cancelled due to February's winter storm.

The Atlantic City Boat Ramp site is aimed specifically at underserved elders in the area. According to a March 1 press release, the site will be able to administer 1,000 vaccinations per week. Of those who registered on the site during its pilot period in February, 83% were elders from the BIPOC community. Of those elders who registered to get vaccinated the week of March 1, 85% were from the BIPOC community.

Though these doses are specifically reserved for people aged 65 and older, Office of the Mayor spokesperson Kelsey Nyland also said that caregivers for these folks are also eligible to be vaccinated at the site. However, they must make an appointment specifically for their own vaccinations at this site, in tandem with the person for whom they are caring.

Though this isn't unusual — Cole also said that tandem appointments are necessary, due to limited vaccine supply — this does create some hurdles for people who don't know to ask for this.

While this problem can be mitigated by community organization representatives who make appointments for elders, and through outreach and education, this doesn't necessarily mean that people won't still fall through the cracks. Greene said that a better way to handle this situation would be to automatically treat the elder and their caregiver as a unit, rather than individuals, particularly for elders who are otherwise homebound. The latter tend to be older seniors, she said, and having to leave their homes four times — twice for their own vaccines, and twice for their caregivers' vaccines — could be extremely difficult for them, physically and emotionally, even if the site is located close to home.

"A caregiver is a partnership with a person of whom they are taking care, as a husband and wife. That's the challenge. You want to do the most to minimize the disruption in their lives. Unfortunately, we are not seeing that happen," Greene said.

It appears PHSKC is trying to take such concerns into account. Cole told the Emerald in a Feb. 23 email that PHSKC's mobile vaccination teams are about to begin visiting the homes of individual homebound seniors. While she didn't have an exact date for when these home visits would start, she said that they would begin in March. Already, she said, PHSKC has begun calling homes to schedule appointments.

Separately, Swedish will be hosting pop-up vaccination clinics in partnership with area senior centers, including the SESSC and the Central Area Senior Center. The details of those clinics have yet to be ironed out, Anyaoku said. Swedish has also partnered with the City of Seattle and First & Goal, Inc. to co-operate a mass vaccination site at Lumen Field Event Center. The site is not yet operational, but officials said in a March 1 press release that "[a]ppointments will be prioritized for community-based organizations serving BIPOC communities, older adults, and immigrants and refugees, but DOH-eligible members of the public will be able to register for a vaccination at this site."

Officials estimate they will be able to administer about 5,000 first doses per week, at 2,500 doses per day over a two-day vaccination period. Supply permitting, at "peak operation," officials estimate that the site "could administer 21,000 vaccinations each day or 150,000 vaccinations every week to the entire region."

President Joe Biden also recently announced that his administration will be significantly ramping up vaccine production and aims to have enough vaccine available for every adult by May, two months earlier than expected. The Food and Drug Administration's Emergency Use Authorization for Johnson & Johnson's new one-dose vaccine has aided in this earlier-than-expected delivery time. On March 3, Washington State Gov. Jay Inslee said in a press release that the Western States Scientific Safety Review Workgroup has authorized the new vaccine for Washington State.

Community members who are interested in learning how to help or in volunteering with the SESSC should contact the center directly at (206) 722-0317. A list of donation items the center could use can be found here. As of March 2, the SESSC also has 200 vaccination appointments available for those who are eligible and asks that those eligible for the vaccine or their caregivers call the center directly to book an appointment with the center.

Community members who are interested in volunteering as a vaccinator with ICHS can follow the link here. Those who are interested in volunteering to help as registrants with language skills should contact ICHS's Human Resources staff at human_resources@ichs.com.

PHSKC said that it has "a process for bringing prospective volunteers on board." Interested volunteers should email King County's Public Health Reserve Corps (PHRC) at phrc@kingcounty.gov for more information and provide a brief description of their area of volunteer interest. Those who would like to volunteer with vaccination clinics will need to complete this process before participating. This process includes creating a profile in the State's online emergency worker volunteer database, signing volunteer forms and a volunteer handbook, and undergoing a background check. The enrollment process typically takes one to two weeks, and accepted volunteers will need to attend a virtual new volunteer orientation and complete certain FEMA Incident Command System courses within three months of being accepted.

📸 Featured Image: An elder receives a first dose of a COVID-19 vaccine at the Atlantic City Boat Ramp vaccination site in Seattle, Washington, on March 2, 2021. (Photo: Carolyn Bick)