How a Walmart in Worcester became a coronavirus hot spot

There’s another, more sobering number: 21. According to United For Respect, an advocacy group for Walmart workers, that’s how many store associates have died from the virus nationwide since the start of the crisis, including one worker at the Quincy Walmart who died on Sunday.

While the company did not address the nationwide total, it issued a statement of sympathy about the death of the employee in Quincy. “There are no words to express the loss of our associate, and we are mourning alongside their family," the company said in a statement on Tuesday.

“Every worker in a retail job that we know right now is terrified,” said Gillian Mason, co-executive director of the worker advocacy group Massachusetts Jobs With Justice. “Walmart can’t turn its stores into petri dishes where workers are constantly at risk.”

The sheer number of cases in Worcester makes it one of the largest outbreak clusters in the state, and among the largest at any retailer in the country. How it happened — despite social distancing measures, temperature screenings, and other CDC recommended guidelines — is a reminder of just how easily the virus can spread, public health officials say, and it should serve as a warning to all businesses looking to reopen in the wake of the crisis.

As of the March 31 announcement of its new procedures, Walmart said it would take several weeks to acquire the equipment for new safety measures in stores. But on or around April 7, the temperature screening and protective gear was in place at the Worcester Walmart off route 146, the company says. Just a few days later, the Worcester public health division began seeing COVID-19 cases that were ultimately tied to the store, said the city’s medical director, Dr. Michael Hirsh. But because the people who were diagnosed didn’t provide their work addresses, it was difficult to link them to Walmart, he said.

So, for the next two weeks the store continued to operate. During that time, Walmart’s corporate headquarters introduced new safety measures, including an April 20 mandate that masks be worn throughout the stores.

But it may have been too late. By the last weekend of April, workers were growing concerned about their co-workers falling sick, and Worcester residents began to express fears about visiting the store.

Worcester City Councilor Sarai Rivera began hearing from constituents: On Sunday, April 26, an elderly woman called Rivera after talking to a cashier at another Walmart nearby. “The cashier warned her not to go to the Walmart off Route 146 because it seemed like a lot of people were getting sick,” Rivera said.

The next day, another constituent reached out: Their spouse worked at the store, Rivera said, and was concerned as more and more people were falling ill. The employees “had started asking questions and no one was giving them answers," she said. “There was no communication."

Rivera reached out to city officials on Tuesday to share her concerns. By then, the officials had begun hearing from concerned family members of employees as well, Hirsh said. Soon after getting in contact with the city, the spouse texted Rivera again with a photo of a sign that had just been posted inside the store: Managers announced the site would be closed for cleaning on April 30, but “associates will be expected to work their scheduled shifts. We all will be helping to clean, sanitize and stock the store so we will be ready to open." The store managers anticipated opening the store the following day at 7 a.m.

The sign was the “straw that broke the camel’s back” Rivera said, and put Worcester city officials on high alert.

“As soon as we did get a tip that something was going on, one of our public health nurses contacted the store manager,” said Karyn Clark, Worcester’s public health director. But it took the nurse several hours to get through. In the interim, the nurse began going through the state’s MAVEN database, which tracks all infectious disease outbreaks in the state and started to suspect a cluster might be tied to the site.

When the nurse finally connected with Walmart, the company revealed that out of over 400 workers at the site, 23 people had contracted the virus. “That’s a big number," Clark said. “Once we confirmed, we felt like we needed to have swift action."

On the morning of Wednesday, April 29, a team of public health inspectors visited the store, and issued a cease and desist order to close it that afternoon, while shoppers were still in the aisles. “We realized that there was a cluster and there were concerns about distancing and other practices were not as tightly adhered to as we’d like,” Hirsh said.

Walmart officials say that they planned to shut down the store for cleaning on April 30, as they have with other locations across the country. “If there’s a place that needs specific attention, then we’ll take the steps necessary to close that store and bring a third party in,” said Charles Crowson, a company spokesman. He acknowledges that the Worcester store was "the first experience where city leadership came to us and asked that we close ahead of our scheduled plan.”

Over the ensuing hours, the city engaged in “extensive discussion” with Walmart on how best to mitigate the problem. By Thursday afternoon, the company had agreed to pay for the testing of all employees, and UMass Memorial Medical Center was able to coordinate tests on-site, setting up a staging area in the store’s outdoor garden center while the interior underwent a deep clean. Over the course of two days, nearly 400 workers were tested, revealing a number far higher than anyone anticipated: In all, 81 employees tested positive for the virus, many of whom were asymptomatic.

“It shows that we made the right call in shutting the store down,” Clark said.

Asked how the store could have seen such a heavy spread of cases, despite having protective measures in place, Walmart spokesman Crowson deferred. “I don’t have the capacity to answer that from a medical standpoint," he said. “But it’s a valid question to explore for sure.”

Cat Huang, the chief technology officer of United For Respect, the Walmart employee advocacy group, has spent the past several weeks fielding concerns about working conditions in stores. It’s led her team to launch a contact tracing tool on the group’s website allowing Walmart workers to report COVID-19 infections. Huang said they launched the site on April 29 with 248 cases they were aware of; since then, over 272 more have come in.

“We’ve heard from tens of thousands of associates about the challenges and fears working on the front lines of the epidemic,” Huang said. “A common theme was one of failure — the failure of Walmart to protect its people and their willful suppression of information around positive cases.”

The Worcester Walmart reopened on Tuesday. But health care officials know that the problems are far from over. Last week, Clark got a message from Quincy’s health commissioner, Ruth Jones, asking if she could share the language of Worcester’s cease and desist order. “She said ‘It looks like we have a cluster here,’" Clark said.

On Tuesday, Quincy officials worked with Walmart to shut down the store after 11 workers tested positive, and one worker died.

Clark hopes that the Worcester case serves as a reminder that community spread of the virus is ongoing.

“Hopefully other Walmarts will heed this as a warning and example that this is real," she said. “There are clusters everywhere.”

Katie Johnston of the Globe staff contributed to this report.

Janelle Nanos can be reached at janelle.nanos@globe.com. Follow her @janellenanos.