MEXICO CITY — As the coronavirus swept the globe early last year, Mexican officials made an unusual decision: They would not impose "coercive" measures to force citizens to obey pandemic restrictions.

No curfews. No arrests. No fines.

Other countries would enforce their lockdowns with police checkpoints and $10,000 penalties. But Mexico had lived through 70 years of authoritarian rule. The country had “a sad, unfortunate, shameful history” of abuse by security forces, said Hugo López-Gatell, the coronavirus czar. And half the population lived in poverty. Clashes between the police and poor laborers could spread the virus — and tarnish a government built on leftist credentials.

Nearly a year later, Mexico is battling a severe epidemic. Hospitals are at the breaking point. Residents flouting stay-at-home messages fueled a new explosion of cases during the Christmas holidays. Deaths have soared past 150,000 — the fourth-highest total in the world, and 19th-highest based on population, according to a count kept by Johns Hopkins University. On Sunday, President Andrés Manuel López Obrador announced that he, too, had tested positive for the coronavirus.

Mexican President Andrés Manuel López Obrador said on Jan. 24 that he had tested positive for the coronavirus, adding that his symptoms were minor. (Reuters)

So was Mexico wrong? The answer is nuanced, say health experts and human rights advocates, and reflects the difficulty of balancing public health and civil rights. It’s especially tricky in a region with a history of heavy-handed policing and vast inequality. Many Latin American countries decreed strict quarantines last spring, and deployed police and soldiers to enforce them. Human rights complaints soared.

Yet while Mexico boasts it has taken a principled approach, health analysts say the government has undermined it with confusing communication and other missteps.

“The countries that do the best get people to comply voluntarily,” said Tom Frieden, a former head of the U.S. Centers for Disease Control and Prevention. “But they are very clear about what people need to do.”

For years, governments have used law enforcement to promote public health goals such as getting people to wear seat belts or stop smoking in restaurants. The coronavirus pandemic took things to a new level. To stem the initial outbreak, China imposed the largest quarantine in history, locking down 50 million people, who were forbidden even to use their cars.

As Mexican officials watched the virus’s global march, they decided in February not to adopt such coercive tactics. Nearly 60 percent of workers — street vendors, gardeners, construction workers — lived off their daily earnings. Dispatching police to keep them home would “exacerbate social unrest, and this unrest could limit our ability to control the epidemic,” said López-Gatell, a Hopkins-trained epidemiologist. López Obrador voiced another concern: Poor workers squeezed by police could “swell the ranks” of crime cartels, López-Gatell recalled in a recent interview.

To limit the spread of the virus, authorities decided to target institutions — closing public schools, threatening penalties for businesses that stayed open, convincing churches to cancel Mass and cities to close parks. Mexico City’s mayor, Claudia Sheinbaum, an ally of the president, ordered stores and public transit to require patrons to wear masks. But there were no fines for citizens walking around without them. Instead, they were blitzed with wear-a-mask posters and stay-at-home banners. Health brigades have made more than 4 million home visits in the capital to offer information about covid-19.

“We don’t believe in repression,” Sheinbaum told reporters this month. “We believe in education.”

Leaders of states governed by the opposition were dubious. “It’s not fair that those who are following these measures have to pay for those who aren’t,” said Enrique Alfaro, governor of Jalisco state. In April, he announced security forces would impose fines and even jail terms on residents who violated pandemic restrictions.

But weeks later, a young Jalisco man died in police custody after reportedly being detained for not wearing a mask. Protesters took to the streets and set fire to police cars. Authorities have since pulled back on targeting citizens, said Anna Bárbara Casillas, coordinator of social programs in Jalisco. “We have found we get better results warning businesses” to comply with covid-19 regulations, she said.

Human rights activists say restricting citizens’ movement might be necessary in a public health crisis, but criminal penalties should be used as a last resort. In Latin America, though, “there was a tendency for governments to resort to the kind of repression that is unfortunately structural in the region,” said Louise Tillotson, a researcher for Amnesty International.

Authorities in the Dominican Republic arrested around 85,000 people over three months for violating lockdowns, “many of whom presumably left their homes to buy food” or other essentials, according to Amnesty International. Argentine police have been accused of kicking and beating people on the streets at night. Officers in El Salvador arrested hundreds of people early in the pandemic for leaving their homes, according to Human Rights Watch.

Mexican officials say they have succeeded without such heavy-handed tactics. They point to a recent poll carried out in 27 countries by London’s Imperial College. Researchers found Mexicans were among those most likely to report wearing masks outside the home — more than Americans, Canadians and many Europeans. A survey by Mexico City’s government this month found rates of mask usage in neighborhoods ranging from 57 to 95 percent.

Yet Mexico didn’t manage to reduce citizens’ movement as much as other countries did. A two-month national lockdown, starting in late March, resulted in a 60-percent decrease in Mexicans going to bus and metro stops, shops and recreational sites, according to Our World in Data. That was a bigger drop than in the United States, but less than in Argentina, Colombia and many European countries. As Mexico gradually reopened its economy, more people returned to the streets and stores.

Then came the Christmas season. A combination of cooler weather, a crush of holiday parties and shopping reignited the pandemic, particularly in and around Mexico City. By mid-December, authorities were forced to announce a new lockdown in the capital.

Mauricio Rodríguez, who leads the coronavirus response team at the National Autonomous University of Mexico, or UNAM, said it would be difficult to use Mexico’s notoriously corrupt police to enforce pandemic restrictions. But the government’s policy of persuasion also proved to be flawed.

“The messages haven’t been consistent,” he said. Federal and state officials have clashed over how quickly to reopen the economy, confusing residents. In a deeply polarized society, the pandemic response quickly became politicized, with the government and its opponents slinging insults at each other. While the federal government issues daily updates on coronavirus cases and fatalities, they are a significant undercount, due to limited testing and difficulties in tallying deaths at home.

In nightly news conferences, López-Gatell warns of the lethality of the virus. But the president has often downplayed the pandemic, going so far as to call lockdowns “dictatorship.”

“This implies a lack of understanding of the magnitude of the disaster,” said Samuel Ponce de Leon, an infectious-disease specialist at the UNAM. “If you don’t want to use coercion, that’s valid, but then you must emphasize other ways of promoting precautions.”

Meanwhile, politicians have been criticized for not practicing what they preach. The president rarely wears a mask. After exhorting people to stay home over the holidays, López-Gatell was photographed at a Pacific beach resort, provoking outrage.

“Public figures should set the example on the restrictions,” Rodríguez said.

Tough enforcement is hardly a guarantee of success in containing a pandemic. Argentina strictly enforced a comprehensive lockdown from March until early November, and still had a major outbreak.

And other factors have contributed to the pandemic’s toll in Mexico. The population has high levels of obesity, diabetes and hypertension. Some people, fearful of costs, or wary of rumors about poor care, wait until they are in serious condition before going to the hospital. Many health analysts blame the government’s policy of limited testing, saying it has been inadequate to track the pandemic and persuade victims to isolate. López Obrador’s government has been reluctant to take on debt to provide stimulus payments that could enable workers to stay at home.

Mexico’s problem “is not an absence of mandates or enforcement,” said Carlos del Rio, a Mexican-born infectious-disease specialist at Emory University. “It’s the absence of leadership.”

Alejandro Macias, a former flu commissioner here, said that no matter how persuasive the government’s messages might be, many people simply had to go to work. They had no savings.

“It’s like the call to Mass,” he said. “Those who want to listen, will.” But some analysts say citizens need to assume more responsibility for preventing the spread of the coronavirus. “It’s much easier to just blame the government,” Ana Laura Magaloni, a prominent law professor, wrote in the daily Reforma.

The deeper issue, she said, is that Mexicans have been “anesthetized” to death by years of rising homicides.

“What we’re not used to in Mexico is feeling responsible for preventing deaths,” she wrote. “Covid is challenging us, perhaps for the first time, to assume our individual responsibility to stop the tragedy.”