- Associated Press - Tuesday, January 21, 2020

COLCHESTER, Conn. (AP) - One day last August, Richard Pawulski was doing yardwork in his family’s lush, wooded backyard in Colchester, when he was bitten by a mosquito.

Pawulski, a healthy 42-year-old husband, father and physical therapist, had no idea he had been bitten, or that the mosquito that bit him was carrying the deadly Eastern equine encephalitis virus, commonly known as EEE.

Now, Pawulski is bedridden and struggles to speak after awakening from a two-month coma with a fatal prognosis. He said he feels like he has “gone through hell” and “wouldn’t wish this on anyone.”

On average, only seven people contract the virus in the United States each year, with a spike in 2019, according to the Centers for Disease Control and Prevention, which said there’s no one cause for the increase to nearly 40 cases last year.

In Connecticut, Pawulski was one of four people to contract the virus last year - and he is the only one who survived.



On Aug. 22, Pawulski began complaining of flu-like symptoms, including a high fever and stiff neck, according to his wife, Malgorzata Pawulski.

He was taken to Middlesex Hospital, where an MRI found fluid inside his brain. He was later transferred to Yale New Haven Hospital, where doctors ran a multitude of tests, trying to figure out why his health was declining so rapidly. Within days, he slipped into a coma. Doctors told his wife and daughter he would never wake up.

On Oct. 1, the mystery of what had made Pawulski sick was solved, but the prognosis was bleak. Pawulski had contracted the EEE virus, which had infected his brain.

The EEE virus can result in neurologic disease, including meningitis and encephalitis, or inflammation of the brain. Approximately a third of all people with encephalitis due to EEE die, usually within two to 10 days after the onset of symptoms. But many people infected with EEE have no apparent illness. It takes 4 to 10 days after the bite of an infected mosquito to develop symptoms.

The Pawulskis’ 14-year-old daughter, Amelia Pawulski, said she was “distraught” when she heard the diagnosis and got more and more afraid every time she heard on the news that another person had died from the virus.

“He was one of my best friends, I couldn’t imagine losing him,” said the teen, who said she feared her dad would miss her high school and college graduations and her wedding.

She often wanted to stay home from school, she said, because classmates were approaching her in the hall asking her about the virus. She became nervous about going outside, for fear of contracting it herself.

For about 60 days, Pawulski remained in a coma and was expected to die, as the state’s three other victims of the virus in Old Lyme, East Lyme and East Haddam had, according to the Connecticut Department of Public Health. His family made funeral arrangements and put him in hospice with palliative care, but remained hopeful that he would wake up.

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A toe moves

On Oct. 22, Richard’s mother, who has been visiting from Poland since her son fell ill, was brushing his teeth when she told him to stick out his tongue - and he did. In a video recorded by the family, his mother and wife can be heard crying and rejoicing over the first sign of consciousness in months.

After that, the good signs continued.

“He let us know he understood when we talked to him, squeezing his hand and moving his toes,” said his wife. “It was very emotional for us.”

Now, Richard is fully conscious and talking at Gaylord Specialty Healthcare in Wallingford, where he has been living for two months. He speaks to his wife on the phone every night and, though his speech is slow and quiet, holds full conversations with his daughter.

His daughter said his sense of humor and sarcasm is back, and his wife said he remembers everything.

Last week, his wife and daughter saw him stand up for the first time since he first went into the hospital in August. The couple’s daughter put her arm around her mom, as Malgorzata Pawulski teared up and cheered on her husband, telling him how proud she was of his progress.

“I didn’t believe that would be able to happen ever again, they told us he would never be able to do it,” Amelia said.

Physical and occupational therapists at Gaylord have been working with Richard to move him regularly from a hospital bed to a chair to strengthen his muscles and are helping him stand, with the goal of walking soon.

“The progress is very good,” said his wife of 17 years.

Before contracting EEE, Pawulski loved to work in his yard and go on vacation with his family, especially to areas like Mexico and the Dominican Republic, where he enjoyed scuba diving. He taught his daughter how to ski.

He worked as a physical therapist helping patients with brain injuries. Now, he spends his days in bed, working with physical and occupational therapists toward his own recovery.

“I’ve never had a patient with this diagnosis before because he is the only survivor in Connecticut,” said Megan Palmer, his occupational therapist at Gaylord.

“We treat him like any other neurologically impaired patient and we hope for the best. There’s really no boundaries, his recovery could be full,” said Palmer, who called Pawulski “a phenomenal miracle.”

“We have no idea, we just keep pushing the limits and challenging him and getting him to be the best he can be,” she said.

Caitlin Boland, his physical therapist, said when Pawulski came in, he was in what they called a “minimally conscious state” in which he would only occasionally wiggle a toe or finger. Now, he is responding to all commands and their therapy is focused on standing and walking, rather than making him comfortable for lifelong in-home care.

“His progress is amazing, it’s a really good story. He’s a really hard worker and never says no,” Boland said. “Every time we throw something at him, he surprises us and does it 10 times better than we would expect.”

Boland said she’s tried to keep in mind that Pawulski used to work with patients who were in the condition he is in now. “It’s definitely a unique experience, educating him on things he has probably educated people to do previously,” she said, adding that she thinks his background in physical therapy helps him pick up on things more quickly than other patients might.

Their common careers also put into perspective how anyone, regardless of their career path or life, could contract a virus like this.

“I think it allowed me to put myself in his shoes when he first got here, like ‘Wow, this can happen to anybody,’” she said.

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Last case in state was 2013

According to the CDC, a total of 38 EEE cases were reported nationwide in 2019, resulting in 15 deaths. Cases were reported in Alabama, Georgia, Indiana, Massachusetts, Michigan, New Jersey, North Carolina, Rhode Island and Tennessee, in addition to Connecticut. More than half of the reported cases were in New England.

Until this year, there was only one case of EEE ever reported in Connecticut, in 2013, according to the state public health department.

In cases where the infection doesn’t affect the central nervous system, people often recover completely from EEE. Patients whose central nervous system is affected can experience physical or mental damage ranging from mild brain dysfunction to severe intellectual impairment, seizures, paralysis and personality disorders, the CDC said.

Those who contract the virus likely first will experience a sudden onset of headache, fever, vomiting and weakness, according to Kate Fowlie, a spokesperson for the CDC, and may later experience confusion, sleepiness, seizures and coma.

In 2018, only six cases of EEE were reported nationwide.

Data shows that the CDC has been tracking the virus since 2009. Between 2009 and 2018, a total of 73 cases were reported, 30 of them fatal.

Fowlie said that spikes in the number of cases from year to year is not abnormal.

“As with most mosquito-borne diseases, there are several factors that contribute to years with higher than average case counts,” Fowlie said. “This could include changes in the bird and mosquito populations and immunity levels, weather patterns, and even human behaviors, including increased awareness and reporting.”

There is no approved vaccine or specific antiviral treatment for EEE infections in humans, she said. The virus is most commonly found in horses, for which there is a vaccine and treatment available, the CDC said.

Humans are infected with the virus “relatively rarely,” and the CDC attributes that to the fact that “the primary transition cycle takes place in and around cedar or hardwood swamp areas where human populations tend to be limited.”

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‘One minute changes your life’

When Pawulski contracted the virus he and his wife, who had both immigrated to the United States from Poland, had just purchased their first home, in Colchester, and were enjoying their first summer with a pool in their backyard.

Their daughter said she and her dad were very close and spent a lot of time swimming and horsing around in the pool.

“It was just like an American dream really,” she recalled.

Now that her father is recovering, the teen said she feels happy but is still worried. And although her family has grown closer, she doesn’t know if things will ever be the same.

Her mom, who works at Middlesex Hospital, has been driving an hour to his rehabilitation center every day. Amelia, a high school freshman, spends every weekend visiting her dad.

“It takes a toll on a person, because there’s only so much you can handle,” Amelia said.

As she looks back on what has happened to her family in the past year, she said her advice to others would be “don’t take things for granted, because you might lose them in a second.”

Her mother said that when she first took her husband to the doctor, she never imagined how drastically their life would change, but she encourages others who may be in a similar situation to not give up.

“One minute changes your life horrible, another minute changes your life like heaven,” she said of her husband’s shocking diagnosis and then surprising recovery.

Online: https://bit.ly/2RcuIrw

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