[19] On 1 December 2020, Díaz Ayuso inaugurated the Hospital Isabel Zendal,[20] praised by her government but heavily criticised by the opposition for its cost overruns and its use as an "advertising campaign".

In accordance with the state of alarm decreed by the Spanish government on 14 March 2020, the government of the Community of Madrid, like the other autonomous communities, took immediate measures [required clarification] such as the closure of schools and leisure centres, shows and sports events, retired people's day centres, religious celebrations, the closure of hotels and tourist accommodation, shops considered not to be of basic need and the limitation of travel to those needed to go to work or buy food.

[30] In October 2020, Alberto Reyero, the regional minister responsible for nursing homes announced his resignation, wishing "good luck and success in the task that she has ahead" to Díaz Ayuso.

[31] However, six days later, the central government approved the State of Alarm for the Community of Madrid following unsuccessful talks and confrontation between Díaz Ayuso and PM Pedro Sánchez.

[38] On 31 August 2021, she announced her intention to contest the leadership of the regional branch of the party, a position left vacant since the resignation of former President Cristina Cifuentes.

The party’s federal leadership closed in on then-unreleased allegations Ayuso’s brother was involved in €1.5 M worth of healthcare material purchased by her administration at the height of the COVID-19 pandemic in April 2020 in Spain.

When disclosed, she reacted by insisting her brother’s business deals were performed according to law and received no special treatment, whilst publicly accusing her party’s top officials of conspiring against her.

[citation needed] Between 200,000 and 670,000 demonstrators gather on 13 November 2022 in Madrid to defend the public health system in the region and against a proposed reform of the sector.

The demonstration is aimed at the health policies of Isabel Diaz Ayuso, who wants to develop public-private partnerships and restructure the community care system.

[44] Having broken in as leader of the PP candidacy with a harsh speech, close to that of José María Aznar, Esperanza Aguirre and Pablo Casado, had declared to be "next to Vox, not in front of it".

[50][51] In the same month of April, when she was already the candidate for the presidency of the Community of Madrid, she proposed that children conceived but not born yet to be counted as members of family units for the purpose of applying for social aid or school places.

[52] In February 2020, she stated that the LGBT law of the Community of Madrid approved by her predecessor in office – who also belonged to the People's Party and of which she herself voted in favour – was a consequence of the "tyrannical progressivism" and that, if it were up to her, "some articles would have to be repealed".

[54] She joined a chorus of politicians, including Spain's Socialist Prime Minister Pedro Sánchez, that repudiated the demand for an apology for colonialism by the President of Mexico, Andrés Manuel López Obrador.

[55] Ayuso accused the Mexican President of instigating an "indigenism that is the new communism", and later said that indigenous movements across Latin America were promoting "a simplistic revision of Spanish history", the wrecking of "Spain's legacy in the Americas … [such as] the mixing and fusion of cultures that have forged such strong Atlantic links", and that Spain "took Spanish and... Catholicism, and therefore civilisation and freedom, to the American continent”.

[45] In September 2021 Ayuso was awarded the Bruno Leoni Prize in recognition of the policies implemented by the Community of Madrid to contrast the COVID-19 epidemic, avoiding indiscriminate lockdowns and aiming at preserving individual freedoms and economic activities.

[60] Previously, the prize had been awarded to personalities such as Nobel laureates Vernon L. Smith and Mario Vargas Llosa, academics (Richard Pipes and Deirdre McCloskey), and democracy activists (Leopoldo López and Canan Arin).