Mexican President López Obrador draws doctors' ire.

President López Obrador later apologised after his comments were denounced by Mexican medical associations amid the COVID-19 pandemic. David Agren reports from Mexico City.

Mexican President Andrés Manuel López Obrador set out to defend the country's coronavirus czsar Hugo López-Gatell on May 8, in a morning press conference. He described López-Gatell as “honest” and “humanistic”, with “a position in favour of the people, not in favour of mercantilism, which unfortunately also came to predominate during the neoliberal period in everything related to health”.

López Obrador, commonly known as AMLO, was referring to the three decades before he took office. He said that in the past some doctors only “looked to enrich themselves”, and that they asked patients “what assets do you have”, rather than “what (condition) you have”. “That's not…Dr López-Gatell”, he said.

Doctors quickly denounced the comments, which came as medical staff stopped wearing their uniforms in public. Health workers have been physically assailed by people considering them COVID-19 risks. Some have had bleach thrown on them. “Many of us are risking our lives treating COVID-19 and the president makes remarks that were not appropriate for a president and much less at this time”, said Asisclo de Jesús Villagómez, former president of the Mexican College of Critical Care Medicine.

More than 40 medical associations issued statements on May 10 urging AMLO to apologise. It was an unprecedented rebuke from a profession careful with its public pronouncements. Mexico's Health Secretariat did not respond to an interview request from The Lancet. AMLO apologised on May 11, saying he was only speaking of some physicians.

His response to accusations from former health secretaries of shortcomings in his government's response has been to raise accusations of corruption in past administrations.

However, physicians report routinely paying out of pocket for supplies. Georgina Magaña, a neurointensivist in Mexico City, said she saw early stories on COVID-19 and started purchasing personal protective equipment (PPE). What has subsequently arrived only “augments” her own personal supplies, she said.

Staff have protested outside public hospitals, too, over a lack of PPE. Anti-graft group Mexicans Against Corruption and Impunity found 219 hospitals had reported shortages—ranging from disposable gowns to N95 masks to hand gel—as of May 14.

Mexico has implemented “safe-distancing” campaigns, shut schools and universities, and closed non-essential businesses. The government has urged people to “stay home”, although quarantines have not been strictly enforced.

Mexico's response has relied heavily on modelling from sentinel surveillance—which reports respiratory disease information from 475 sites across the country—rather than widespread testing. “I don't think testing is a must”, López-Gatell told CNN on May 16. “We will use testing but in a carefully planned manner.”

Mexico has done 0·4 tests per 1000 people, ranking last among members of the Organisation for Economic Co-operation and Development. “Mexico is reserving PCR just for the serious patients”, said Xavier Tello, a physician and health-care consultant. “Contacts are not being tested, identified, or traced.” Foreign media outlets have alleged that Mexico is undercounting COVID-19 deaths. López-Gatell has denied hiding any death figures and has projected the true death rate to be more than eight times higher than the officially confirmed figures—not an unusual occurrence in a pandemic, he said.

Mexico started reopening in stages on May 18, beginning with 324 municipalities with no COVID-19 cases reported in the past 28 days. Public health experts asked, however, if testing had occurred in those municipalities. “They cannot know [which municipalities to open] with their sampling scheme”, said Malaquías López-Cervantes, public health professor at the National Autonomous University of Mexico. He said sentinel surveillance could provide a national picture, but not one at the state or local level.

The Health Secretariat recorded 51 633 COVID-19 cases and 5322 deaths on May 18. “We have been able to flatten the curve”, López-Gatell said on May 16. The pandemic “will lengthen, but serious cases will not overwhelm our hospital capacity”.

Even with his controversial comments and COVID-19 approach, AMLO has remained popular, according to polls—and retained the support of many physicians. Esther Zurita, a general practitioner in private practice, said most people took the president's comments out of context. She backs his COVID-19 response. “Dr López-Gatell is doing a good job of communicating the strategy…It would be extremely arrogant to judge the results prematurely.”