Incarcerated people are also especially vulnerable to COVID-19 due to immutable conditions of confinement, well-documented unhygienic environments, and inadequate medical care in carceral facilities. Confinement itself creates risk of rapidly spreading contagions, but overcrowding compounds those general risks. Harsh, unhygienic environments further heighten risks, and correctional facilities in Massachusetts have a long history of failing to resolve documented environmental health violations. Finally, inadequate medical care in correctional facilities threatens lives.