"They forgot about us": experiences of the COVID-19 pandemic among people deprived of housing in an urban centre in Ontario, Canada.

OBJECTIVES: People deprived of housing have been disproportionately affected by the COVID-19 pandemic and the public health mitigation measures implemented in response. Emerging evidence has shown the adverse health outcomes experienced by these communities due to SARS-CoV-2 infection; however, the voices of community members themselves have not been widely amplified in the published literature. METHODS: We conducted an interpretive qualitative study. People deprived of housing were involved in study development, recruitment, and data analysis. People deprived of housing or precariously housed were recruited during street outreach from June to July 2020. Participants completed one-on-one semi-structured interviews that were audio-recorded, transcribed, and analyzed thematically. RESULTS: Twenty-one participants were interviewed. Central to participants' experiences of the COVID-19 pandemic were descriptions of access to services, in terms of both changes in service availability and the reality of how accessible existing services were to the community, represented by the theme access. Four other themes were generated from our analysis and include feeling and being unheard, stripped of dignity, I've been broken, and strength and survival (with a subtheme, community care). CONCLUSION: Future emergency response efforts must meaningfully engage people deprived of housing in planning and decision-making in order to minimize adverse impacts of health emergencies and the associated public health responses. There needs to be more careful consideration of the unintended harmful impacts of public health measures implemented in response to pandemics.

RéSUMé: OBJECTIFS: Les personnes sans abri ont été démesurément affectées par la pandémie de COVID-19 et par les mesures sanitaires mises en œuvre en réponse à la pandémie. Des données probantes émergentes montrent les résultats sanitaires indésirables éprouvés par ces communautés en raison de l'infection par le SRAS-CoV-2, mais les voix des membres de ces communautés ne sont généralement pas amplifiées dans les articles publiés. MéTHODE: Nous avons mené une étude qualitative interprétative. Des personnes sans abri ont été mises à contribution dans l'élaboration de l'étude, le recrutement des participants et l'analyse des données. Des personnes sans abri ou au logement précaire ont été recrutées lors d'activités d'approche dans la rue en juin et juillet 2020. Elles se sont prêtées à des entretiens semi-directifs en tête à tête qui ont été enregistrés, transcrits, puis analysés par thèmes. RéSULTATS: Vingt et une personnes ont été interviewées. Leurs expériences de la pandémie de COVID-19 ont été fortement axées sur le thème de l'accès aux services, tant pour ce qui est des changements dans la disponibilité des services que de l'accessibilité réelle des services existants pour les membres de ces communautés. Quatre autres thèmes sont ressortis de notre analyse : le sentiment/le fait de ne pas être entendu, d'être dépouillé de sa dignité, d'avoir été brisé, et la force et la survie (et un thème secondaire : les soins de proximité). CONCLUSION: Les futurs efforts d'intervention d'urgence doivent inclure une véritable collaboration avec les personnes sans abri dans la planification et la prise de décisions afin de réduire les répercussions néfastes des urgences sanitaires et des mesures de santé publique connexes. Il faut examiner plus attentivement les effets pervers des mesures sanitaires mises en œuvre en réponse aux pandémies.

Tonic adaptation in symptomatic and asymptomatic subjects.

Tonic accommodation and tonic vergence were measured in symptomatic and asymptomatic subjects before, during, and after 45 min of binocular reading at near (5 D). Reading produced significant increases in both tonic levels, with the magnitude of change being similar in the two groups. After reading, both groups exhibited rapid loss of the tonic vergence effect, but showed no evidence for decay of the tonic accommodation effect. Differences between the groups were observed in the rate of adaptation during the course of reading, with both tonic components increasing more slowly for the symptomatic subjects than for the asymptomatic subjects. In addition, baseline tonic accommodation was significantly higher in the symptomatic group than in the asymptomatic group. The results suggest that although the failure to undergo tonic oculomotor adaptation is not a causal factor in asthenopia, the initial steady-state level and/or subsequent temporal changes of tonic accommodation and tonic vergence may be related to nearwork symptomatology.

Near work, visual fatigue, and variations of oculomotor tonus.

One hour of near work produced adaptive changes in the resting states of accommodation and binocular vergence, which may be responsible for different aspects of visual fatigue. Two groups of college students read from either hard copy or a video display terminal (VDT). Immediately before and after reading, the subjects' distance acuity, dark vergence, dark focus, and accommodative response accuracy for a monocular stimulus were measured. After reading, subjects also rated their subjective feelings of visual fatigue. Reading produced significant changes in both accommodation and vergence, which did not differ for the hard copy and VDT modes of presentation. Dark focus and accommodative responses shifted in the myopic direction by an average of 0.6 D and at least 0.35 D, respectively; dark vergence distance shifted in the convergent direction by an average of 11.4 cm. These changes were greatest for subjects whose initial resting postures corresponded to a far distance. After reading, one third of the subjects exhibited lower visual acuity at distance. This change was significantly correlated with changes in dark focus (r = 0.35) but not with changes in dark vergence (r = -0.12). In contrast, subjective ratings of visual fatigue were not correlated with changes in the dark focus (rho = 0.13), but they were significantly correlated with changes in dark vergence (rho = 0.58). These findings indicate that ordinary near work can produce significant changes in the resting states of accommodation and vergence, whose magnitude depend on the subject's initial oculomotor resting tonus.(ABSTRACT TRUNCATED AT 250 WORDS)