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The Psychosocial Impacts of COVID-19 on Children: A Parents’ Perspective 

 

 

 

By  

Nontokozo Macingwane  

 

Master of Arts 

Social and Psychological Research  

Supervisor: Dr Mpho Mathebula 

School of Human and Community Development  

Department of Psychology  

University of the Witwatersrand  

 

 

 

 

 

A research project submitted in partial fulfilment of the requirements for the degree of MA by Coursework and Research 

Report (Social and Psychological Research) in the Faculty of Humanities, University of the Witwatersrand, Johannesburg, 15 

March 2024.  

  



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ABSTRACT 

 

 

The societal and psychological repercussions of the COVID-19 pandemic on children have 

become a crucial focus, necessitating thorough examination. Given the pandemic's disruptions 

in various aspects of children's lives, ranging from education to social interactions, a 

comprehensive investigation is vital to unravel the intricate impacts on their well-being and 

development. This Qualitative research delves into the psychological and social consequences 

of COVID-19 on children aged 6-17 in Gauteng, South Africa. Through semi-structured 

interviews with seven participants, including parents and guardians, the study aimed to discern 

the psychological and social effects of the pandemic on their children. Employing thematic 

analysis, six major themes were identified: Psychological and Emotional Impact, Fear and 

Anxiety, Adjustment to Changes in Routine and Social Contact, Changes in Everyday 

Functioning, Impact on Learning and Education, and Changes in Behaviour and Emotions 

Post-Lockdown. The thematic analysis uncovered a range of emotional responses among 

children during the COVID-19 pandemic, including loneliness due to extended indoor 

confinement and diverse expressions of fear and anxiety. Furthermore, the findings emphasized 

the challenges in adapting to changes in social contact and routine, disruptions in everyday 

functioning, and notable consequences on children's learning and education. The COVID-19 

pandemic significantly impacted the psychological well-being and social functioning of 

children, underscoring the need for focused support to enhance their resilience and overall well-

being. The findings highlight the importance of prioritizing social connections, adaptive coping 

mechanisms, effective reintegration into educational settings, and collaborative efforts among 

stakeholders to support children's psychological resilience and overall well-being during and 

after the crisis. 

Key Words: Children, COVID-19, Psychological Impact, Social Impact  

  



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Declaration 

I, Nontokozo Macingwane, declare that this research report is a product of my independent 

work. I am submitting it for the Master of Arts in Social and Psychological Research at the 

University of the Witwatersrand, Johannesburg. This work has not been presented for any 

previous degree or examination at this university or any other institution.  

Signed:  

Date: 23/02/2024 

  



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Acknowledgements 

 

 

I express my heartfelt gratitude to the Almighty for His enduring mercy and blessings, guiding 

me throughout this academic journey. 

I wish to convey my sincere thanks to those who have played a vital role in the completion of 

this research. I am particularly grateful to my supervisor, Dr Mpho Mathebula, for her 

invaluable guidance, insightful feedback, and consistent support throughout the entire research 

process.  

My appreciation extends to the participants who generously shared their experiences and 

insights, crucial to the success of this study. 

 I also acknowledge the encouragement and understanding provided by my family and friends 

during the challenging phases of this research journey. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



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Contents 

 

ABSTRACT ........................................................................................................................................... 2 

Declaration............................................................................................................................................. 3 

Acknowledgements ............................................................................................................................... 4 

CHAPTER 1: INTRODUCTION ...................................................................................................... 10 

1.1 Introduction ................................................................................................................................... 10 

1.2 Background of the Problem ......................................................................................................... 10 

1.3 Statement of the Problem ............................................................................................................. 11 

1.4 Rationale ........................................................................................................................................ 12 

1.5 Research Aim ................................................................................................................................ 13 

1.6 Research Objectives ...................................................................................................................... 13 

1.7 Research Questions ....................................................................................................................... 13 

1.8 Summary of Research Methodology ........................................................................................... 14 

1.9 Chapter Outline of the Research Report .................................................................................... 14 

CHAPTER 2: LITERATURE REVIEW .......................................................................................... 16 

2.1 Introduction ................................................................................................................................... 16 

2.2 Coronavirus Disease-2019 ............................................................................................................ 16 

2.2.1 COVID-19 Transmission ....................................................................................................... 17 

2.2.3 Clinical Symptoms of COVID-19 ......................................................................................... 18 

2.2.4 COVID-19 Risk Factors ........................................................................................................ 20 

2.2.5 COVID-19 Diagnosis ............................................................................................................. 21 

2.2.6 Treatment and Management of COVID-19 ......................................................................... 22 

2.3 Global Impact of COVID-19 ........................................................................................................ 23 

2.4 COVID-19 in the South African Context .................................................................................... 24 

2.4.1 Intervention and Prevention of COVID-19 spread/outbreak in South Africa ................. 25 

2.4.2 Social Impacts of COVID-19 in South Africa ..................................................................... 27 

2.4.3 The State of Mental Health in South Africa during the Pandemic ................................... 28 

2.5 COVID-19 in Children ................................................................................................................. 29 

2.5.1 Diagnosis, Treatment and Management of COVID-19 in Children .................................. 30 

2.5.2 Impact of COVID-19 in Children ......................................................................................... 31 

2.5.3 Negative/Indirect Impact of COVID-19 on Children ......................................................... 32 

2.5.3.1 Family Level Factors ...................................................................................................... 33 

2.5.3.2 Child Level Factors ......................................................................................................... 36 



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2.5.3.4 Service level Factors ........................................................................................................ 40 

2.5.4 Positive Impacts of COVID-19 on Children ............................................................................ 42 

2.6.1 The Biopsychosocial Model ....................................................................................................... 43 

2.6.2 The Ecological Systems Theory ................................................................................................ 44 

2.7 Conclusion ..................................................................................................................................... 45 

CHAPTER 3: RESEARCH METHODOLOGY ............................................................................. 46 

3.1 Introduction ................................................................................................................................... 46 

3.2 Research Paradigm ....................................................................................................................... 46 

3.3Research Approach ........................................................................................................................ 47 

3.4 Sample and Sampling ................................................................................................................... 47 

3.5 Research Instrument .................................................................................................................... 49 

3.6 Method of Data Collection ........................................................................................................... 49 

3.7 Data Analysis ................................................................................................................................. 50 

3.8 Method of Data Verification ........................................................................................................ 51 

3.9 Ethical Considerations .................................................................................................................. 53 

3.10 Reflexivity .................................................................................................................................... 54 

3.11 Conclusion ................................................................................................................................... 55 

CHAPTER  4: RESULTS .................................................................................................................. 55 

4.1 Introduction ................................................................................................................................... 55 

4.2 Theme One:  Emotional Impact .................................................................................................. 57 

4.2.1 Loneliness due to extended periods of indoor confinement ............................................... 57 

4.3 Theme Two: Fear and Anxiety .................................................................................................... 58 

4.3.1 Consistent mask-wearing as manifestation of fear ............................................................. 59 

4.3.2 Frustration as response to challenges in understanding the pandemic............................. 59 

4.3.4 Surprising optimism and focus on safety guidelines ........................................................... 59 

4.4 Theme Three: Adjustment to Changes in Routine and Social Contact ................................... 60 

4.4.1 Challenges in adapting to lockdown restrictions................................................................. 60 

4.4.2 initial struggles to the loss of social contact ......................................................................... 60 

4.4.3 Negative impact on social life and hindrance in learning through play ............................ 61 

4.5 Theme Four: Changes to Everyday Functioning ....................................................................... 61 

4.5.1 Disrupted sleep patterns ........................................................................................................ 62 

4.5.2 Disrupted eating habits .......................................................................................................... 62 

4.5.3 Impact on daily lives and habits ........................................................................................... 63 

4.6 Theme Five: Impact on Learning and Education ...................................................................... 64 

4.6.1 Academic Pressure ................................................................................................................. 64 

4.6.2 Changes in transitioning from online to regular classes ..................................................... 65 



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4.6.3 Decline in Performance during Lockdown .......................................................................... 65 

4.7 Theme Six: Changes in Behaviour and Emotions Post-Lockdown .......................................... 65 

4.7.1 Cautious reconnection with social activities ........................................................................ 66 

4.7.2 Relief and excitement in returning to engagement ............................................................. 67 

4.8 Conclusion ................................................................................................................................. 67 

CHAPTER 5: DISCUSSION ............................................................................................................. 68 

5.1 Introduction ................................................................................................................................... 68 

5.1.1 Profound Impact of Extended Indoor Confinement on Children's Psychological Well-being 

during the COVID-19 Pandemic ....................................................................................................... 69 

5.1.2 Coping Mechanisms and Resilience: Understanding Children's Adaptive Responses to 

Fear and Anxiety during the COVID-19 Pandemic......................................................................... 70 

5.1.3 Exploring the Impact of Changes to Everyday Functioning on Children during the 

COVID-19 Pandemic .......................................................................................................................... 71 

5.1.4 Exploring the Far-reaching Impacts: How Disruptions in Sleep, Eating Habits, and Daily 

Routines Reflect the Comprehensive Influence of the COVID-19 Pandemic on Children's Lives

 .............................................................................................................................................................. 72 

5.1.5 Navigating Educational Challenges: Exploring the Impact of COVID-19 on Children's 

Learning and Academic Well-being .................................................................................................. 73 

5.1.6 The Dynamic Journey: Understanding and Nurturing Children's Emotional and 

Behavioural Responses in the Post-Pandemic Era ........................................................................... 75 

5.2 Conclusion ..................................................................................................................................... 76 

CHAPTER 6: LIMITATIONS AND RECOMMENDATIONS ..................................................... 76 

6.1 Introduction ................................................................................................................................... 76 

6.2 Limitations ..................................................................................................................................... 77 

6.3 Recommendations ......................................................................................................................... 77 

6.3.1 Technology Integration.......................................................................................................... 78 

6.3.2 Policy Advocacy ..................................................................................................................... 78 

6.3.3 Collaboration Between Stakeholders ................................................................................... 79 

6.3.4 Research .................................................................................................................................. 79 

6.4 Conclusion ................................................................................................................................. 80 

References ............................................................................................................................................ 81 

APPPENDIX A................................................................................................................................ 90 

Ethical Clearence Certificate ......................................................................................................... 90 

APPENDIX B .................................................................................................................................. 91 

Participant information sheet ........................................................................................................ 91 

APPENDIX C .................................................................................................................................. 93 

Consent form ................................................................................................................................... 93 

APPENDIX D .................................................................................................................................. 94 



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Interview Schedule .......................................................................................................................... 94 



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List of Tables 

 

Table 1. Parcipant Characteristics ....................................................................................... 48 

Table 2. Summarizing the main themes and Subthemes. .................................................. 57 

 

List of Figures 

Figure 1: Representation of Psychological and Emotional Impact ................................... 57 

Figure 2: Representation of Fear and Anxiety .................................................................... 58 

Figure 3: Representation of Adjustment to Changes in Routine and Social Contact ..... 60 

Figure 4: Representation of Changes to Everyday functioning......................................... 62 

Figure 5: Representation of Impact on Learning and Education ..................................... 64 

Figure 6: Representation of Changes in Behaviour and Emotions Post-Lockdown ....... 66 

  



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CHAPTER 1: INTRODUCTION   

1.1 Introduction  

The psychosocial impacts of the Coronavirus Disease-2019 (COVID-19) on children represent 

a crucial area of inquiry amid the global pandemic. As the virus rapidly spread across the world, 

children found themselves grappling with multifaceted challenges that extended beyond 

immediate health concerns. The closure of schools, implementation of social isolation 

measures, economic hardships faced by families, and disruptions to routine activities have 

collectively shaped the psychosocial landscape for children. This exploration delves into the 

unique experiences of children during the pandemic, aiming to unravel the complexities of their 

emotional and social well-being in the face of unprecedented global changes. 

1.2 Background of the Problem  

The global outbreak of the Coronavirus Disease-2019 (COVID-19), caused by the novel corona 

virus SARS-CoV-2, precipitated unprecedented challenges across the world (Umakanthan et 

al., 2020). Beyond its immediate health implications, the pandemic cast a profound impact on 

various aspects of society, particularly vulnerable populations such as children (Shereen et al., 

2020; Saladino et al., 2020). South Africa, like many other nations, grappled with the 

multifaced repercussions of the virus (Adebiyi et el., 2021).  

In the context of South Africa, the COVID-19 pandemic unfolded against a backdrop of 

existing social, economic, and healthcare disparities (Adebiyi et el., 2021). The country, 

characterised by diverse cultural landscapes and socioeconomic conditions, faced unique 

challenges in managing psychosocial implications of the virus, especially among children 

(Adebiyi et el., 2021). Although COVID-19 has been contained, its impact extends beyond 

immediate health concerns, intertwining with pre-existing issues and exacerbating 

vulnerabilities (Shereen et at., 2020).  

Children, as a particularly susceptible demographic, experienced the effects of the pandemic 

in distinctive ways (Bloom et al., 2022; Kim et.al., 2022). The closure of schools, social 

isolation measures, economic hardships faced by families, and disruptions in routine activities 

potentially influenced the psychosocial well-being of children (Bloom et al., 2022; Kim et al., 

2022). These circumstances underscore the importance of investigating and understanding the 

nuanced psychosocial impacts of COVID-19 on children within the South African context.  



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While extensive research has been conducted globally on the broader implications of the 

pandemic (Caggiano et al., 2020; Hiscott et al., 2020; Pawar, 2020), there is a noticeable gap 

in the understanding of specific psychosocial challenges faced by children in South Africa. 

Existing studies, such as those conducted by (Bloom et al., 2022; Evelyn Thsehla & Hofman, 

2023) often lack granularity in addressing the experiences of South African children during the 

global health crisis.  

This research study seeks to bridge the gap by delving into the psychosocial impacts of 

COVID-19 on children aged 6-17 years in South Africa. This study aims to contribute valuable 

insights that can inform interventions, and support systems tailored to the needs of South 

African children. The research intends to uncover the intricacies of children’s experiences, 

shedding light on both the challenges and resilience exhibited within this specific cultural 

context. In doing so, this research study aspires to advance our understanding of the 

psychological and social dimensions of the pandemic on the well-being of South African 

children.  

1.3 Statement of the Problem  

The COVID-19 pandemic, a contagious respiratory ailment that emerged from the wet markets 

of China in December 2019, has evolved into a global health crisis with far-reaching 

implications across age groups and societal landscapes (Umakanthan et al., 2020). Stemming 

from a coronavirus strain, this novel virus has not only posed a significant threat to physical 

health but has also cast a profound shadow on mental well-being and presented formidable 

societal challenges (Shereen et al., 2020; Saladino et al., 2020). As the world grappled with the 

rapid spread of the virus, various preventative measures, including the widespread adoption of 

masks, emphasis on hand hygiene, and the enforcement of physical distancing, were 

implemented in a bid to curb its transmission. Additionally, the development and distribution 

of vaccines emerged as a pivotal strategy to safeguard individuals against severe illness and 

hospitalization, offering a glimmer of hope during the pandemic. 

The undeniable impact of COVID-19 on children has been a focal point in numerous studies 

that have sought to address the psychological and social well-being of this vulnerable 

demographic during the ongoing crisis. Research conducted by Bloom et al. (2022) and Kim 

et al. (2022), among others, has predominantly focused on the objective effects of the pandemic 

on children, providing critical insights into the challenges they face. Bloom et al. (2022) 

documented significant psychological and emotional impacts on children, including heightened 



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feelings of loneliness due to extended periods of indoor confinement, increased fear, and 

anxiety stemming from uncertainty and disruption to routine activities. Additionally, 

disruptions in social contact and educational settings have presented substantial challenges for 

children's social development and academic progress. Kim et al. (2022) highlighted further 

issues faced by children, such as difficulties adapting to abrupt changes in daily routines and 

limited social interactions. The study revealed notable consequences on children's learning and 

education, with disparities in access to remote learning resources exacerbating educational 

inequalities. However, a discernible gap persists in the literature, particularly regarding the 

subjective experiences of parents and caregivers in relation to the pandemic's impact on their 

children. The dynamic interplay between the child's perspective and the parent's perception is 

a crucial aspect that requires deeper exploration, as it holds the potential to unravel a more 

comprehensive understanding of the multifaceted consequences of COVID-19 on children. 

The COVID-19 pandemic presents a significant problem for children due to its pervasive 

effects on physical health, mental well-being, and social development. Children are particularly 

vulnerable to the indirect impacts of the pandemic, including disruptions to routine activities, 

limited social interactions, and challenges in accessing educational resources. These 

disruptions can have long-lasting consequences on children's overall well-being and 

development, underscoring the urgent need for research to explore and address the complex 

ramifications of COVID-19 on children's lives (Umakanthan et al., 2020; Shereen et al.,2020). 

1.4 Rationale  

Several studies done during the COVID-19 pandemic consciously excluded children from their 

research endeavours, primarily driven by ethical considerations inherent in investigating this 

vulnerable population. El Seira, Adriany, and Kurniati (2020) underscored the myriad 

challenges faced by researchers when attempting to study children during the outbreak, 

highlighting ethical concerns that prompted a cautious avoidance of face-to-face interactions 

to safeguard the well-being of the children involved in data collection. Consequently, the 

studies on the psychological and social impacts of COVID-19 on children leaned towards a 

more objective and quantitative orientation, perhaps as a pragmatic response to the ethical 

complexities associated with direct engagement. 

To achieve a more comprehensive and nuanced understanding of the psychosocial impacts on 

children, a qualitative approach becomes imperative. The intricacies of children's experiences, 

emotions, and coping mechanisms demand a more in-depth exploration that goes beyond 



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quantitative metrics. However, within the South African context, there is a glaring scarcity of 

qualitative studies specifically focusing on the psychosocial impacts of COVID-19 on children. 

This dearth of qualitative research limits the depth of insights available and hampers efforts to 

tailor interventions and support systems that address the unique needs of children. 

This research endeavours to contribute significantly to the existing body of knowledge by 

shifting the focus towards the subjective experiences of parents in understanding the 

psychosocial impacts of COVID-19 on children. By exploring the intricate interplay between 

parental perspectives and the well-being of children aged 6-17 in Gauteng, South Africa, this 

study aspires to offer nuanced insights that can inform targeted interventions, support systems, 

and policy decisions tailored to the unique needs of children in this region during and beyond 

the pandemic. 

In essence, the exclusion of children from many studies, coupled with the predominance of 

quantitative approaches and the scarcity of qualitative research within the South African 

context, underscores the urgency of adopting a more holistic and culturally sensitive 

investigative approach. By employing qualitative methods that delve into the lived experiences, 

perceptions, and emotions of children in the wake of COVID-19, this research study seeks to 

fill the existing knowledge gaps and enhance our overall comprehension of the psychosocial 

impacts on this vulnerable population within the South African context. 

1.5 Research Aim 

To explore the psychological and social impacts of COVID-19 on children aged 6-17 years in 

Gauteng, South Africa.  

1.6 Research Objectives  

1. To explore parents’ perceptions and understanding of the psychological and social 

impacts of COVID-19 on children. 

2. To explore children’s adjustment to the national lockdown restrictions 

3. To explore children’s adjustment after the pandemic.  

1.7 Research Questions  

1. What are parents’ perceptions and understanding of the psychological and social 

impacts of COVID-19 on children? 

2. How did children adjust to the lockdown restrictions during the COVID-19? 



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3. How did children adjust after the pandemic? 

1.8 Summary of Research Methodology  

In this research, a total of seven participants, including adults with children and young 

adolescents aged 6-17, were interviewed using snowball sampling through social media 

platforms. Participants included parents, aunts, uncles, grandparents, and older siblings, 

representing diverse familial roles. Exclusion criteria were applied to individuals with severe 

mental health conditions, and the study focused exclusively on participants residing in the 

Gauteng province. The research adopted an interpretive research paradigm to understand the 

subjective meanings individuals assign to their experiences during the COVID-19-2019 

pandemic. Data was collected through in-person, semi-structured, and in-depth interviews 

lasting approximately 45 minutes to 1 hour, focusing on children's reactions during lockdowns 

and the post-pandemic period. Ethical considerations were prioritized, including obtaining 

ethical clearance, written informed consent, and maintaining confidentiality. Thematic analysis 

was employed for data analysis, ensuring a rigorous and systematic approach to uncovering the 

psychological and social impacts of COVID-19 on children. 

1.9 Chapter Outline of the Research Report  

Chapter 1 serves as the introduction to the study, delineating the statement of the problem and 

providing the rationale for the research. The chapter outlines the aim and objectives that 

underpin the study, setting the stage for a comprehensive exploration of the psychosocial 

impacts of COVID-19 on children in the South African context. 

In Chapter 2, the literature review unfolds, offering a detailed discussion of existing literature 

on various dimensions: COVID-19, its impact on children, the specific context of South Africa, 

and the theoretical framework guiding the study. This comprehensive review provides a 

foundation for understanding the broader landscape and theoretical underpinnings of the 

research. 

Chapter 3 shifts focus to the methodology, placing the study within a descriptive framework. 

It provides insight into the sample selection process, which involved seven parents and 

guardians sharing their experiences. The chapter details the methods of data collection and 

analysis, emphasizing their completeness, relevance, and meaningfulness. Ethical 

considerations are also expounded upon, ensuring transparency and ethical integrity in the 

research process. 



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Moving on to Chapter 4, the findings of the study are presented and discussed in-depth, 

utilizing thematic data analysis, and drawing connections to relevant theoretical frameworks. 

This chapter unfolds the nuanced complexities of the psychosocial impacts of COVID-19 on 

children, supported by verbatim quotes and a thorough exploration of the data. 

Chapter 5 serves as the culmination of this study, encapsulating conclusions drawn from the 

research. This chapter synthesizes key insights gained, emphasizing their implications and 

potential applications in understanding, and addressing the psychosocial impacts of COVID-

19 on children in the South African context. It primarily comprises a detailed discussion, 

providing comprehensive insights into the themes identified through thematic analysis. 

Chapter 6 is dedicated to exploring the limitations of the current study. It critically examines 

the constraints, challenges, and potential biases inherent in the research methodology. 

Additionally, Chapter 6 provides valuable recommendations for future research, emphasizing 

areas for improvement and suggesting avenues for further investigation into the psychosocial 

impacts of COVID-19 on children. 

 

 

 

 

 

 

 

 

 

 

 



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CHAPTER 2: LITERATURE REVIEW  

2.1 Introduction  

This chapter undertakes a comprehensive exploration of existing literature, focusing on four 

pivotal dimensions: COVID-19, its impact on children, the South African context, and the 

theoretical framework guiding the research. By synthesizing and critically analysing the wealth 

of knowledge available, this chapter lays the groundwork for a more informed and contextually 

rich investigation into the psychosocial impacts of the COVID-19-2019 on children in South 

Africa. The examination of global implications, specific effects on children, unique challenges 

in the South African context, and the theoretical lenses employed ensures a robust foundation 

for understanding the multifaceted dynamics of the research topic.  

2.2 Coronavirus Disease-2019 

The World Health Organization (WHO) made a landmark declaration on March 11, 2020, 

officially classifying the COVID-19-2019 (COVID-19) as a global pandemic. This decisive 

move came in response to the escalating number of coronavirus cases worldwide (Kakodkar et 

al., 2020). At the core of this pandemic was the novel coronavirus, scientifically identified as 

SARS-CoV-2, marking the seventh known coronavirus capable of affecting humans and 

causing the disease now universally recognized as COVID-19 (Platto et al., 2020). 

According to insights provided by (Berche, 2023), two prevailing theories sought to unravel 

the origins of COVID-19. The first posited that the outbreak emerged in China towards the end 

of 2019, attributing the genesis to the consumption of animals carrying the pathogen. The 

second theory suggested a potential laboratory incident involving gain-of-function 

manipulation of SARS-CoV-2. 

Tracing the initial cases of COVID-19 back to Wuhan, the epicentre of the outbreak, attention 

was drawn to a seafood market that featured live species of bats, pangolins, snakes, and badgers 

(Kakodkar et al., 2020). Research findings by various sources, including (Gibson et al., 2020; 

Melo Neto et al., 2020; Platto et al., 2020; Qureshi et al., 2021), converged on the conclusion 

that bats played a pivotal role in the virus's genesis. Snakes and pangolins, identified as 

intermediary hosts, further fuelled the transmission of the virus (Melo Neto et al., 2020). 

A critical aspect of the virus's evolution was its ability to become infective through contact 

with an animal reservoir. This reservoir served as an environment conducive to the virus's 

multiplication and acquisition of genetic mutations. These mutations played a pivotal role in 



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enabling the coronavirus to cross species boundaries, proliferate, and effectively infect human 

hosts (Platto et al., 2020). 

As the world grappled with the relentless spread of COVID-19, the WHO, in an online report, 

grimly reported staggering figures. From December 2019 to July 2023, the global tally 

surpassed 767 million confirmed cases, with a devastating toll of over 6 million reported deaths 

(WHO, 2023). The gravity of these numbers underscored the profound impact of COVID-19 

on a global scale, leaving societies, healthcare systems, and economies strained in 

unprecedented ways. 

2.2.1 COVID-19 Transmission 

Melo Neto et al. (2020) provides valuable insights into the persistence and transmission 

dynamics of the coronavirus. Their research highlights that the virus could maintain its 

infectious viability on inanimate surfaces within the temperature range of 21-23 degrees 

Celsius for up to three days. This revelation underscored the importance of stringent hygiene 

measures and surface disinfection to curb the potential spread of the virus. 

Examining the incubation period of the coronavirus, the research by (Melo Neto et al., 2020) 

revealed a variable timeframe ranging from one to fourteen days. Notably, instances were 

documented where an extended incubation period of 24 days was observed. 

Melo Neto et al. (2020) identified two critical factors influencing the transmission of the 

coronavirus. Firstly, the virus exhibits contagiousness during its incubation period, implying 

that individuals could transmit the virus even before manifesting symptoms. This feature 

heightens the challenge of early detection and containment. Secondly, individuals infected with 

the virus remain contagious for the duration of their symptomatic phase, extending the risk of 

transmission throughout the course of illness and even on clinical recovery. 

Several additional factors are implicated in the transmission dynamics of SARS-CoV-2. Daily 

habits, encompassing frequented places and personal hygiene practices, played a role in the 

likelihood of viral spread (Djordjevic et al., 2021). Environments with lower temperature and 

humidity were identified as facilitating faster transmission. Closed spaces where individuals 

shared breathing air were noted as high-risk settings for virus transmission. 

 



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2.2.3 Clinical Symptoms of COVID-19 

The clinical landscape of COVID-19 unfolded with a remarkable spectrum of manifestations, 

varying from mild to severe, and even critical. Understanding the nuances of these clinical 

presentations is pivotal in devising effective strategies for detection, management, and long-

term care. 

As elucidated by Gao et al. (2021), the elusive nature of asymptomatic cases poses a unique 

challenge. Unlike symptomatic individuals, those with asymptomatic manifestations show no 

overt clinical symptoms or abnormal imaging findings. Remarkably, the absence of a specific 

incubation period for asymptotic symptoms makes early detection a complex task. Gao et al. 

(2021) underscored that despite the lack of apparent symptoms, asymptomatic individuals 

remain capable of testing positive for COVID-19 through the Transcriptase-polymerase chain 

reaction (RT-PCR) test. The revelation that asymptomatic carriers retained the potential to 

transmit the virus to others emphasized the need for widespread testing and preventive 

measures. 

Tragically, a substantial number of asymptotic cases went unnoticed due to the lack of obvious 

symptoms and poor prevention awareness. This inadvertent oversight significantly contributed 

to the swift global dissemination of the virus. The global health community faced the challenge 

of not only identifying and isolating symptomatic cases but also implementing strategies to 

detect and contain the elusive asymptomatic carriers. 

Moving to the mildest end of the spectrum, the most common clinical symptoms associated 

with COVID-19, as reported by (Gao et al., 2021), include a constellation of discomforts such 

as sore throat, muscle pain, fever, fatigue, cough, nasal congestion, headache, anorexia, 

malaise, and diarrhoea. While individually these symptoms might appear mild, collectively 

they play a significant role in the detection of the virus. Alimohamadi et al. (2020) highlighted 

the importance of recognizing these mild symptoms as they served as indicators for further 

testing, quarantine measures, and contact tracing, thereby contributing to the broader effort of 

controlling the virus's spread. 

Individuals with mild symptoms of COVID-19 typically do not exhibit dyspnoea or shortness 

of breath, and their imaging findings remained within the normal range. This category of 

patients, as suggested by the National Institutes of Health (NIH, 2023), often received treatment 

at home through telemedicine or in an ambulatory setting, underlining the feasibility of 

managing mild cases outside of the hospital environment. 



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Moderate clinical manifestations, characterized by shortness of breath and mild pneumonia 

symptoms on chest imaging (Gao et al., 2021), presents a more challenging scenario. NIH 

(2023) recommended close monitoring for individuals experiencing moderate symptoms due 

to the potential for rapid progression. While these cases fall short of severe manifestations, the 

need for vigilant observation underscored the dynamic nature of the disease and the 

significance of timely intervention. 

Severe symptoms of COVID-19 signal a more critical phase, encompassing respiratory 

infection symptoms, shortness of breath, and oxygen saturation levels equal to or below 93% 

(Gao et al., 2021a; NIH, 2023). The severity of these symptoms warrants hospitalization, where 

patients receive oxygen therapy to address the compromised respiratory function. The rapid 

clinical deterioration observed in severe cases underscored the importance of timely and 

targeted medical intervention. 

At the apex of the clinical severity spectrum lies the critical manifestations of COVID-19, 

representing the most severe cases. These critical symptoms include a rapid progression of the 

disease, respiratory failure, cardiac shock, thrombotic disease, organ failure, and exacerbation 

of underlying comorbidities (Gao et al., 2021a; NIH, 2023). Patients experiencing critical 

symptoms often find themselves in the Intensive Care Unit (ICU), where a multidisciplinary 

approach is employed to manage the complexities of the disease. Treatment strategies include 

the use of immunomodulators to modulate the immune response, addressing any comorbid 

conditions, and managing nosocomial complications. 

Post-recovery, individuals who successfully battle COVID-19 may face a new phase of 

challenges, as discussed by (Kamal et al., 2021). The long-term effects and manifestations that 

persisted after recovery required thorough evaluation and targeted treatment. The study 

revealed that approximately 10.8% of recovered patients remained asymptomatic, providing 

insights into the subset of individuals who might be overlooked in post-recovery care. 

Furthermore, a significant proportion of individuals experienced lingering symptoms and new 

conditions, shedding light on the importance of comprehensive post-recovery care programs. 

Fatigue emerged as the most common post-recovery symptom, affecting a considerable portion 

of individuals who had battled the virus. This persistent fatigue, often described as post-viral 

fatigue syndrome, presents a challenge for both patients and healthcare providers. 

Understanding and addressing these post-recovery symptoms is integral to ensuring the holistic 

well-being of individuals who had weathered the acute phase of the disease. 



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A smaller percentage of individuals, as revealed by (Kamal et al., 2021), suffered from critical 

post-recovery complications such as myocarditis, stroke, and pulmonary fibrosis. These 

findings underscored the need for ongoing monitoring and specialized care for individuals with 

a history of COVID-19. The long-term impact of the virus on various organ systems 

necessitated a nuanced and comprehensive approach to post-recovery healthcare. 

2.2.4 COVID-19 Risk Factors 

Qureshi et al. (2021) provides valuable insights into common risk factors associated with 

COVID-19 infection, shedding light on the multifaceted nature of susceptibility and severity. 

Among the prominent risk factors identified, age is a critical determinant of the disease's 

impact. Older individuals are found to be at a higher risk of developing severe illnesses when 

infected with COVID-19-2019. As age increases, so does the associated risk of mortality.  

Comorbidities represent another significant risk factor associated with COVID-19 infection. 

Individuals, regardless of age, who have pre-existing serious health conditions such as diabetes, 

lung issues, heart conditions, a weakened immune system, or obesity face an elevated risk of 

developing severe illness and complications upon contracting the virus.  

In addition to age and comorbidities, several other risk factors are linked to COVID-19 

infection. These included C-reactive protein (CRP), body temperature, D-dimer, albumin 

levels, and the Sequential Organ Failure Assessment (SOFA) score. Elevated levels of CRP, 

an inflammatory marker, often indicate a more severe immune response to the virus. 

Monitoring body temperature is crucial as fever is recognized as a common symptom and an 

indicator of infection. D-dimer levels, indicative of blood clot formation, are identified as a 

risk factor, reflecting the virus's potential to induce coagulation-related complications. 

Albumin levels, reflecting nutritional status and overall health, also play a role in assessing the 

severity of the infection. The SOFA score, encompassing multiple organ systems, serves as a 

comprehensive tool to evaluate the extent of organ dysfunction and predict outcomes. 

Understanding these diverse risk factors allowed healthcare professionals to tailor their 

approach to patient care, implementing targeted interventions based on individualized risk 

profiles. These risk factors not only influence the severity of the disease but also guided 

decision-making regarding hospitalization, treatment strategies, and post-recovery care. 



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2.2.5 COVID-19 Diagnosis 

The diagnosis of COVID-19-2019 relies on a combination of clinical symptoms, 

epidemiological contact, and a positive COVID-19 test, as emphasized by (Gibson et al., 2020; 

Melo Neto et al., 2020). The Berlin diagnostic criteria play a pivotal role in confirming COVID-

19 infection, requiring the presence of acute hypoxemic respiratory failure, bilateral airspace 

worsening on imaging studies like computed tomography (CT), chest X-ray, or ultrasound, not 

fully explained by other factors, and a presentation within one week of worsening respiratory 

symptoms. This comprehensive approach aimed to ensure accurate and timely diagnoses, 

particularly in cases where respiratory distress was a primary concern. 

Molecular detection of the viral genome, specifically the Severe Acute Respiratory Syndrome 

Coronavirus 2 (SARS-CoV-2) ribonucleic acid, stands out as a fundamental method for 

confirming COVID-19 infection (Qureshi et al., 2021). Various samples, including urine, 

feces, upper respiratory tract specimens, and lower respiratory tract specimens, are analysed 

for the presence of the virus. The two primary diagnostic tools that gained prominence are 

Reverse Transcription Polymerase Chain Reaction (RT-PCR) and CT scans (Kakodkar et al., 

2020). 

RT-PCR, developed by the Centres for Disease Control and Prevention (CDC), emerged as the 

gold standard for COVID-19 diagnosis. This technique demonstrates high sensitivity, capable 

of detecting even low viral titters. Its 95 percent sensitivity allows for the early and accurate 

identification of infections, facilitating prompt intervention and containment efforts (D’Cruz 

et al., 2020). The widespread adoption of RT-PCR as the standard diagnostic tool marks a 

crucial step in the global response to the pandemic, enabling efficient and reliable confirmation 

of COVID-19 cases. 

CT scans, characterized by their speed, non-invasiveness, and accessibility, prove to be 

valuable tools for diagnosing pneumonia and are particularly common in COVID-19 patients. 

Not only did CT scans provide rapid results, but they also exhibit great sensitivity in detecting 

viral presence. This imaging technique plays a crucial role in assessing the severity and extent 

of lung involvement, guiding healthcare professionals in determining appropriate treatment 

strategies  (Qureshi et al., 2021). 

Blood testing is an additional diagnostic avenue for COVID-19, according to Kakodkar et al. 

(2020) and Gibson et al. (2020). Blood tests reveal distinct patterns in COVID-19 patients, 

showcasing either normal or decreased lymphocyte counts and leucocytes. These 



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haematological indicators contribute to the overall diagnostic picture, aiding healthcare 

professionals in assessing the patient's immune response and formulating a comprehensive 

understanding of the disease's impact on the body. 

In retrospect, the integration of diverse diagnostic tools marks a critical aspect of the global 

effort to combat the COVID-19 pandemic. The combination of clinical criteria, molecular 

detection methods like RT-PCR, imaging techniques such as CT scans, and blood tests 

facilitates a multidimensional approach to diagnosis. This comprehensive strategy not only 

ensures the accuracy of COVID-19 diagnoses but also provides valuable insights into the 

disease's clinical manifestations and severity, guiding appropriate medical interventions and 

public health measures. 

2.2.6 Treatment and Management of COVID-19  

The effectiveness of COVID-19 treatment hinges on its timely administration, ideally within 

days after the onset of clinical symptoms, as emphasized by the Centres for Disease Control 

and Prevention (CDC) in 2023. Antiviral medications play a pivotal role in managing 

individuals with mild to moderate symptoms of COVID-19. These approved antiviral 

treatments targeted specific components of the virus, impeding its replication within the host's 

body. By doing so, these antiviral medications not only alleviate symptoms but also play a 

crucial role in preventing the progression of the infection to severe illness or death. 

Individuals experiencing mild symptoms of COVID-19, which are identified as the most 

manageable, were often able to recover and receive treatment at home. Over-the-counter 

medications, such as paracetamol, proved effective in addressing mild symptoms, providing 

relief to patients without the need for hospitalization. Additionally, medications like Tylenol 

and ibuprofen are commonly used in the treatment of mild symptoms, as outlined by the CDC 

in 2023. 

For those facing severe respiratory distress, supplementary oxygen at a rate of 5 litters per 

minute is a standard intervention. The provision of oxygen support is critical in managing 

severe cases, ensuring that patients received the necessary respiratory assistance during the 

acute phase of the infection. In instances where complications like acute kidney injury (AKI) 

and septic shock arise, a comprehensive approach involving renal replacement therapy and 

adherence to sepsis protocols is implemented, as detailed by (Kakodkar et al., 2020). 



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Kakodkar et al. (2020) highlights an additional concern in the treatment of COVID-19 patients, 

noting the potential development of fungal infections in the middle or later stages of the disease. 

To address this, individuals are provided with empiric antimicrobial coverage, underlining the 

importance of a holistic and proactive approach to managing the varied manifestations of the 

virus. 

Moreover, the introduction of vaccines marked a significant milestone in the fight against 

COVID-19. Designed to prevent severe illness and protect individuals from reinfection, 

vaccines aimed to decrease both the spread of the virus and the associated mortality rate. 

Vaccination efforts were critical in establishing widespread immunity within populations, 

contributing to the global strategy to curb the impact of the pandemic. 

The evolution of COVID-19 treatment strategies involved timely administration of antiviral 

medications, effective management of symptoms, and proactive measures to address potential 

complications. The introduction of vaccines played a pivotal role in preventing severe 

outcomes and reducing the overall impact of the virus. The past approach to COVID-19 

treatment reflects a dynamic and multifaceted response, incorporating a range of interventions 

to address the diverse clinical presentations and severity levels associated with the disease. 

2.3 Global Impact of COVID-19  

The global repercussions of the COVID-19 pandemic have been extensive, touching nearly 

every facet of human existence and societies on a worldwide scale. Stemming from the novel 

coronavirus SARS-CoV-2, the outbreak resulted in widespread sickness, loss of lives, 

disruptive economic patterns, and profound alterations in daily life. Health systems in 

numerous countries grappled with unparalleled challenges, facing overwhelmed hospitals, and 

strained medical resources as they coped with the surge in cases (WHO, 2020). The rapid 

transmission of the virus across borders underscored the interdependence of our globalized 

world, emphasizing the need for cohesive international strategies in effectively managing 

public health crises. 

On the economic front, the pandemic served as a catalyst for a global recession, affecting 

businesses, industries, and livelihoods across the board. Imposed lockdowns, travel 

restrictions, and disruptions in supply chains contributed to widespread unemployment and 

financial instability. This economic downturn disproportionately impacted vulnerable 

communities, exacerbating pre-existing inequalities within and between nations (Internation 

Monetary Fund, 2020). Governments around the world responded with a range of stimulus 



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packages and relief measures, emphasizing the imperative for collaborative global strategies to 

address the socio-economic challenges resulting from the crisis. 

Beyond the realms of health and economics, COVID-19 instigated transformative shifts in 

social dynamics and cultural norms. The pandemic accelerated the widespread adoption of 

remote work, online education, and virtual social interactions, fundamentally altering the way 

individuals lead their lives and conduct work (Cheng et al., 2021) . The shared experience of 

navigating through lockdowns and adhering to social distancing measures has left an indelible 

mark on mental health, community relationships, and perceptions of personal and societal 

resilience. 

2.4 COVID-19 in the South African Context 

South Africa emerged as the most profoundly affected country by the COVID-19 pandemic in 

Africa, as highlighted by Stiegler and Bouchard (2020). The initial case of COVID-19 in South 

Africa was reported on the 5th of March 2020, signalling the onset of the country's encounter 

with the global health crisis. By July of 2020, South Africa had garnered international attention, 

ranking as the fifth country worldwide with the highest number of confirmed COVID-19 

infections. The province that bore the brunt of the pandemic's impact during this period was 

Gauteng, as noted by Lewis and Mulla (2021). 

 

As the pandemic unfolded, the South African government and health authorities took proactive 

measures to assess and address the situation. By January 19, 2023, an online report from the 

Department of Health indicated that the country had conducted more than 21 million COVID-

19 tests. Among these tests, over 4 million returned positive results, highlighting the substantial 

prevalence of the virus within the population. Encouragingly, the report also indicated that 

more than 3 million individuals had successfully recovered from COVID-19, reflecting the 

resilience of the healthcare system and the ability to manage a significant portion of the cases. 

Tragically, the toll of the pandemic was evident in the reported numbers of deaths, surpassing 

102,000 by January 19, 2023. Each reported death represented not just a statistic but a profound 

loss for families and communities. The gravity of the situation underscored the significance of 

ongoing efforts to mitigate the impact of the virus and protect vulnerable populations. 

Furthermore, the data reflected the dynamic nature of the pandemic, with more than 1000 new 

COVID-19 cases reported on that specific day. This constant influx of new cases highlights the 



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ongoing challenges faced by South Africa in containing the spread of the virus and managing 

the healthcare implications. 

South Africa's experience with COVID-19 2019 demonstrates the need for a comprehensive 

and sustained response to a global health crisis. The country's ranking among the most affected 

nations underscores the interconnectedness of the world and the urgency for collaborative 

efforts to address public health emergencies. The data, while indicative of past challenges, also 

served as a call to action for ongoing vigilance, preparedness, and international cooperation in 

the face of emerging health threats. 

2.4.1 Intervention and Prevention of COVID-19 spread/outbreak in South Africa 

In an earnest effort to mitigate the devastating impact of the COVID-19 pandemic, the South 

African government took decisive early action by implementing a nationwide lockdown. The 

initial restrictions, characterized as moderate, were introduced on the 15th of March 2020, 

demonstrating a commitment to proactive public health measures (Hatefi et al., 2020; Lurie et 

al., 2021). Subsequently, on the 27th of March 2020, a comprehensive and stringent nationwide 

lockdown, denoted as level 5, was instituted. This full lockdown imposed severe restrictions, 

prohibiting individuals from leaving their homes for any non-essential purposes and even 

restricting alcohol sales. The rationale behind these measures was grounded in the urgent need 

to curb the transmission of the virus and protect public health. 

However, faced with financial constraints and recognizing the challenges posed by limited 

resources, the government decided to gradually ease the lockdown restrictions. Despite these 

efforts, the country experienced three waves of the COVID-19 pandemic, with the most severe 

occurring during July of 2021. The third wave prompted the maintenance of an adjusted level 

4 lockdown, which entailed the closure of businesses, reflecting the ongoing struggle to contain 

the virus's spread. During this challenging period, South Africa recorded a staggering 480,570 

new cases and 11,415 deaths, as reported by Chetty (2021). Notably, concerns were raised 

about potential underreporting, with natural deaths surpassing reported COVID-19 deaths, 

highlighting the complexities in accurately capturing the full impact of the pandemic. 

Recognizing the need for international collaboration and support, the World Health 

Organization (WHO) deployed a surge team in South Africa from March 2020 to October 2021. 

Comprising healthcare professionals trained in infection prevention and control, international 

and local experts, health promotion practitioners, and COVID-19 champions, the surge team 

played a pivotal role. Their efforts included assessing public and private health facilities, 



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facilitating the acquisition and distribution of computers to enhance data management through 

Go.Data, conducting interaction reviews, and training case investigators and contact tracers. 

These initiatives aimed to reduce the transmission of COVID-19 by ensuring effective contact 

identification and follow-up. 

In tandem with these measures, South Africa implemented various intervention strategies to 

curb the spread of the COVID-19-2019. Key among these strategies were COVID-19 testing 

and vaccination campaigns. Diagnostic testing for COVID-19 served a tripartite role, as 

highlighted by Baxter, Abdool Karim, and Abdool Karim (2021). First and foremost, testing 

confirmed positive cases, enabling the provision of appropriate clinical care. Secondly, testing 

played a crucial role in intervention strategies, facilitating contact tracing and 

isolation/quarantine measures. Lastly, COVID-19 testing contributed to surveillance purposes 

by monitoring temporal trends, geo-spatial patterns, and demographic spread of the virus. 

Reports from the National Institute for Communicable Diseases (NICD) provided insights into 

the scale of COVID-19 testing in South Africa. From the 1st of March through the 27th of June 

2020, more than 1.4 million COVID-19 laboratory tests were conducted nationally. Notably, 

Gauteng province contributed significantly, accounting for 40% of the tests conducted during 

week 26 of 2020. However, the period also witnessed a continuing increase in the number of 

positive cases from week 15 to week 26 in 2020. Subsequent reports by the NICD for the period 

January to June 2023 indicated a substantial escalation in testing, with more than 21 million 

tests reported nationally. During week 11 of 2023, Gauteng recorded the highest number of 

PCR tests, underlining the ongoing commitment to monitoring and managing the spread of the 

virus. 

The vaccination campaign emerged as a critical component of South Africa's ongoing efforts 

to combat the spread of SARS-CoV-2. Commencing in February 2021, the vaccination rollout 

initially targeted high-risk populations, including healthcare workers, the elderly (aged 50 years 

and above), and individuals with comorbidities, as outlined by the World Health Organization 

(WHO, 2023). The primary objective of the vaccines was to confer immunity against COVID-

19 infection. 

An online report by the WHO in June 2023 revealed a commendable milestone, with a total of 

38,882,146 vaccine doses administered to South Africans. Three authorized vaccines were 

utilized for the prevention of SARS-CoV-2 in South Africa, each with its unique characteristics 

and administration protocols. The Pfizer-BioNTech vaccine involved two doses administered 



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21-42 days apart, with full vaccination achieved two weeks after the second dose. The Johnson 

and Johnson vaccine, administered as a single dose, resulted in full vaccination after 28 days. 

The Sinovac vaccine required two doses, administered 2-4 weeks apart, with a person 

considered fully vaccinated two weeks after the second dose. 

The introduction of these vaccines marked a turning point in the battle against COVID-19 in 

South Africa. Not only did they contribute to a reduction in the rate of transmission and 

infection of the virus, but they also played a pivotal role in lowering the mortality rate. Vaccines 

became a beacon of hope, offering protection to individuals and communities, and significantly 

contributing to the broader global effort to control the pandemic. 

 South Africa's response to the COVID-19 pandemic encapsulates a multifaceted and adaptive 

approach, characterized by early and stringent lockdown measures, international collaboration, 

robust testing strategies, and a comprehensive vaccination campaign. The journey reflects the 

nation's resilience in the face of unprecedented challenges and underscores the importance of 

evidence-based decision-making, public health infrastructure, and global cooperation in 

addressing complex health crises. The ongoing commitment to monitoring, testing, and 

vaccination initiatives demonstrates the imperative of continued vigilance and proactive 

measures in the pursuit of a healthier and more resilient society. 

2.4.2 Social Impacts of COVID-19 in South Africa 

Amidst the throes of the pandemic, South Africa found itself grappling with exacerbated 

challenges that had already been pervasive before the advent of COVID-19. Issues such as food 

shortages, inadequate sanitation, financial strain, and soaring unemployment rates were 

magnified, particularly in impoverished communities (Stiegler & Bouchard, 2020). The 

compounding effect of these challenges manifested in violent acts, including confrontations 

with law enforcement, hunger riots, and instances of looting in certain communities. 

To safeguard the livelihoods of South Africans, the government implemented measures to 

address the economic fallout. This included a significant increase in social grants and the 

implementation of Temporary Employer/Employee Relief Scheme (TERS) benefits, providing 

crucial support for unemployed individuals during these challenging times (Blecher, Daven, 

Meyer-Rath, Silal, & van Niekerk, 2021).  

The strategic decision to close businesses and prohibit alcohol sales in South Africa yielded 

notable benefits. Not only did these measures contribute to curbing the spread of the virus 



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within communities, but they also led to a reduction in alcohol-related casualties. While the 

prohibition of alcohol sales correlated with a decrease in domestic violence in South African 

homes, there were reports indicating a surge in such incidents against women during the third 

week of the national lockdown. Paradoxically, violent crimes experienced a decline during this 

period (Stiegler & Bouchard, 2020).  

Access to healthcare services emerged as another pressing challenge during the pandemic. 

South African hospitals faced overwhelming pressures and struggled to respond adequately to 

the crisis, particularly during the peak of the third wave (Chetty, 2021). In the Gauteng 

province, hospitals found it challenging to meet the escalating demands for beds required to 

accommodate patients with COVID-19. The government's intervention strategies, 

encompassing community containment measures and distancing rules, inadvertently had a 

detrimental impact on the diagnosis and treatment of other contagious diseases, such as HIV 

and malaria (Hatefi et al., 2020).   

The pandemic illuminated multifaceted challenges, prompting South Africa to adopt a 

comprehensive approach to address intricate issues. Balancing public health measures and 

mitigating socio-economic impacts on vulnerable populations was crucial. Government 

initiatives, including economic support and containment measures, demonstrated dynamic 

responsiveness to evolving challenges. Lessons learned from this experience will guide future 

strategies, aiming to build resilience and foster a more inclusive and equitable society. 

2.4.3 The State of Mental Health in South Africa during the Pandemic 

During the throes of the COVID-19 pandemic, South Africa found itself navigating uncharted 

territory as the government implemented a national lockdown to curb the rampant spread of 

the virus. This period, as documented by Duby et al. (2022), brought to light the inadequately 

documented mental health effects of the stringent lockdown restrictions imposed. Research 

findings, including those by Lentoor and Maepa (2021), highlighted a surge in anxiety and 

stress among South Africans, particularly impacting adolescents, girls, and young women. 

Before the pandemic, data from 2018, as presented by the South African College of Applied 

Psychology, suggested that one in six South Africans grappled with anxiety, depression, or 

substance abuse. Alarming figures included 41% of pregnant women experiencing depression, 

61% of the population suffering from PTSD, and 27% contending with severe mental disorders 

and undergoing treatment (Cooper & Kramers-Olen, 2021). As the pandemic unfolded, 



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research studies, such as those by Cooper and Kramers-Olen (2021), pointed to a significant 

escalation in the prevalence of mental disorders. 

The initial wave of the pandemic, as examined by Lentoor and Maepa (2021), revealed a 

disconcerting landscape, with 61.2% of participants reporting stress and anxiety, 39.5% 

expressing financial concerns, and 31.6% grappling with feelings of sadness, frustration, and 

anger. Simultaneously, the South African Depression and Anxiety Group found that, despite 

adhering to lockdown restrictions, 65% of respondents experienced stress during the initial 

lockdown in March 2020 (Cooper & Kramers-Olen, 2021) 

A comprehensive study by (De Man et al., 2022) delved into the relationship between mental 

health and COVID-19-related stressors and during lockdown. Their findings underscore the 

significant impact of distress related to virus infection and containment measures, correlating 

with heightened depressive and anxiety symptoms. Individuals with pre-existing mental 

disorders reported experiencing secondary effects of the pandemic, ranging from sleep 

disturbances and substance withdrawal symptoms to unemployment and depressive symptoms 

(Cooper & Kramers-Olen, 2021).  

The precarious state of mental health during the pandemic was further exacerbated by a myriad 

of compounding factors. Household unemployment, elevated fears of domestic violence, 

strained family relationships, food security concerns, and economic stress contributed to the 

overall deterioration of mental well-being in the population. As South Africa grappled with the 

multifaceted challenges of the pandemic, the toll on mental health became a pressing concern 

that warranted attention and intervention. 

2.5 COVID-19 in Children 

As of the information available in an online report by the World Health Organization in 2023, 

children are generally considered to be at a low risk of contracting the Coronavirus. In the rare 

instances where children do become infected, they are more likely to exhibit mild symptoms 

such as cough, vomiting, and diarrhoea. However, severe clinical symptoms and, albeit rarely, 

fatalities were reported among some children who contracted the virus. 

During the level three lockdown period in South Africa, a report by Hatefi et al. (2020) 

highlighted that more than a thousand children under the age of nine tested positive for COVID-

19. This alarming number encompassed even newborns and infants. Notably, the incidence of 

asymptomatic infections among children was found to be lower than that observed in the 



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general population. This discrepancy is speculated to be associated with the robust immune 

response and AEC2 levels within the children's bodies, as suggested by Gao et al. (2021). 

Additionally, factors such as reduced international travel, limited outdoor activities, and lower 

exposure to cigarette and air pollution are cited as contributors to the lower prevalence of the 

virus in children, as noted by Zare-Zardini et al. (2020). 

The risk of children being infected with the virus also exhibited a dependence on age, with the 

likelihood of severe outcomes increasing as children grew older. Kufa-Chakezha, Cohen, and 

Walaza (2021) reported that, out of the 1.8 million cases of  COVID-19 detected in South 

Africa, only 0.7% were associated with death among children, and 4.2% were linked to hospital 

admissions. A subsequent online report by the National Institute for Communicable Diseases 

indicated a rise in hospital admissions to 5% for children under 19 years in December 2021. 

2.5.1 Diagnosis, Treatment and Management of COVID-19 in Children 

The diagnostic tools employed for monitoring children infected with COVID-19 mirror those 

used for adults, emphasizing a standardized approach to identification and confirmation of 

cases. As elucidated by Zare-Zardini et al. (2020), the initial step involves contact tracing, 

especially if there has been exposure to an infected person. Subsequently, laboratory testing is 

conducted through blood tests and/or nasal swabs to detect COVID-19 nucleic acid using the 

reliable RT-PCR method. In addition to these molecular diagnostic tools, X-ray and CT scan 

images are utilized as confirmatory and complementary methods, as noted by Sankar et al. 

(2020) and Zare-Zardini et al. (2020). The integration of various diagnostic modalities ensures 

a comprehensive assessment of COVID-19 infection in children. 

In December 2021 alone, there were over 2 million tests conducted for individuals under the 

age of 19, with more than 370,000 testing positive for COVID-19, according to the National 

Institute for Communicable Diseases (NICD, 2021). The Gauteng province emerged as a 

significant contributor, accounting for 27.2% of the tests among individuals under the age of 

19, highlighting the need for widespread testing efforts to effectively monitor and manage the 

spread of the virus in this demographic. 

The treatment protocol for infected children aligns with approaches used for adults. Home 

isolation, typically recommended for a period of 2 weeks, is a common practice. Anti-viral 

therapy, like that employed for adults, constitutes a key element in managing infected children. 

For those exhibiting mild to severe symptoms of COVID-19, oxygen therapy, administered 

through masks and nasal catheters, is often recommended to alleviate respiratory distress. In 



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cases of COVID-19 pneumonia in children, antimalarial drugs and nitric oxide inhalation are 

suggested treatment modalities (Zare-Zardini et al., 2020), underscoring the importance of a 

tailored approach based on the severity of symptoms. 

Efforts to curb the spread of COVID-19 in children involve vaccination, with the Pfizer vaccine 

approved for administration to children older than 12 years, according to the South African 

Medical Research Council (SAMRC, 2023). However, despite approval, the uptake among 

children remains limited, attributed to parental resistance and hesitancy among healthcare 

workers. Addressing these concerns and fostering awareness are crucial in optimizing 

vaccination coverage among the paediatric population, contributing to broader community 

immunity. 

2.5.2 Impact of COVID-19 in Children  

Throughout the pandemic and in its aftermath, children have navigated unique challenges 

contingent upon their developmental stages (WHO, 2023). The heterogeneous nature of 

children's experiences with COVID-19-2019 and the government-imposed restrictive measures 

underscores the need for a nuanced understanding of their specific vulnerabilities. The 

repercussions of the pandemic have left an indelible mark on the health and well-being of 

children, with potential lifelong implications for some. 

Mitigation measures and the socio-economic impacts of COVID-19 disproportionately 

affected children, as outlined in an online report by the World Health Organization (WHO, 

2020). This report delineates three primary channels through which children were impacted. 

First, there was the direct risk of being infected with COVID-19. Second, children faced 

immediate socio-economic repercussions stemming from measures to curb the virus's spread. 

Third, there were potential long-term effects due to the delayed implementation of the 

Sustainable Development Goals. 

Children found themselves experiencing psychological effects of being confined to one place 

during COVID-19 (Loades et al., 2020; Prime et al., 2020). Fear and anxiety (Sprang & Silman, 

2013), disturbance of daily routines (Brooks et al., 2020), as well as disruptions of sleep and 

eating habits (Marelli et al., 2021), were among the problems children experienced during the 

COVID-19 pandemic.  

A study conducted by (Richard et al., 2023), involving children aged 2-17 years highlighted 

that 13% of the participants experienced severe impacts from the pandemic. Lifestyle changes, 



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family vulnerabilities, and health challenges during the pandemic collectively contributed to a 

severe and multidimensional impact on these children. Reports of suicidal ideation, social 

withdrawal, emotional problems, and symptoms of depression and anxiety emerged as 

prevalent themes in various studies, underscoring the multifaceted toll the pandemic has taken 

on the mental health of children (Aljaberi et al., 2021; García-Fernández et al., 2023; 

Pfefferbaum, 2021). 

The research conducted on Italian children by Mensi et al. (2022) revealed alarming statistics 

regarding the mental health impact of the pandemic. Psychotic symptoms were present in 16% 

of cases, suprathreshold panic in 25%, suprathreshold anxiety in 46%, and suprathreshold 

depression in 18.7%. Eating-related symptoms affected 51%, sleep difficulties were reported 

by 57%, a propensity towards social withdrawal post-pandemic stood at 51%, while instances 

of suicidal ideation and self-harming behaviour were reported in 30% and 9%, respectively. 

These findings underscore the complex and pervasive impact of the pandemic on the mental 

well-being of children, highlighting the urgent need for comprehensive support and 

intervention strategies to address the diverse array of challenges children are facing Mensi et 

al (2022).  

2.5.3 Negative/Indirect Impact of COVID-19 on Children   

The vulnerability of children to the indirect risks of COVID-19 is a focal point of concern, as 

emphasized in a comprehensive narrative review conducted by (Goldfeld et al., 2022). The 

findings of this study shed light on 11 distinct areas of impact, categorized into three 

overarching domains: family-level factors, child-level factors, and service-level factors. This 

multifaceted exploration underscores the intricate web of challenges faced by children because 

of the pandemic's indirect consequences. 

Research studies, including Gupta and Jawanda (2020) and UNICEF (2023), as well as a 

comprehensive study by Save the Children (2020), collectively corroborate the assertion that 

children, particularly those from disadvantaged backgrounds and communities, bear a 

disproportionate burden of the repercussions of COVID-19. The inequities laid bare by the 

pandemic accentuated existing disparities, with poor children facing an elevated risk of 

suffering from the consequences of the virus. This heightened risk manifests in various 

dimensions, including an increased susceptibility to poor nutrition, heightened exposure to 

violence within the home environment, and a greater likelihood of experiencing maltreatment. 



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The expansive study conducted by Save the Children (2020) stands out as one of the most 

comprehensive examinations of the impact of COVID-19 on children. Its findings bring into 

sharp relief the stark reality that children from poor backgrounds are grappling with challenges 

that extend beyond the immediate health implications of the virus. The increased risk of poor 

nutrition, coupled with the heightened vulnerability to domestic violence and maltreatment, 

underscores the pressing need for targeted interventions and support mechanisms to mitigate 

these adverse outcomes. 

 Children with pre-existing mental health conditions emerged as a particularly vulnerable 

subgroup. Richard et al. (2023) notes that disruptions in healthcare routines and the heightened 

stress experienced by caregivers, exacerbated by the lack of specialized care provision, 

disproportionately impacted the mental health of these children. The intricate interplay between 

pre-existing mental health conditions, disruptions in healthcare access, and the added stress on 

caregivers paints a complex picture of the challenges faced by children. 

2.5.3.1 Family Level Factors 

Family-level factors refer to the influences within the family environment that impact the well-

being and development of children (Ma et.al., 2023). These factors encompass a range of issues 

related to economic stability, parenting practices, parental mental health, and overall household 

dynamics. During the COVID-19 pandemic, several key family-level factors significantly 

affected families and children:  

2.5.3.1.1 Job loss and reduced family income 

The impact of COVID-19 on South African households is characterized by stark inequalities, 

with varying levels of access to essential resources such as assets, income, employment, social 

protection, and healthcare, as highlighted by Scotté and Zizzamia (2021). The disparities in 

vulnerability have been exacerbated by the pandemic-induced economic upheaval, resulting in 

a substantial increase in the unemployment rate across the country, as noted by Posel, Oyenubi, 

& Kollamparambil (2021). 

A recent study conducted by social sciences researchers from five different South African 

universities underscores the magnitude of the economic fallout. The study reveals that 

approximately 3 million South Africans lost their jobs between February and April 2020, 

attributing these losses directly to the pandemic, with women being disproportionately affected 

(news24, 2023). This substantial loss of employment not only represents a staggering figure 



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but also unravels the broader socio-economic implications, particularly on the most vulnerable 

segments of the population. 

The repercussions of the economic downturn, as illuminated by (Goldfeld et al., 2022), extend 

beyond mere job losses. Deteriorating economic circumstances given rise to increased levels 

of persistent disadvantages and higher rates of families newly thrust into disadvantage. The 

widening economic disparities placed a considerable strain on the social fabric, exacerbating 

existing inequalities and magnifying the challenges faced by vulnerable households. 

 Economic pressure during the pandemic has been linked to harsher parenting practices and 

elevated parental stress (Wolf, Freisthler, & Chadwick, 2021). The intricate interplay between 

economic hardship and parenting dynamics underscores the far-reaching consequences of the 

pandemic on family life. The stress induced by financial insecurity has the potential to permeate 

household relationships, affecting parental well-being and, subsequently, the overall dynamics 

within families. 

2.5.3.1.2 Increased child abuse and neglect 

Research has compellingly demonstrated that during pandemics, the incidence of neglect and 

child abuse tends to surge, primarily attributed to heightened stress levels, increased isolation, 

and reduced access to support for families, as highlighted by Merrill et al. (2021). In the specific 

context of South Africa, the restrictive measures implemented in response to the COVID-19 

pandemic, coupled with widespread unemployment and job losses, created a concerning 

backdrop that may have contributed to a rise in family violence and child maltreatment. 

The compounding effects of governmental restrictions and economic hardships amplified the 

risk of family violence, with children living in adverse conditions facing an elevated threat, as 

noted by Greeley (2020). The confluence of these factors creates an environment that can be 

particularly challenging for vulnerable children, exacerbating existing adversities and 

increasing their susceptibility to maltreatment. 

Disturbingly, the pandemic in South Africa witnessed a notable increase in reported cases 

related to domestic abuse and child maltreatment (Kourti et al., 2023). This surge in incidents 

underscores the urgency of addressing the growing crisis of violence within households. 

Paradoxically, Goldfeld et al. (2022) highlight a concerning decrease in the number of reports 

to child maltreatment hotlines during the pandemic. This decline in reporting may be attributed 

to reduced contact between educators and children, as schools and educational institutions 

faced disruptions and closures due to the pandemic. 



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An online report by the American Psychological Association (APA, 2020) further reinforces 

the link between increased parental stress and the likelihood of neglect and child abuse. The 

stressors induced by the pandemic, including economic uncertainties, health concerns, and 

disruptions to daily life, placed additional strain on parents, elevating the risk of harmful 

behaviour towards children. 

The confinement measures implemented during the pandemic, as necessitated by health 

protocols, created an alarming situation where children were confined to their homes, unable 

to escape potentially abusive situations. This heightened vulnerability significantly increased 

the risk of children experiencing violence within the confines of their homes. 

2.5.3.1.3 Poorer parental mental health  

During past epidemics, the prioritization of mental health needs was a rarity, with limited 

access to professionally trained mental health professionals, as noted by (Decosimo et al., 

2019). In a research study done by (Bloom et al., 2022) in the South African context, aimed at 

exploring how caregivers coped during the pandemic, a reciprocal relationship between child 

mental health and parental or caregiver mental health became evident. The study unveiled that 

higher levels of endorsement of mental health issues in children were associated with elevated 

levels of stress, depression, and anxiety in parents. 

The ramifications of poor parental mental health extended beyond the emotional realm, with 

additional associations identified between parental mental health struggles due to the pandemic 

and economic hardships, as well as increased family uncertainty. Scrimin et al. (2022) further 

highlights that parental stress during the pandemic was linked to heightened emotional and 

physical discomfort in children, underscoring the interconnectedness of familial well-being. 

Studies conducted by Whaley and Pfefferbaum (2023) delve into the myriad stresses 

experienced by parents and caregivers during the pandemic. Many caregivers and parents faced 

with COVID-19-2019 grappled with Post-Traumatic Stress Disorder (PTSD), anxiety, and 

stress. Although a significant number of parents adapted over time, the psychological outcomes 

were influenced by a multitude of factors, including employment status, pre-existing 

vulnerabilities, demographic factors, family structure, household responsibilities, and 

cohesion. 

2.5.3.1.4 Increased household stress 



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The lockdown restrictions enforced by the government precipitated profound changes in family 

routines and rituals during the past tense of the pandemic. Extensive research conducted by 

(Chanchlani et al., 2020; Drane et al., 2020; Goldfeld et al., 2022) collectively demonstrated 

that families underwent significant challenges in supporting their children's needs, particularly 

concerning remote learning and other childcare demands. Parents and caregivers found 

themselves grappling with the delicate balance of managing unemployment, working from 

home, or navigating employment uncertainties amid financial instability. 

The pandemic's impact extended beyond the logistical challenges, permeating parent-child 

relationships. According to Vaterlaus et al. (2021), the adoption of new roles by parents during 

the pandemic had the potential to influence the dynamics within parent-child relationships. The 

constrained interaction with the outside world, a consequence of lockdown measures, was 

identified as a potential stressor, contributing to strains in parent-child relationships. 

The disruptions in daily life imposed by lockdowns forced families to adapt rapidly to 

unprecedented circumstances, navigating the complexities of remote work, financial 

uncertainties, and the evolving needs of children. As evidenced by the collective findings of 

various research studies, the challenges presented by the COVID-19 tested the resilience of 

families, influencing not only practical aspects of daily life but also the delicate fabric of 

relationships within the household. 

2.5.3.2 Child Level Factors 

Child-level factors pertain to characteristics and experiences unique to the individual child that 

influence their well-being and development (Griffith et al., 2016). These factors encompass 

various aspects of a child's life, including their physical and mental health, educational 

experiences, and socio-emotional development. During the COVID-19 pandemic, several key 

child-level factors significantly impacted children's experiences and outcomes: 

2.5.3.2.1 Poorer mental health/ Psychological impact  

The psychological health of children during the Coronavirus Desaese-2019 pandemic became 

a focal point of concern, with various factors contributing to poorer mental health outcomes. 

Beyond the immediate health threats posed by the virus, the pervasive fear of infection left a 

lasting imprint on the minds of young individuals. The World Health Organization (2023) 

underscores that this fear, ingrained during the pandemic, may have enduring consequences, 

shaping their perspectives and emotional responses well into adulthood. Buheji et al. (2020) 



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and Chawula, Tom, Singh Sen, & Sagar (2021) emphasize the multifaceted impact of lockdown 

measures, which not only disrupted routine activities but also severed crucial social ties that 

are integral to children's development. 

In the South African context, Bloom et al. (2022) shed light on the distinctive challenges faced 

by children compared to adolescents during lockdowns. The enforced isolation led to a surge 

in hyperactivity, misconduct, and emotional problems among children. The absence of regular 

peer interactions, a crucial element of their social development, manifested in behavioural 

changes such as increased clinginess, irritability, and hesitancy to seek information about the 

pandemic (Buheji, et al., 2020). 

The psychological toll on children extends beyond their immediate surroundings, reaching into 

the broader societal context. Depression and anxiety rates among children and adolescents 

surpass those in the general population, underlining the far-reaching consequences of the 

pandemic on the younger demographic (Chawula, Tom, Singh Sen, & Sagar, 2021). This 

heightened vulnerability was exacerbated by a disconnection from peers, as social support 

structures play a pivotal role in children's ability to cope with stressors.  

The COVID-19 pandemic cast a shadow on children's mental health, as indicated by findings 

from various studies, including those conducted by Loades et al. (2020) and Prime et al. (2020). 

Loades et al. (2020) and Prime et al. (2020) bring attention to the psychological effects of 

confinement, revealing that children grappled with anxiety and fear during the pandemic. 

Sprang and Silman's (2013) work highlights the enduring impact of fear and anxiety on 

children's mental well-being. Brooks et al. (2020) emphasize the disturbance of daily routines, 

which serves as a cornerstone of stability for children. This disruption, combined with 

uncertainties, contributes to heightened stress levels. Marelli et al. (2021) shed light on 

disturbances in sleep and eating habits, elucidating the interconnectedness of physical and 

mental health 

The socioeconomic dimension further amplifies these challenges. Children from families with 

lower socioeconomic status, parents with limited educational attainment, and those residing in 

confined living spaces faced heightened vulnerability to mental health challenges (Ng & Ng, 

2022).  

2.5.3.2.2 Poorer child health and development  

The COVID-19 pandemic, as elucidated by Goldfield et al. (2022), triggered a substantial 

transformation in the landscape of children's play, bringing forth repercussions that extend 



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beyond the realm of recreation. The imposition of lockdown restrictions resulted in the closure 

of recreational spaces, fundamentally altering the dynamics of physical activities for children. 

The reduction in opportunities for outdoor play and structured sports activities during the 

lockdown period had a profound impact on the time children spent engaged in physical 

activities. 

Remarkably, this shift in play patterns manifested in unintended consequences, particularly 

concerning children's health. Goldfield et al. (2022) observed an increase in snacking 

behaviours and weight gain among children during the pandemic. The absence of recreational 

outlets and the subsequent sedentary lifestyle adopted during lockdowns contributed to 

alterations in dietary habits, potentially leading to long-term health implications. 

Furthermore, the pandemic disrupted routine health care services, creating a ripple effect on 

children with additional health care needs. Goldfield et al. (2022) pointed out that missed health 

care appointments resulted in lower rates of identifying children experiencing developmental 

delays. The interruption in regular health assessments and interventions may have profound 

consequences on the timely identification and addressing of developmental challenges, 

impacting children's overall well-being. 

The impact of the COVID-19 pandemic on children extends beyond mental health, affecting 

their overall well-being and developmental trajectories. Loades et al. (2020) and Prime et al. 

(2020) underscore the widespread effects of confinement, revealing potential setbacks in child 

health and development. The disruption of routines, as highlighted by Brooks et al. (2020), not 

only contributes to psychological distress but may also impede important developmental 

milestones. Additionally, Marelli et al.'s (2021) insights into disturbances in sleep and eating 

habits underscore the comprehensive nature of the challenges faced by children during the 

pandemic, potentially impacting their growth and development.  

Amin and Parveen (2022) delve into the educational aspect, highlighting how the lack of 

competition during school closures and social isolation may have led to a delay in children's 

personal and psychological development. The absence of structured learning environments, 

peer interactions, and extracurricular activities may have impeded the holistic development of 

children, influencing aspects beyond academic achievements. 

Economic upheavals resulting from widespread job losses during the pandemic accentuated 

vulnerabilities, particularly for already marginalized children. UNICEF (2023) draws attention 

to the exacerbation of malnutrition among vulnerable children due to the deterioration in the 



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quality of their diets. The compounding shocks created by COVID-19, such as loss of income 

and disruptions in food supply chains, contributed to a precarious nutritional landscape for 

many children. 

2.5.3.2.3 Poorer academic achievement 

The profound impact of COVID-19 on children's educational experiences has been 

underscored by Goldfeld et al. (2022), emphasizing that the adversities brought about by the 

pandemic significantly jeopardized their learning journeys. Particularly vulnerable were 

children whose parents had lower educational qualifications, as they often found themselves 

grappling with a lack of resources and time necessary to adequately support their children's 

education. The repercussions of these challenges extended beyond mere academic struggles; 

children who experienced adversities also contended with societal prejudice, as their 

compromised learning engagement became a source of discrimination, potentially resulting in 

diminished academic achievement. 

The shift to digital learning platforms, while essential for continuity during the pandemic, 

inadvertently exacerbated existing socio-economic disparities. As noted by Amin and Parveen 

(2022) and Gupta and Jawanda (2020), the use of digital learning devices tended to widen the 

gap between children hailing from low and high socio-economic statuses. In disadvantaged 

communities, where issues such as slow internet speed or the absence of internet facilities were 

prevalent, the academic achievement of children suffered disproportionately. The limitations 

imposed by digital access disparities amplified educational inequalities, reinforcing the 

existing divide between privileged and underprivileged learners. 

Furthermore, the chasm between advantaged and disadvantaged learners during the pandemic 

was quantified to be three times more pronounced in the context of distance learning compared 

to traditional contact learning (Sonnemann & Goss, 2021). The implications of this widening 

gap extend beyond the immediate educational setbacks, as they potentially foretell long-term 

consequences for the affected children's future opportunities and societal contributions. 

Literature reveals the multifaceted impact of the COVID-19 pandemic on children's education. 

The transition to remote learning, characterized by challenges such as maintaining focus and 

adapting to virtual methods. The resulting blurred home-school boundaries and uncertainties 

have heightened academic pressure, contributing to increased stress levels among children 

(Loades et al., 2020; Prime et al., 2020). Furthermore, lockdowns witnessed a decline in 

academic performance, reflecting concerns highlighted in existing research on the adverse 



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effects of disrupted education during pandemics (Prime et al., 2020; Viner et al., 2020; Xie et 

al., 2020). The digital divide exacerbated educational inequalities, and the reopening of schools 

introduced challenges in adapting to a structured learning environment (Loades et al., 2020; 

Prime et al., 2020). 

 

2.5.3.4 Service level Factors 

Service-level factors encompass the institutional and systemic aspects that influence the 

provision of services and support to children and families (Howard et al., 2003). These factors 

involve various services such as healthcare, education, and social welfare systems, as well as 

broader societal structures. During the COVID-19 pandemic, several key service-level factors 

significantly impacted children's access to essential services and support: 

2.5.3.4.1 School closure 

The global implementation of distance learning, as reported by Goldfield et al. (2022) in April 

2020, marked a transformative moment in education, affecting approximately 86% of the 

global student population. This paradigm shift in learning methods was accompanied by a 

myriad of consequences, reshaping the educational landscape, and impacting the lives of 

students worldwide. Notably, parents responded to the uncertainties of the pandemic by 

withdrawing their children from both informal and formal childcare arrangements, reflecting a 

collective apprehension about the safety of traditional educational settings. 

The closure of schools during the pandemic, while a necessary measure to curb the spread of 

the virus, led to a cascading set of challenges. Goldfeld et al