During periods of social crisis, city governance and resilience become critical factors to manage the emergency. In terms of a health and economic crisis, the importance of such terms is even more meaningful. This chapter explores the case of Mexico City during the COVID-19 emergency. The study uses a multilevel framework of city governance and resilience (Lazarus JV, Binagwaho A, El-Mohandes AA, Fielding JE, Larson HJ, Plasència A, … Ratzan SC, Nat Med 26(7):1005–1008, 2020) to make sense of the empirical findings. The evidence from the case study suggests that the reactions from the largest healthcare organization in Mexico (IMSS), the federal, and the local government differed from each other in a variety of ways. Such contradictions between organizations and governments led to confusion and contradictory strategies. The findings contrast with the current understanding of city governance and resilience, which calls for communication and collaboration between government levels. This paper contributes to a better understanding of city governance and resilience during an emergency.