Dr. Abbas Ali went to Walmart and bought himself a 12-by-18 picture frame.

It wasn’t a frame that he needed. As a pulmonary specialist and critical care physician who would soon be treating coronavirus patients, he wanted the Plexiglas. He removed the frame’s edges and fashioned the acrylic into a face shield that would protect him from patients’ coughs as he inserted ventilator tubes into their airways.

It was early March. Supplies for personal protective equipment were short and Ali was anticipating the wave of illness to hit Milwaukee. He knew health care workers would be at heightened risk.

He had good reason to be concerned.

Health care workers account for at least 17% of all COVID-19 cases in Wisconsin — and likely more, data collected since then shows.

Officials with the state Department of Health Services say health care providers could also account for a chunk of the 25% of cases where an occupation was not listed on test forms.

Faced with serious health risks every day and an ongoing shortage of adequate personal protective equipment, nurses, doctors and others who work in health care settings are expressing growing outrage as the pandemic rages on.

As the nation labels them heroes and honors them with songs, free meals and temporary housing, many front-line workers say they appreciate the support, but what they really want is proper gear to protect themselves and paid time off if they get sick.

“We’re frustrated that we continue to show up for battle against an enemy unlike one we’ve ever seen, without the protection, resources or the support that we need to do our job safely,” said Ryann Streicher, a labor and delivery nurse from the Madison area. “We’re frustrated that every day we work through fatigue, stress and hazards because we care about our patients, but we don’t see that same commitment from our elected leaders and our employers to support us in our vital work.”

Live Updates:The latest on coronavirus in Wisconsin

Daily Digest:What you need to know about coronavirus in Wisconsin

Share Your Story:We want to talk to doctors, nurses and others affected by coronavirus

At the same time hospitals across the country and in Wisconsin have faced shortages of masks and other protective equipment, individual health systems have implemented differing — and rapidly changing — policies pertaining to special pay, sick leave, furloughs and other aspects of employment during the pandemic.

On April 8, Advocate Aurora announced it would implement “special COVID-19 pay” for employees who work in the emergency department, dedicated COVID-19 units or in other units that have COVID-19 patient populations of at least 50%. Advocate Aurora, one of the largest health care systems in the country, has 15 hospitals and about 32,000 employees in Wisconsin.

The pay — an extra $6.25 to $15 per hour — is to be in place until the end of May and evaluated monthly thereafter, the announcement stated.

“We recognize and appreciate the contributions all of you are making,” said the letter, signed by President and CEO Jim Skogsbergh. “Sacrifice and selflessness clearly define the spirit of the Advocate Aurora Health team member and we are grateful to you all.”

Froedtert Health announced a similar plan April 13, but according to interviews and comments from an employee chat site, the plan stirred friction among staff. Complaints came from health care workers assigned to units that care for very sick COVID-19 patients but that didn’t have 50% or more patients with the virus.

“Wow. I spend 100% of my 12-hour shift caring for these patients though they make up less than 50% of our unit,” one employee wrote on Workplace, the hospital network’s internal chat site.

Another called the policy divisive and said it caused a drop in morale.

“I feel like WE ALL have to come into the building to WORK regardless of WHERE so we are ALL AT RISK JUST THE SAME,” wrote another. “We pass coworkers in elevators, corridors, parking structures … We are ALL risking our lives to come here.”

And another said simply: “I am incredibly disappointed in the lack of acknowledgement administration has for their staff.”

Cathy Jacobson, president and CEO of Froedtert Health, responded on the forum, informing the staffers that the pay policy was “consistent with current market trends” and that the special pay plan was put in place in anticipation of a “surge we have not yet experienced.”

“All health systems are experiencing dramatic declines in revenue and we need to balance focusing our resources on the response to the pandemic with ensuring financial stability,” Jacobson wrote. “That means we must put thresholds in place to determine when someone does and does not qualify for special pay.”

Jacobson then encouraged employees to “maintain a culture of dignity and respect in all forums, including on Workplace.”

Within 10 days, Froedtert Health had canceled the special pay altogether. Administrators said in a memo to employees that the plan had been based on estimates that the system’s hospitals would see more than 500 COVID-19 inpatients per day — which hasn’t happened.

Froedtert Health Systems instead has had roughly 70 to 80 COVID-19 inpatients across its campuses in recent weeks, administrators said.

A nurse who works with COVID-19 patients at Froedtert Hospital in Wauwatosa told the Milwaukee Journal Sentinel that workers were extremely upset when they learned that they would lose the hazard pay.

“There were tears, there was anger, there was disbelief … lots of feelings of abandonment,” said the nurse, who didn’t want to be identified for fear of retaliation.

Another Froedtert nurse said in an interview that the hazard pay plan “made no sense whatsoever” and that the focus should be on ensuring staff have sufficient safety equipment.

“They call us heroes, but we don't really want to hear that,” she said. “All we really want is what we need to do our job safely and the staff to do it.”

At Ascension, hospital administrators questioned the morality of nurses requesting hazard pay and called doing so “potentially unethical.”

“Hazard pay is additional pay for performing hazardous duty or work involving extreme physical hardship, and is not legally required or mandated,” the memo states. “Hazard pay is not appropriate, and perhaps unethical, for caregivers to ask for increased monetary payment to provide care in the pandemic.”

Considering the lack of safety equipment and the increased danger and workload required, nurses argued the extra pay was warranted.

In order to limit the number of people in rooms with COVID-19 patients, nurses have been required to take on additional tasks such as cleaning, removing trash and doing some of the work that physical therapists typically do — all while wearing used masks and gowns.

“Two days ago we were given boxes of masks that were dry rotting in the box,” said one nurse who works at an Ascension hospital emergency room. “The next box we were given was disintegrating during use and within two hours of wearing it had holes in it … We are scared for our lives.”

Ascension representatives said in cases where supplies are found to be "less than appropriate for use in a hospital setting, the product is immediately pulled and prevented to circulate."

Numbers show a clear risk of infection

At least 9,282 health care workers nationwide have contracted the virus and at least 27 have died, according to an April 14 report from the U.S. Centers for Disease Control and Prevention, which analyzed data from mid-February through early April.

As with the state figures, the national numbers are likely far higher. The data analyzed came from just a fraction of the 315,500 cases reported to the CDC during that time.

On a standardized form asking whether the individual who tested positive for COVID-19 was a health care provider, only 16% answered the question. Of the replies, 19% were identified as health care providers.

Another analysis by the CDC — of 12 states that have tracked health care provider status of COVID-19 tests — suggested that health care providers accounted for closer to 11% of all cases.

“The total number of COVID-19 cases among (health care providers) is expected to rise as more U.S. communities experience widespread transmission,” the April 14 report said.

Many area hospital systems have been tight-lipped about the number of staffers infected with COVID-19.

Ascension initially said in an email to the Journal Sentinel only that a “small number of staff and providers have tested positive.”

On Friday, after the Journal Sentinel first published a story describing Ascension's refusal to release the figures, representatives said that 41 of the health care network's 16,500 Wisconsin associates have tested positive for COVID-19.

“These individuals are quarantined at home and will return to work based on CDC guidelines,” wrote Ascension Wisconsin spokeswoman Victoria Schmidt. “Our infectious disease team works with the WI Department of Health Services on contact tracing and notifies patients, families, and associates in contact with these individuals, as appropriate.”

Froedtert Health declined to provide information to the Journal Sentinel on how many of its employees have contracted COVID-19.

“We had to beg to know the number of COVID patients we have in the hospital,” said one nurse. “They finally gave it to us, but won’t release how many employees have gotten sick, which I think we deserve to know.”

Aurora, meanwhile, provides employees with an update on the number of staff members overall who have tested positive for the virus. As of Wednesday, 389 employees had positive test results and 1,005 were in quarantine, according to Aurora’s internal COVID-19 System Tracker.

More than three dozen state lawmakers, all Democrats, urged GOP leaders in an April 13 letter to advance measures that would mandate that front-line health care workers are provided proper personal protective equipment, hazard pay, paid sick time and full health care coverage.

“As policy-makers we owe it to the public, public health, and those frontline health care workers to provide for what they need,” the lawmakers wrote to Assembly Speaker Robin Vos, R-Rochester, and Senate Majority Leader Scott Fitzgerald, R-Juneau. “We have heard directly from healthcare heroes about the circumstances confronting them; now it is up to us to act on their needs and with the urgency the situation demands.”

SEIU Healthcare Wisconsin, a union that represents about 6,000 health care workers and support staff across the state, is pushing for state lawmakers to enact legislation.

“Hospital systems have stockpiled cash for years, with tens of millions of dollars in annual “net income,” union leaders wrote in a statement. “They can provide healthcare heroes not only a living wage, but also hazard pay for their service during this pandemic.”

A rigid protocol, at work and at home

Ali — the critical-care physician who designed his own face shield from a picture frame and a welding helmet — isn’t counting on the hospitals to keep him safe.

He has implemented a rigid protocol in his personal and professional world to prevent the spread of the virus. The steps he takes underline the dangers all front-line workers face.

He carries a metal clamp that he uses to push elevator buttons at work and open cabinets.

He purchased a portable sink, as well as a washer and dryer, that he set up outside the garage at his Mequon home. When he comes home from caring for his COVID-19 patients, he goes into the garage and removes all clothing and items that could be contaminated. He washes his scrubs and leaves his work shoes outside. He wipes the steering wheel and transmission shift handle of his car with sanitizer as well as the door handles and window buttons.

He keeps his cellphone and pager in plastic cases and washes them after every use.

He uses one entrance to the house and has restricted his living space to a hallway, bedroom and bathroom, his “wing” of the house. He put tape down on the floor that separates areas that are clean and stays out of the kitchen and other parts of the house.

“I wipe down the door knobs and light switches when I come and go,” he said.

No family dinners with his wife and their three teenagers. No hugs or kisses. They are keeping at least 6 feet apart.

It’s been lonely, Ali said.

“I miss the quality time I used to spend with my family, especially the children,” he said. “I see it as a price I have to pay to keep my family safe and at the same time fulfill my professional obligation to serve the community ... This is a very challenging time.”

Maria Perez of the Milwaukee Journal Sentinel contributed to this report.

Editor's note, April 25 5:15 p.m.: Ascension representatives said in cases where supplies such as masks and gowns are not in appropriate condition to be used in a hospital, they are pulled. An earlier version of this story attributed this to a different hospital system.