Foregone healthcare during the COVID-19 pandemic: early survey estimates from 39 low- and middle-income countries.

In addition to the direct health effects of the Coronavirus disease (COVID-19) pandemic, the pandemic has increased the risks of foregone non-COVID-19 healthcare. Likely, these risks are greatest in low- and middle-income countries (LMICs), where health systems are less resilient and economies more fragile. However, there are no published studies on the prevalence of foregone healthcare in LMICs during the pandemic. We used pooled data from phone surveys conducted between April and August 2020, covering 73 638 households in 39 LMICs. We estimated the prevalence of foregone care and the relative importance of various reported reasons for foregoing care, disaggregated by country income group and region. In the sample, 18.8% (95% CI 17.8-19.8%) of households reported not being able to access healthcare when needed. Financial barriers were the most-commonly self-reported reason for foregoing care, cited by 31.4% (28.6-34.3%) of households. More households in wealthier countries reported foregoing care for reasons related to COVID-19 [27.2% (22.5-31.8%) in upper-middle-income countries compared to 8.0% (4.7-11.3%) in low-income countries]; more households in poorer countries reported foregoing care due to financial reasons [65.6% (59.9-71.2%)] compared to 17.4% (13.1-21.6%) in upper-middle-income countries. A substantial proportion of households in LMICs had to forgo healthcare in the early months of the pandemic. While in richer countries this was largely due to fear of contracting COVID-19 or lockdowns, in poorer countries foregone care was due to financial constraints.

Thermodynamic Proof That the Thermal Energy of a Uniform Fluid Never Converts into Its Own Mechanical Energy.

The conversion of mechanical (i.e., kinetic and potential) energy into internal (or thermal) energy is ubiquitous in fluids, while the reverse process seems less common. Little is known a priori about in what circumstances the former conversion occurs or not. The present study investigates this problem by applying thermodynamics to nonequilibrium situations. It is thereby found that if a fluid is uniform in temperature, pressure, and composition, then its mechanical energy necessarily turns into its internal energy but not vice versa (with its kinetic energy determined relative to the vessel holding it). This result is essentially based on the second law of thermodynamics, but the conventional way of evaluating the energy conversion needs to be corrected to obtain it. It may constitute the first thermodynamically general and rigorous explanation of why heat is usually generated, e.g., when a liquid is stirred vigorously or when an electric current flows through an electrolyte solution. If a fluid is not uniform, however, it is possible that its internal energy is transformed into its mechanical energy. Such behavior is illustrated by considering a representative case in which two identical pure fluids are brought into contact with each other at the same temperature but at different pressures.