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Background Knowing the spatiotemporal pattern of the early geographic spread of coronavirus disease 2019 (COVID-19) would inform the preparedness for a possible recurrence of COVID-19. Methods We ascertained the number of confirmed cases during the early spread of COVID-19 during the Wuhan outbreak in 2020 and the Nanjing outbreak in 2021. Results We observed a speeding-up pattern of geographic spread, in particular to cities of no particular orientation then outflowing to commercial cities during the first month of both the Wuhan and Nanjing outbreaks. Conclusion Re-emergence of COVID-19 indicates it is becoming endemic, with new outbreaks and a risk of increased transmission remaining a challenge to local public health institutions. Social distancing and lockdowns should continue in response to any potential widespread and focal outbreaks.

Early signs of geographic spread of COVID-19: lessons learnt from outbreaks in Wuhan 2020 and Nanjing 2021