Y village and two villages less than 2 km away accounted for approximately 50% of the total cases in Shijiazhuang. These villages are all located within 10 kilometres of Shijiazhuang Zhengding airport. Most young people in the villages prefer the city and migrate to work, leaving behind most of the elderly individuals, women and children. As of January 18, most of the confirmed cases in Shijiazhuang were farmers. The average age of the patients was 45 years old, and 27% of the patients were over 60 years old. The number of female cases was 1.5 times the number of male cases, and there were nearly 70 confirmed cases in primary and secondary school students. Geographical conditions contribute to the high concentration of the population. Since the villages are not far away from each other, their residents have close contact with each other. One of the important activities is going to the market. According to contact tracing efforts, on January 1, 2021, 13 individuals with confirmed infection from nearby villages went to the market at Y village, as villagers from other towns often drive to the market in their private cars. In addition to going to the market, an important activity for housewives is attending wedding banquets. Women represented a high proportion of the confirmed cases because they participate in more social activities than men do. In wedding ceremonies, women in the village act as drummers and play various musical instruments. There is a local custom of holding weddings at the end of the year. A total of 124 confirmed cases participated in a wedding banquet in Shijiazhuang that lasted from the end of 2020 to the beginning of 2021. A 44-year-old woman from Y village participated in three wedding banquets in just four days from December 30, 2020, to January 2, 2021. In addition, religious activities can easily lead to the spread of the pandemic. Before the outbreak of the pandemic, some people had gathered at the home of a family in the village for religious activities, which, like other gatherings, easily facilitated the spread of the pandemic.
Most of the villagers said that since the domestic pandemic was basically under control in the summer of 2020, they relaxed their vigilance. This is reflected in the increase in party activities and the decision not to wear masks during hot weather. People treat cough and headache as minor diseases and may not go to the hospital. Moreover, rural residents' low awareness of medical treatment, poor medical habits and insufficient access to high-quality medical resources are important reasons for the outbreak. Rural primary medical institutions play an important role as gatekeepers, as do village clinics and township health centres, which are superior management units. The current public information of the Hebei epidemiological survey indicates that at least 62 people came to such medical institutions for treatment and medicine due to obvious symptoms, such as cough, headache and fever, but they did not arouse due vigilance. In reality, due to their limited conditions, rural primary clinics have no ability to diagnose patients. However, their main role should be to find suspected patients in time and report them to the hospital. The village's prevention and control logic has failed in this case. Primary medical institutions do not play a "sentinel" role in the actual diagnosis and treatment process.
The direct causes of the logic failure of village pandemic prevention and control are traffic, culture, wedding banquets, geographical location, and population structure. These factors can be catalysts that intensify the spread of the pandemic in Y village. For example, convenient transportation and geographical location contribute to the quick spread of the pandemic. The gathering of people, for example, at the market and wedding banquets, further increases the number of people infected. Regarding the population structure, young people go out to work, leaving behind the elderly individuals, women and children, who generally lack information sources and have little understanding of the pandemic.