Humans need to have relationships with others. Belonging needs are the feelings associated with a group, such as love, affection and so on, coming from family, friends, and other relationships. People are all eager to establish mutual connections with others, and to integrate into a certain group, as well as during the pandemic. Physical distancing and restrictions on gathering activities may lead to loneliness, anxiety, depression and other psychological outcomes. During the regular control periods when the fear of being infected is no longer the predominant emotion, the need for social interaction could trigger activities facilitating the spread of COVID-19 based on the analysis of the Hebei cases.
In Hebei Province, a 61-year-old person was confirmed as the case of COVID-19 on January 2, 2021. Before that, there were hardly any infections in rural communities. The attention to fight against COVID-19 was paid more to cities. But after the New Year holiday, China reported clusters of infections in multiple provinces (eg, Hebei, Heilongjiang, and Jilin), the majority of which broke out in rural areas and many patients are elderly people. On January 13 of 2021, China reported its biggest jump of daily COVID-19 cases since March 5, 2020. The outbreak in Hebei shows the weakness of rural areas in combating COVID-19: poor health facilities and quarantine limitations could ravage whole rural communities.
Figure 3 tries to identify the chain of vulnerabilities that led to the super spread in the rural areas from the very beginning. The rural elderly group has their needs and behavior patterns rooted from social customs, which have potential impacts on the COVID-19 control. Mahjong playing, neighbor visiting, square dancing and other gathering activities are important for the rural elderly to socialize. Frequent inside interactions, gathering activities such as regular fairs and occasional events (eg, funerals and weddings) are typical ways to spend daily time, which can be found in many confirmed cases of Hebei and Heilongjiang provinces. Multiple times of wedding attendances without wearing masks during the New Year holiday accelerated the virus spread. Moreover, the elderly people in China tend not to see the doctor when they are ill, and the utilization rate of hospitalization services of rural residents is much lower. Many patients had visited village clinics before they were confirmed. Rural residents prefer to choose the common practice in villages:intravenous therapy, which creates obstacles for early detections and may lead to cross-infections. From the management perspective, almost back to "normal" life combined with few earlier cases, gradually loosened the nerves of local government and rural residents. Lack of restrictions on indoor gatherings, loosened monitor of people returning home from risky regions and other management loopholes (eg, slackened management for the village screening and lack of public education for the COVID-19 infections) also contribute to the super spread. The worst scenario would be that rural elderly keep their intensive interactive gatherings without wearing masks and do not go to see a doctor when fever and cough symptoms are shown, meanwhile there are management loopholes of the epidemic control, which is just the Hebei case.
Immediately after the outbreak, combination strategies were implemented such as restrictions on gatherings, screening measures at village entrances for checking temperature and health code, publicizing the importance of wearing masks, and mass testing to separate the virus carriers to stop the community transmission as early as possible. Village doctors and medicine shops are demanded to guide filtered villagers to fever clinics in a timely and standardized manner. To increase the screening efficiency of suspected patients, some local governments suggest township hospitals and village clinics should be integrated as epidemic monitoring and reporting sites. These measures tend to be effective and this wave of local transmission ceased on February 7 of 2021.
When someone makes a contribution to the society, he or she feels self-worth or gains recognition and respect from others, and then his or her esteem needs are fulfilled. The pandemic has cut some group fun to satisfy esteem needs or some interactive opportunities for individuals to win others' recognition, but many citizens stand out by contributing as a volunteer or set up self-groups, which help people in need with supply delivery, medical assistance and in other means.
In Beijing, the man, before confirmed on June 11 of 2020, went to the fever clinic by bike immediately after he showed up fever symptoms. Out of respect for self and others, he has a good habit of wearing a mask whenever necessary and also told others to do so. Therefore, none of his relatives and friends were confirmed. Due to his prompt report and clear recall of all the places he had been and a detailed name list he had contacted after he was confirmed, the exposed places and population could be separated earlier, and the source of this wave of outbreak-the Xinfadi market was soon located. His good memories out of sense of responsibility were cross-checked by the big data of his travel. It turns out that they do match.
Surrounding the Xinfadi market, mass testing for COVID-19 and other control measures were performed to stop the transmission rapidly. The information and responsible behaviors of this first identified case provided the important basis for that. He also set an example for others to report self-travel histories and go to fever clinic with good self-protection without delay. Even experts said that the actions of the first confirmed person greatly increased their confidence in winning the COVID-19 fight. Indeed, containing the virus transmission cannot succeed without these self-disciplined and responsible actions of individuals. The epidemiological investigation and big data cannot function without the permission of citizens. Some people monitor their health conditions themselves at home consciously, some people choose not to travel unless necessary, some people follow local regulations strictly after traveling back from risky areas. Everyone matters in the fight against the pandemic (Figure 4).
Affected by the pandemic, some people lose their jobs or could not earn more money or get promotion as usual. For self-development, many citizens choose to continue their studies. However, many examinations and learning activities have been cancelled or postponed, which further suppressed people's needs for self-improvement.
On December 22 of 2020, a resident of Shunyi District in Beijing had the nucleic acid test as required for taking part in the postgraduate entrance examination. On the next day, he was confirmed positive for the coronavirus. Relevant departments contacted him immediately, hoping that he would recall his whereabouts and close contacts in the past 14 days and help locate the source of the virus as soon as possible. Emergency management was initiated immediately by Shunyi District. For example, the epidemiological investigation was carried out timely. As of December 23, 2020, a total of 260 close contacts (sub-close contacts included) including fellow passengers, passengers on the same flight, taxi drivers, hotel and restaurant service staff have been investigated, and 10 of them were from other cities. Various prevention and control measures such as centralized isolation control, nucleic acid testing, and trace tracking and co-investigation have been implemented.
The first case identified of Shunyi District in Beijing has the need of self-development to continue his studies. He followed the corresponding regulations for the entrance examination and had the nucleic acid test as required. It shows that some screening measures could help identify the infections, especially for large group events to satisfy certain needs, otherwise cluster of cases might possibly surge. Due to the adoption of appropriate control measures in time, the transmission chain was clarified soon. Therefore, this case did not bring about too much panic or negative effects in a large scale.