Dear editor: In March 2020, as the SARS-CoV-2 infection spread in Mexico, the national healthcare system was fully restructured. Several high specialty hospitals in Mexico City served Covid-19 patients only. While the Instituto Nacional de Neurología y Neurocirugía (INNN) was not a Covid hospital, the Emergency and Intensive Care Unit (ICU) areas were restructured, and the care flow chart for emergency and outpatient care were modified. These changes were made considering the likelihood of having: 1) Covid-19 patients with severe neurological symptoms/complications, and 2) outpatients with neurological/neurodegenerative diseases cared for in the hospital, in higher risk of SARS-CoV-2 infection after a chronic use of immunomodulators and the high prevalence of obesity, diabetes, and hypertension. Our concerns were that hospitalized neurological patients could be asymptomatic but able to infect other patients, and the risk of nosocomial infections in Covid-19 confirmed patients. Thus, an appropriate strategy to evaluate patients upon emergency- or elective-hospital admission was urgently needed. As well as molecular tests or at least a chest CT scan plus ancillary tests for Covid-19 biomarkers. Since routine RT-PCR was not available in our center, all biological samples were processed in the Instituto de Nacional de Medicina Genómica and the Instituto de Diagnóstico y Referencia Epidemiológicos, and results were delivered within 3 to 5 days. Since serological tests were also unavailable, infection underdiagnosis was a concern. In a descriptive review of suspected Covid-19 infection cases in the period March 1 to December 31, 2020, 558 Covid-19 suspicious cases were found at the INNN; 354 healthcare workers and 204 patients. In that period, 1 230 patients were hospitalized for neurosurgery or neurological treatment; from them, 204 were suspected of Covid-19 infection but only 24 were confirmed by RT-PCR and a compatible clinical picture. Four confirmed cases (17%) were newly admitted patients and were transferred to a Covid hospital; all other cases were inpatients, suffering from brain tumor (5), epilepsy (3), Parkinson disease (2), or neuromuscular disorders (3). A summary of the clinical outcome in Covid-19 patients is shown in table I. As the epidemiologic risk in Mexico City was lowered from “highest” to “moderately high”, our temporary Covid areas (emergency and ICU Covid unit, 12 beds) were de-converted. In October, all confirmed Covid patients were transferred to the neuroinfectology unit (4 beds). New patients were referred to Covid-19 designated hospitals. On December 25, 2020, RT-PCR results were delivered within two days and serologic tests were available, but the lack of healthcare workers persisted. Fatigue and psychological complaints were common in healthcare staff, particularly in Covid-19 areas. A year after the onset of the pandemic, several health challenges persist in Mexico and the world. The pandemic worsened the pre-existing lack of appropriate infrastructure, medications, supplies, and sanitary personnel in low/middle income areas. Vaccination programs will be key in controlling the pandemic. However, it will take time, considering the limitations in mass vaccination efforts and the emergency of mutated SARS-CoV-2 strains (variants B117, 1351 and P1). Simple sanitary measures like the strict use of face masks¹ and frequent hand washing should be mandatory.