After months of decision-makers failing to heed warnings that the coronavirus pandemic made U.S. carceral facilities “ticking time bombs,” resulting in what critics have called “mass murder,” more than 200 health experts on Thursday urged President-elect Joe Biden to take swift action to reduce incarceration rates.

In a joint letter to the incoming administration’s Covid-19 Advisory Board, medical and public health professionals from institutions across the country called for safely releasing some detainees from federal, state, and local facilities—including jails, prisons, and immigrant detention centers—to limit the spread of the virus.

“Depopulating carceral settings, including for detained youth and immigrants, during the Covid-19 pandemic would save lives and help limit the spread of the virus to communities nationwide,” the letter says. “Physical distancing is unattainable in overcrowded and unsanitary carceral facilities, making viral outbreaks especially likely among a population with disproportionately high numbers of people who are medically vulnerable.”

Even though such facilities “have become leading coronavirus hotspots,” leaders at all levels “have not sufficiently sought to reduce the public health threat that their conditions present,” the letter says. The estimated 11% reduction in the detained population during the pandemic is “inadequate given the scale of U.S. incarceration.”

The letter explains how, in the absence of adequate efforts to drive down incarceration rates this year, infections have exploded in “dangerously overcrowded” facilities:

The rate of Covid-19 cases reported in federal and state prisons is over four times the national rate of confirmed cases. The Covid-19 mortality rate in prisons is twice that of the general population, after adjusting for age, sex, and race/ethnicity. Jails and immigration detention centers have also reported higher rates of Covid-19 positivity than the U.S. population. The movement of staff between correctional facilities and their communities and the close contact between staff and incarcerated people enables the virus to spread into and out of these facilities.

The Marshall Project and the Associated Press, which have been tracking Covid-19 infections and deaths in U.S. state and federal prisons since March, report that at least 197,659 prisoners had tested positive for the virus and 1,454 had died as of mid-November. By that same point, the letter notes, at least 42,000 corrections workers had tested positive and 86 had died, according to UCLA Law’s Covid-19 Behind Bars Project.

After detailing the “insufficient” efforts nationwide to reduce detention and incarceration in order to minimize the spread of Covid-19 behind bars—and the harmful and deadly consequences that follow—the letter urges the Covid-19 Advisory Board to make several recommendations to Biden and Vice President-elect Kamala Harris:

• Centers for Disease Control and Prevention shall explicitly recognize and include decarceration and expanded access to healthcare for incarcerated and recently released individuals as necessary guidance for federal, state, and local officials.
• Department of Justice leaders shall utilize existing authorities, such as compassionate release and home confinement, to expedite the immediate release or transfer of elderly and medically vulnerable people out of the Bureau of Prisons.
• Support Covid-19 relief funding for state, local, and tribal carceral systems to incentivize a significant reduction of incarcerated populations and to assist reentry and community-based organizations to respond to Covid-19.
• Direct the attorney general to minimize arrests, decline, to seek detention of individuals at their initial appearance in court, and consent to the release of those already detained, absent clear and convincing evidence that the person poses a specific threat of violence to a specific person.
• Support the Covid-19 in Corrections Data Transparency Act, which would require the BOP, U.S. Marshals Service, and state and local correctional agencies to report disaggregated data to the CDC on the effects of Covid-19 in their facilities, including any racially or ethnically disparate impacts.
• Ensure that pandemic-related decarceration is not racially imbalanced.
• Implement universal and regularly repeated testing for all correctional staff and people incarcerated.

“We urge you to recommend policies that are commensurate with the challenge before us,” concludes the letter, addressed to Drs. David Kessler, Vivek Murthy, Marcella Nunez-Smith, co-chairs of the Biden-Harris transition Covid-19 Advisory Board.

In a statement about the letter from the research and advocacy group the Sentencing Project, signatory Gregg Gonsalves of the Yale School of Public Health pointed out that “in the context of Covid-19 occupancy limits are being enforced for restaurants, bars, and other indoor settings around the country.”

“Detention and correctional facilities are crowded, often unsanitary spaces and should be subject to occupancy limits as well to stem the spread of SARS-CoV2,” added the epidemiology professor, using the formal name of the virus. “We need to decarcerate to keep people in these places and in the surrounding communities safe.”

Dr. Carlos Franco-Paredes from the University of Colorado, Denver, shared a broader message about social justice and the responsibilities of those in the health field.

“Health equity is a critical component of social justice and well-being and therefore addressing the longstanding history of social injustices leading to the unfair distribution of health and disease constitutes a critical priority of the practice of modern medicine,” Franco-Paredes said. “As physicians we must strive to reduce social inequities through advocacy efforts and policy change to remove racial residential segregation, food and housing insecurity, poor educational opportunities, discrimination, and other structural vulnerabilities including mass incarceration and the death penalty.”

“Health equity is not only about medical interventions during a clinical encounter; it involves community-activism to improve life opportunities and the redistribution of social capital and resources among marginalized communities to promote healthier lives and social wellness,” he added noting that “the Covid-19 pandemic has been responsible for as  many deaths among incarcerated individuals in the U.S. over a nine-month period as the total number of individuals executed by the death penalty over a 44-year period.”

In addition to demands for safely releasing people from carceral facilities, calls have mounted for detainees to receive priority Covid-19 vaccines once they become available. The Marshall Project reported Thursday that according to more than 40 draft proposals, incarcerated people will be among the “phase one” recipients of the vaccine in at least six states.

This post was originally published on Radio Free.